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7-item depression scale speeds primary care Dx.



PARIS Paris, in Greek mythology
Paris or Alexander, in Greek mythology, son of Priam and Hecuba and brother of Hector. Because it was prophesied that he would cause the destruction of Troy, Paris was abandoned on Mt.
 -- A 7-item rating scale for depression was as effective as the standard 17-item Hamilton Rating Scale for depression in a study with 142 patients.

Although the 17-item scale is considered the standard, "questions about its internal consistency In statistics and research, internal consistency is a measure based on the correlations between different items on the same test (or the same subscale on a larger test). It measures whether several items that propose to measure the same general construct produce similar scores. , 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 col·le·gi·um  
n. pl. col·le·gi·a or col·le·gi·ums
1. An executive council or committee of equally empowered members, especially one supervising an industry, commissariat, or other organization in the Soviet Union.
 Internationale Neuro-Psychopharmacologicum.

The Abbreviated Hamilton Depression Rating Scale The Hamilton Depression Rating Scale (HAM-D) is a 21-question multiple choice questionnaire which doctors may use to rate the severity of a patient's depression. It was originally published in 1960 by Max Hamilton, and is presently one of the most commonly used scales for rating  (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 Noun 1. guilt feelings - remorse caused by feeling responsible for some offense
guilt trip, guilty conscience, guilt

compunction, remorse, self-reproach - a feeling of deep regret (usually for some misdeed)
, involvement in work and activities, psychological anxiety, somatic anxiety, somatic somatic /so·mat·ic/ (so-mat´ik)
1. pertaining to or characteristic of the soma or body.

2. pertaining to the body wall in contrast to the viscera.


so·mat·ic
adj.
 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 psychopharmacology (sī'kōfär'məkŏl`əjē), in its broadest sense, the study of all pharmacological agents that affect mental and emotional functions.  unit at Toronto Western Hospital The Toronto Western Hospital is located at the corner of Bathurst Street and Dundas Street West in Toronto, Canada. It is part of the University Health Network. TWH has 256 beds, with 46,000 visits to its emergency department annually. .

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 Major depressive disorder
A mood disorder characterized by profound feelings of sadness or despair.

Mentioned in: Conduct Disorder

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

Philadelphia Bureau
COPYRIGHT 2004 International Medical News Group
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2004 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Psychiatry
Author:Zoler, Mitchel L.
Publication:Internal Medicine News
Geographic Code:1USA
Date:Nov 15, 2004
Words:773
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