Neurology – ClinCaseQuest

The Hamilton Anxiety Rating Scale (HAM-A/HARS) online calculator

Nataliia Lopina — Fri, 21 Jan 2022 07:10:54 +0000

The Hamilton Anxiety Rating Scale evaluates anxiety levels based on clinical questions, quantifies the severity of anxiety syndrome, and is often used to evaluate antipsychotic drugs.

It consists of 14 indicators, each of which is defined by several symptoms. Each indicator is rated on a 5-point scale from 0 (none) to 4 (severe). The Hamilton Anxiety Scale can help objectify and rate the severity of a patient’s anxiety.

The Hamilton Anxiety Scale can help objectify and assess the severity of a patient’s anxiety.

Each parameter is assessed according to the level of severity:

Point Values:

0=Not Present
+1=Mild
+2=Moderate
+3=Severe
+4=Very Severe

To assess the Hamilton anxiety scale, it is necessary to add the selected points.

1. Anxious mood: Worries, anticipation of the worst, fearful anticipation, irritability.	Not Present	0
	Mild	+1
	Moderate	+2
	Severe	+3
	Very Severe	+4
2. Tension: Feelings of tension, fatigability, startle response, moved to tears easily, trembling, feelings of restlessness, inability to relax.	Not Present	0
	Mild	+1
	Moderate	+2
	Severe	+3
	Very Severe	+4
3. Fears: Of dark, of strangers, of being left alone, of animals, of traffic, of crowds.	Not Present	0
	Mild	+1
	Moderate	+2
	Severe	+3
	Very Severe	+4
4. Insomnia: Difficulty in falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors.	Not Present	0
	Mild	+1
	Moderate	+2
	Severe	+3
	Very Severe	+4
5. Intellectual: Difficulty in concentration, poor memory.	Not Present	0
	Mild	+1
	Moderate	+2
	Severe	+3
	Very Severe	+4
6. Depressed mood: Loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing.	Not Present	0
	Mild	+1
	Moderate	+2
	Severe	+3
	Very Severe	+4
7. Somatic (muscular): Pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone.	Not Present	0
	Mild	+1
	Moderate	+2
	Severe	+3
	Very Severe	+4
8. Somatic (sensory): Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation.	Not Present	0
	Mild	+1
	Moderate	+2
	Severe	+3
	Very Severe	+4
9. Cardiovascular symptoms: Tachycardia, palpitations, pain in chest, throbbing of vessels, fainting feelings, missing beat.	Not Present	0
	Mild	+1
	Moderate	+2
	Severe	+3
	Very Severe	+4
10 . Respiratory symptoms: Pressure or constriction in chest, choking feelings, sighing, dyspnea.	Not Present	0
	Mild	+1
	Moderate	+2
	Severe	+3
	Very Severe	+4
11. Gastrointestinal symptoms: Difficulty in swallowing, wind abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation.	Not Present	0
	Mild	+1
	Moderate	+2
	Severe	+3
	Very Severe	+4
12. Genitourinary symptoms: Frequency of micturition, urgency of micturition, amenorrhea, menorrhagia, development of frigidity, premature ejaculation,loss of libido, impotence.	Not Present	0
	Mild	+1
	Moderate	+2
	Severe	+3
	Very Severe	+4
13. Autonomic symptoms: Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair.	Not Present	0
	Mild	+1
	Moderate	+2
	Severe	+3
	Very Severe	+4
14. Behavior at interview: Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, etc.	Not Present	0
	Mild	+1
	Moderate	+2
	Severe	+3
	Very Severe	+4

Score interpretation:

Scores ≤17 indicate mild anxiety severity.
Scores of 18-24 indicate mild to moderate anxiety severity
Scores of 25-30 indicate moderate to severe anxiety severity
Scores >30 indicate severe anxiety

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Literature:

Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959; 32:50–55 https://pubmed.ncbi.nlm.nih.gov/13638508/
Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. J Affect Disord 1988;14(1):61–8 https://pubmed.ncbi.nlm.nih.gov/2963053/ Per Bech. Measuring States of
Anxiety with Clinician-Rated and Patient-Rated Scales, Different Views of Anxiety Disorders. 2011, DOI: 10.5772/21246 https://www.intechopen.com/books/different-views-of-anxiety-disorders/measuring-states-of-anxiety-with-clinician-rated-and-patient-rated-scales

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Email (indicate if you want the results to be sent to your email)

Date of assessment

≥1 of the following (A or B)

A. Clonal bone marrow plasma cells ≥10%

B. Biopsy-proven bony or extramedullary plasmacytoma

≥1 myeloma defining event (C1 or C2)

• C1. End organ damage attributable to underlying plasma cell disorder (≥1 of the following): *

o Hypercalcemia (Serum calcium >1 mg/dL (>0.25 mmol/L) higher than upper limit of normal or >11 mg/dL (>2.75 mmol/L))

o Renal insufficiency (Creatinine clearance<40 mL per min or serum creatinine >2 mg/dL (177 μmol/L))

o Anemia (Hemoglobin >2 g/dL (20 g/L) below lower limit of normal

o Bone lesions (≥1 osteolytic lesion on skeletal x-ray

• C2. ≥1 of the following biomarkers of malignancy: *

o Clonal bone marrow plasma cells ≥60%

o Involved:uninvolved sFLC ratio ≥100

o >1 focal lesion on MRI

Result

Diagnostic result

Negative. Not positive for multiple myeloma by IMWG criteria

Diagnostic result

Positive for multiple myeloma by IMWG criteria

Details:

* Required

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ABCD2 Score System for stroke risk assessment after suspected TIA, online calculator

Elena Shevchenko — Wed, 14 Jul 2021 11:39:00 +0000

ABCD² Score System estimates the risk of stroke after a suspected transient ischemic attack (TIA). The ABCD² score can help physicians to provide risk stratification stroke in patients presenting with a TIA. Patients with a low risk of stroke could undergo outpatient diagnostic tests. Patients with moderate and high risk should be hospitalized for careful diagnosis.

Patient’s score	Range	Risk group	Stroke Risk	Recommendation
0	0	0	0	0

The addition of the selected points is required.

Criteria	Value	Points
Age ≥ 60 years	Y/N	+1
BP ≥ 140/90 mmHg	Y/N	+1
Clinical features of the TIA	Unilateral Wwakness	+2
	Speech disturbance without weakness	+1
	Other symptoms	0
Duration of symptoms	< 10 minutes	0
	10-59 minutes	+1
	≥ 60 minutes	+2
History of diabetes	Y/N	+1

Multiple studies have shown that as the ABCD² score increases the risk of a subsequent stroke also increases.

Results:

Total score	Risk group	Stroke Risk	Recommendation
0-3	Low Risk	• 2-Day Stroke Risk: 1.0% • 7-Day Stroke Risk: 1.2% • 90-Day Stroke Risk: 3.1%	• Arrange expedited evaluation as an outpatient with the goal of obtaining the relevant studies and consultations within 24 hours. • Consider further imaging modalities including MRI and carotid ultrasound as outpatient. • Consider consulting Neurology to help determine whether the patient would benefit from further inpatient evaluation or to expedite outpatient follow-up when appropriate.
4-5	Moderate Risk	• 2-Day Stroke Risk: 4.1% • 7-Day Stroke Risk: 5.9% • 90-Day Stroke Risk: 9.8%	• Admit patient for further evaluation to the hospital. • Consult Neurology. • Consider obtaining an MRI and other appropriate vascular and embolic imaging.
6-7	High Risk	• 2-Day Stroke Risk: 8.1% • 7-Day Stroke Risk: 11.7% • 90-Day Stroke Risk: 17.8%	• Admit patient for further evaluation to the hospital. • Consult Neurology. • Consider obtaining an MRI and other appropriate vascular and embolic imaging.

A prospective observational study of 637 patients presenting to the ED found that the ABCD² score did not add incremental value beyond an ED evaluation that included central nervous system and carotid artery imaging in the ability to risk-stratify patients with transient ischemic attack in the study’s cohort. (Stead 2010)
In this population of patients with TIA patients, a rapid ED-based outpatient protocol that included early carotid imaging and treatment when appropriate, found that the rate of stroke was independent of ABCD² risk stratification. (Stead 2010)

Limitations:

The ABCD²score should not be used as a substitute for clinical judgement or decision making. The ABCD score was developed in an outpatient setting (not in emergency departments!). It has been shown to have lower accuracy when ABCD² score used by non-specialists (primary care or emergency physicians).

Patients with a low baseline risk of stroke (≤ 2%) with a low ABCD² score (0-2) are at low risk for having a stroke within the next 7 days (0.4-0.8%). In this population of patients with TIA patients, rapid emergency department-based outpatient diagnostic tests are recommended.

In centers where computed tomography and carotid ultrasound studies are performed in collaboration with a stroke service, adding assessment based on the ABCD² score to the evaluation appears unnecessary.

Based on the the poor performance of the ABCD² score system in the emergency department setting, combined with difficulties in arranging the necessary imaging and specialty follow-up within 24-hour window, that most emergency department physicians were likely to choose to perform a rapid evaluation of TIA patients (imaging, possible neurology consultation) regardless of the ABCD² score.

Literature
Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, Sidney S. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007 Jan 27;369(9558):283-92. https://pubmed.ncbi.nlm.nih.gov/17258668/
Josephson SA, Sidney S, Pham TN, Bernstein AL, Johnston SC. Higher ABCD2 score predicts patients most likely to have true transient ischemic attack. Stroke. 2008 Nov;39(11):3096-8. doi: 10.1161/STROKEAHA.108.514562. Epub 2008 Aug 7. https://pubmed.ncbi.nlm.nih.gov/18688003/
Rothwell PM, Giles MF, Flossmann E, Lovelock CE, Redgrave JN, Warlow CP, Mehta Z. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet. 2005 Jul 2-8;366(9479):29-36. https://pubmed.ncbi.nlm.nih.gov/15993230/
Sanders LM, Srikanth VK, Blacker DJ, Jolley DJ, Cooper KA, Phan TG.Performance of the ABCD2 score for stroke risk post TIA: meta-analysis and probability modeling. Neurology. 2012 Sep 4;79(10):971-80. doi: 10.1212/WNL.0b013e31825f9d02. Epub 2012 Jun 13. PubMed PMID: 22700810. https://pubmed.ncbi.nlm.nih.gov/22700810/
Stead LG, Suravaram S, Bellolio MF, Enduri S, Rabinstein A, Gilmore RM, Bhagra A, Manivannan V, Decker WW. An assessment of the incremental value of the ABCD2 score in the emergency department evaluation of transient ischemic attack. Ann Emerg Med. 2011 Jan;57(1):46-51. doi: 10.1016/j.annemergmed.2010.07.001. Epub 2010 Sep 19. PubMed PMID: 20855130. https://pubmed.ncbi.nlm.nih.gov/20855130/
Perry JJ, Sharma M, Sivilotti ML, Sutherland J, Symington C, Worster A, Émond M, Stotts G, Jin AY, Oczkowski WJ, Sahlas DJ, Murray HE, MacKey A, Verreault S, Wells GA, Stiell IG. Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attack. CMAJ. 2011 Jul 12;183(10):1137-45. doi: 10.1503/cmaj.101668. Epub 2011 Jun 6. PubMed PMID: 21646462. https://pubmed.ncbi.nlm.nih.gov/21646462/

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Сообщение ABCD2 Score System for stroke risk assessment after suspected TIA, online calculator появились сначала на ClinCaseQuest.