7-item depression scale speeds primary care Dx.
Although the 17-item scale is considered the standard, "questions about its internal consistency, reliability, and lengthy time to administer make it impractical in a primary care setting," Roger S. McIntyre, M.D., said in a poster presentation at the 24th Congress of the Collegium Internationale Neuro-Psychopharmacologicum.
The Abbreviated Hamilton Depression Rating Scale (HAM-D7) was introduced by Dr. McIntyre and his associates in 2002 as a quicker and simpler method for physicians to assess depression in patients. With HAM-D7, patients are rated on depressed mood, guilt feelings, involvement in work and activities, psychological anxiety, somatic anxiety, somatic symptoms, and suicide. (See chart at right.)
These items were selected from the larger HAM-D17 scale because they frequently appear at baseline in patients who are depressed and are especially sensitive to change with treatment. The maximum score in the HAM-D7 scale is 26, said Dr. McIntyre, head of the mood disorders psychopharmacology unit at Toronto Western Hospital.
To see if HAM-D7 might be particularly well suited to use by primary care physicians, Dr. McIntyre and his associates conducted a study that involved 50 primary care physicians from locations across Canada.
The complete study enrolled 455 patients, but Dr. McIntyre's report at the congress included the initial findings from the first 142 patients.
Participants had a diagnosis of major depressive disorder based on DSM-IV criteria and had scored at least 19 on the full Hamilton Depression Rating Scale (HAM-D17).
At baseline, all patients began an open-label regimen with an antidepressant drug. They were reassessed every 2 weeks for 8 weeks, so that each patient underwent a total of five assessments.
The patients were randomized into two groups: One group was followed using the HAM-D17 questionnaire and the other was followed using the HAM-D7 scale. All patients were also assessed with the Montgomery-Asberg Depression Rating Scale and with the Clinical Global Impression scale.
Throughout the five assessments that each patient received, the pattern of change in the depression score was very similar between the HAM-D17 and HAM-D7 groups.
The 75 patients in the HAM-D17 group entered the study with an average score of 24, which fell steadily through the next 8 weeks to a low of 7.
The 67 patients in the HAM-D7 group entered the study with an average score of 14, which also fell steadily, paralleling the score change in the other group and reaching a final mean of 4 after 8 weeks of receiving antidepressant treatment, Dr. McIntyre reported.
With the HAM-D17 scale, 63% of the patients responded to their treatment regimen and 42% went into remission. With the HAM-D7 scale, 69% of the patients responded and 44% were in remission after treatment, Dr. McIntyre said.
The Brief Hamilton Rating Scale for Depression (HAM-D7) Item Questions 1. Depressed mood Have you been feeling down or depressed? Sad? Does the feeling lift at all if something good happens? In the last week, how often have you felt this way? 2. Feelings of guilt If YES to the first question: What have your thoughts been? Have you been feeling guilty about anything that you have done or have not done? What about things that happened a long time ago? Have you thought you have brought (this depression) on yourself in some way? Do you feel that you are being punished by being sick? 3. Interest, pleasure, If working: Have you been able to get as much level of activites done as you usually do (when you are feeling (work and OK)? How have you been spending your time this activities) past week (when not at work)? Have you felt interested in doing (those things), or do you feel you have to push yourself to do them? Have you stopped doing anything you used to do? If YES: Why? is there anything you look forward to? 4. Tension, nervousness If YES: Is this more than usual for you? Have (psychological you been worrying a lot about little things, anxiety) things you do not ordinarily worry about? If YES: Like what, for example? 5. Physical symptoms of How bad have these symptoms become? How much of anxiety (somatic the time or how often have you had them? anxiety) 6. Energy level What about backaches, muscle aches, or (somatic symptoms) headaches? Have you felt any heaviness in your limbs, back, or head? 7. Suicide (ideation, If YES: What have you thought about? Have you thoughts, plans, actually done anything to hurt yourself? attempts) Source: Primary Psychiatry 2003;10:39-42
BY MITCHEL L. ZOLER
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|Author:||Zoler, Mitchel L.|
|Publication:||Internal Medicine News|
|Date:||Nov 15, 2004|
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