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HAMD汉密尔顿抑郁量表 -给力心理
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HAMD汉密尔顿抑郁量表

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发表时间:2015-02-25 09:57:40 387 0 0

 

     1.测验材料。    

 

    汉密尔顿抑郁量表由汉密尔顿(Hamilton)于1960年编制,是临床上评定抑郁状态时应用得最为普遍

 

的量表。本量表有17项、2l项和24项等3种版本,这里介绍的是24项版本。这些项目包括抑郁所涉及

 

的各种症状,并可归纳为7类因子结构。

 

    2.适用范围。

 

    本量表适用于有抑郁症状的成年病人。可用于抑郁症、躁郁症、神经症等多种疾病的抑郁症状之评定,

 

尤其适用于抑郁症。然而,本量表对于抑郁症与焦虑症,却不能较好地进行鉴别,因为两者都有类似的项

 

目。

 

    3.施测步骤。

 

    (1)评定方法:一般采用交谈和观察的方式,由经过训练的两名评定员对被评定者进行HAMD联合检

 

查,待检查结束后,两名评定员独立评分。在评估心理或药物干预前后抑郁症状的改善情况时,首先在入

 

组时评定当时或入组前一周的情况,然后在干预2~6周后再次评定来比较抑郁症状严重程度和症状谱的变

 

化。

 

    (2)评分标准;HAMD大部分项目采用0~4分的5级评分法:(O)无,(1)轻度,(2)中度,(3)重度,(4)很重。少数项目评分为O~2分的3级评分法:(O)无,(1)轻一中度,(2)重度。下面分别介绍24项目名称及具体的评分标准。

 

    1)抑郁心境:(1)只在问到时才诉述;(2)在谈话中自发地表达;(3)不用言语也可以从表情、姿势、声音或欲哭中流露出这种表情;(4)病人的自发言语和非言语表达(表情、动作),几乎完全表达为这种情绪。

 

    2)有罪感:(1)责备自己,感到自己已连累他人;(2)认为自己犯了罪,或反复思考以往的过失和错误;(3)认为目前的疾病是对自己错误的惩罚,或有罪恶妄想;(4)罪恶妄想伴有指责或威胁性幻觉。

 

    3)自杀:(1)觉得活着没有意思;(2)希望自己已经死去,或常想到与死有关的事;(3)消极观念(自杀观念);(4)有严重自杀行为。

 

    4)入睡困难:(1)主诉有时有入睡困难,即上床后半小时仍不能入睡;(2)主诉每晚均入睡困难。

 

    5)睡眠不深:(1)睡眠浅多恶梦;(2)半夜(晚12点以前)曾醒来(不包括上厕所)。

 

    6)早醒:(1)有早醒,比平时早醒1小时,但能重新入睡;(2)早醒后无法重新入睡。

 

    7)工作和兴趣:(1)提问时才诉述;(2)自发地直接或间接表达对活动、工作或学习失去兴趣,如感到无精打采,犹豫不决,不能坚持或需强迫才能工作或活动;(3)病室劳动或娱乐不满3小时;(4)因目前的疾病而停止工作,住院者不参加任何活动或者没有他人帮助便不能完成病室日常事务。

 

    8)迟缓:(1)精神检查中发现轻度迟缓;(2)精神检查中发现明最迟缓;(3)精神检查困难;(4)完全不能回答问题(木僵)。

 

    9)激越:(1)检查时有些心神不定;(2)明显的心神不定或小动作多;(3)不能静坐,检查中曾起立;(4)搓手、咬手指、扯头发、咬嘴唇。

 

    10)精神性焦虑:(1)问时诉述;(2)自发地表达;(3)表情和言谈流露出明显的忧虑;(4)明显惊恐。

 

    11)躯体性焦虑:(1)轻度;(2)中度,有肯定的躯体性焦虑症状;(3)重度,躯体性焦虑症状严重,影响生活或需加处理;(4)严重影响生活和活动。

 

    12)胃肠道症状:(1)食欲减退,但不需他人鼓励便自行进食;(2)进食需他人催促或请求和需要应用泻药或助消化药。

 

    13)全身症状:(1)四肢、背部或颈部有沉重感,背痛、头痛、肌肉疼痛,全身乏力或疲倦;(2)症状明显。

 

    14)性症状:(1)轻度;(2)重度;(3)不能肯定,或该项对被评者不适合(不计入总分)。  

 

    15)疑病:(1)对身体过分关注;(2)反复思考健康问题;(3)有疑病妄想;(4)伴幻觉的疑病妄想。

 

    16)体重减轻:(1)一周内体重减轻1斤以上;(2)一周内体重减轻二斤以上。

 

    17)自知力:(0)知道自己有病,表现为抑郁;(1)知道自己有病,但归于伙食太差、环境问题、工作太忙、病毒感染或需要休息等;(2)完全否认有病。

 

    18)日夜变化:如果症状在早晨或傍晚加重,先指出哪一种,然后按其变化程度评分。(1)轻度变化;

 

(2)重度变化。

 

    19)人格解体或现实解体:(1)问及时才诉述;(2)自发诉述;(3)有虚无妄想;(4)伴幻觉的虚无妄想。

 

    20)偏执症状:(1)有猜疑;(2)有牵连观念;(3)有关系妄想或被害妄想;(4)伴有幻觉的关系妄想或被害妄想。

 

    21)强迫症状:(1)问及时才诉述;(2)自发诉述。

 

    22)能力减退感:(1)仅于提问时方引出主观体验;(2)病人主动表示有能力减退感;(3)需鼓励、指导和安慰才能完成病室日常事务或个人卫生;(4)穿衣、梳洗、进食、铺床或个人卫生均需要他人协助。

 

    23)绝望感:(1)有时怀疑“情况是否会好转”,但解释后能接受;(2)持续感到“没有希望”,但解释后能接受;(3)对未来感到灰心、悲观和绝望,解释后不能排除;(4)自动反复诉述“我的病不会好了”或诸如此类的情况。

 

    24)自卑感:(1)仅在询问时诉述有自卑感;(2)自动诉述有自卑感(我不如他人);(3)病人主动诉述:“我一无是处”或“低人一等”,与评2分者只是程度的差别;(4)自卑感达妄想的程度,例如“我是废物”或类似情况。

 

  (二)测验的记分 

 

  在记分上分总分和因子分。总分即所有项目得分的总和。当2个人同时评定时,可以采用两者得分相加或算术平均数。在一般的心理咨询、治疗和药物研究中,往往用一个人的评分。  依据各项目反映的症状特点,HAMD可分为7个因子。分别为:(1)焦虑/躯体化,由精神性焦虑、躯体性焦虑、胃肠道症状。疑病和自知力、全身症状6项组成;2)体重,即体重减轻1项;(3)认知障碍,包括自罪感、自杀、激越、人格或现实解体、偏执症状和强迫症状6项;(4)日夜变化,仅日夜变化l项;(5)迟缓,由抑郁情绪、l“作和兴趣、迟缓和性症状4项组成;(6)睡眠障碍,由入睡困难、睡眠不深和早醒3项组成;(7)绝望感,由能力减退感、绝望感和自卑感3项组成。每个因子各项日得分的算术和即为因子分。

 

  (三)结果的解释

 

  总分是一项很重要的资料,能较好地反映病情的严重程度,即症状越轻,总分越低;症状越重,总分越高。通过总分在心理咨询或药物治疗前后的变化来衡量各种心理、药物干预的效果。同时,在研究人组病例时,通过HAMD的测评,可以较详细了解研究对象症状的严重程度,用于不同研究结果之间的类比和重复。按照Dayris JM的划分,对于24项版本,总分超过35分可能为严重抑郁;超过20分,可能是轻或中度的抑郁;如小于8分,则没有抑郁症状。在17项版本则分别为24分、17分和7分。 因子分可以反映来访者或病人的抑郁症状的特点,同时也可反映心理或药物干预前后靶症状的变化特点。

Hamilton汉密尔顿抑郁量表(HAMD) (24项版) HAMD量表是临床上评定抑郁状态时最常用的量表。(24项版)

 

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