The hospital anxiety and depression scale

What are mood disorders? 

Group of diagnoses where a disturbance in the person’s mood is hypothesised to be the main underlying feature 

What are the 2 groups of mood disorders?

Depressive and bipolar (hypomanic) disorders.

What is the DSM 5 major depressive disorder diagnosis for major depressive disorder?

5 or more of the following symptoms present in 2-week period and represent a change from previous functioning. At least one symptom is: depressed mood or loss of interest or pleasure. Other symptoms include: depressed most of the day, nearly every day shown by subjective report or observation, significant weight loss or decrease in appetite, insomnia or hypersomnia nearly every day, psychomotor agitation or retardation nearly every day, fatigue or loss of energy, feelings of worthlessness or excessive guilt, inability to think or concentrate, recurrent thoughts of death, clinically sig distress or impairment in social, occupational or important areas of functioning, not attributable to physiological effects of substance or another medical condition, occurrence of major depressive episode not explained by schizophrenia, never been a manic or hypomanic episode.

What are some disorders related to bipolar disorder?

Bipolar I disorder, bipolar II disorder, cyclothymic disorder, substance/medication-induced bipolar and related disorder, bipolar and related disorder due to another medical condition, other specified bipolar and related disorder, unspecified bipolar and related disorder. 

What are symptoms of depressive periods of bipolar disorder?

Sadness, loss of energy, feelings of hopelessness or worthlessness, loss of enjoyment from things that once were pleasurable, difficulty concentrating, uncontrollable crying, difficulty making decisions, irritability, increased need for sleep, a change in appetite causing weight loss or gain, thoughts of death or suicide, 

What are symptoms of mania for bipolar disorder?

Excessive happiness, hopefulness and excitement, sudden changes from being joyful to being irritable, angry and hostile, restlessness, rapid speech and poor concentration, increased energy and less need for sleep, high sex drive, tendency to make grand and unattainable plans, tendency to show poor judgement (e.g quit job), drug and alcohol abuse, increase impulsivity,

What are the most freq occurring anxiety disorders?

Generalised anxiety disorder, panic disorder, agoraphobia, specific phobia, social anxiety disorder (social phobia), separation anxiety disorder. 

 

What are other anxiety-related disorders? 

PTSD and OCD

What is anxiety?

Normal response to stress/danger i.e feeling fearful or tense when confronted by angry stranger. Can be feeling of unease. Normal, vital reaction to threat – freeze, flight, fight 

What is the difference between anxiety and fear?

Anxiety is adaptive and anticipation of future threat, fear is emotional response to real or perceived imminent threat.

 

What are anxiety disorders?

Excessive fear and anxiety, related behavioural disturbances, out of proportion to objective danger. Result in significant distress and/or interference in core areas of functioning. They occur because people believe situations to be more dangerous than they really are. 

What are the 4 components of anxiety disorders?

Physical: activation of sympathetic nervous system and hormonal system (fight or flight), cognitive: unrealistic thoughts (exaggerated danger, fear losing control), emotional: terror, panic, irritability, behavioural; coping (avoidance etc) 

What is the DSM 5 generalised anxiety disorder?

Excessive anxiety and worry, occuring more days than not for at least 6 months, about a number of events or activities. Person finds it difficult to control the worry. Anxiety and worry are associated with 3 or more of 6 symptoms: restlessness, easily frustrated, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance. Anxiety, worry or physical symptoms cause clinically sig distress or impairment in social, occupational or other important areas of functioning. Disturbance is not attributable to physiological effects of substance. Disturbance is not better explained by another mental disorder.

What are panic attacks and panic disorders symptoms DSM 5? 

Abrupt surge from a calm or anxious state, of intense fear or discomfort that reaches a peak within minutes. 4 or more symptoms occur: palpitations, sweating, trembling, shortness of breath or sensations of smothering, feeling of choking, chest pain or discomfort, abdominal distress, dizziness, chills or heat sensations, numbness or tingling, derealisation or depersonalisation, fear of losing control and fear of dying.

What are panic disorders? 

Due to catastrophic misinterpretation of bodily sensations, sensations believed more dangerous than they are and viewed as indicative of an immediately impending physical/mental disaster. Cycle starts with initial stimulus being interpreted as dangerous, leads to apprehension and range of bodily sensations, bodily sensations interpreted in catastrophic fashion, further increase in apprehension leads to more bodily sensations.

What is agoraphobia?

Anxiety about being in situations from which escape is difficult or embarrassing, or in which help might not be available in the event of panic or panic-like symptoms. Situations avoided or cause great anxiety, or need a companion. Not better accounted for by another disorder.

What is social anxiety disorder DSM 5? 

Marked fear of anxiety about 1 or more social situations in which the individuals is exposed to scrutiny by others. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated. 

What are the main features of social anxiety disorder? 

Fear or anxiety is out of proportion to actual threat, social situations almost always provoke fear/anxiety, social situations are avoided or endured with intense fear or anxiety, anxiety or avoidance is persistent – lasting more than 6 months, anxiety causes clinically sig distress or impairment in social, occupational or other important areas of functioning.

What are specific phobias DSM 5?

Marked fear about specific object/situations, phobic object/situation almost always provokes immediate fear or anxiety, anxiety is out of proportion to actual danger, phobic object/situation is actively avoided, anxiety causes clinically sig distress in social, occupational or other functioning areas, anxiety is longer than 6 months.

What are obsessions – OCD?

Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress. Individual attempts to ignore/suppress such thoughts, urges or images, or to neutralise them with some thought or action. 

What are compulsions – OCD?

Repetitive behaviours or mental acts that person feels driven to perform in response to an obsession, or according to the rules that must be applied rigidly. Behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event/situation. Behaviours or acts are not connected in a realistic wat with what they are designed to neutralise or prevent or are clearly excessive.

What are PTSD criterion DSM V? 

Exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following ways: directly experienced, witnessing in person, learning that a relative or close friend was exposed, repeated or extreme exposure to aversive details of traumatic events. Persistent avoidance of stimuli associated with traumatic event as evidenced by 1 or both: avoidance of distressing memories, thoughts or feelings associated with trauma or avoidance of external reminders that arouse distressing memories, thoughts or feelings related to the trauma.  

What are Negative alterations in cognitions and mood associated with the trauma, evidenced by? 

Inability to recall important aspects of the trauma, persistent and exaggerated negative beliefs or expectation about oneself, others or the world, persistent distorted cognition about the cause or consequences of the event leading to blame of self/others, persistent negative emotional state, markedly diminished interest in participation in sig activities, persistent inability to experience positive emotions, feelings of detachment or estrangement. 

What are marked alterations in arousal and reactivity associated with?

Irritable behaviour or angry outbursts, reckless or self-destructive behaviour, hypervigilance, exaggerated startle response, problems with concentration, sleep disturbance.

What is Cronbach's alpha? 

Assesses correlations between individual scale items, aim for > .7 - .8 as a rule of thumb.  

 

What is criterion validity? 

Extent to which the scale correlates with established measures of the construct or related constructs that are measured at the same time.  

What is discriminant validity? 

Indicates that 2 measures that are not meant to be measuring the same construct are in fact not too closely related. Can be examined by comparing bivariate correlation of the new questionnaire with a measure of anxiety symptoms. 

What is sensitivity? 

Probability of a measure being positive if the individual has the diagnosis/problem in question 

What is specificity?

Probability of a measure being negative if the individual does not have the diagnosis/problem in question

What is Likert scale?

Item is worded as a declarative statement followed by response options indicating varying degrees of agreement or endorsement. Often used to measure opinions, beliefs and attitudes. Options should have roughly equal intervals. Odd numbers enable mid points. Freq 5 points, but sometimes 3,7,9. Summary score from several items.

Why is finding latent variables helpful?

Simplifies a large amount of data, investigates clusters of variables of measures, can support development of theory. In test construction, to examine whether different questions are measuring the same underlying construct and also whether there may be sub-scales. 

What is factor analysis? 

Aims to explain the maximum amount of common variance in a correlation matrix using the smallest number of explanatory constructs (factors). Measured variables are predicted from the components.

What are causes of biases?

Health symptoms may manifest differently in different cultures, language differences in religion and spiritual beliefs on expression and perception of psychopathology, role of cultural stereotypes in perception of normality – behaviour considered as a symptom of psychopathology in 1 culture – may be seen as a typical in another. Cultural differences may affect client-clinical relationships – may feel more inhibited, apprehensive. 

What is the hospital anxiety and depression scale (HADS)?

14 items, 7 anxiety, 7 depression. Scoring 4 point scale 0-3. Higher scores indicate higher levels of anxiety/depression. Anxiety and depression scored separately. Any individual scoring above 11 on either subscale should have a suicide risk assessment. Without suicidal risk, 0-7 = normal, 8-10, elevated distress, 11-14 abnormal, 15-21 severe distress. 

What can HADS be used for? 

Screening for symptoms of depression and general anxiety in order to contribute to potential diagnosis and treatment, monitoring progress of treatment in clinical practice, treatment effectiveness studies, theoretical research studies investigating anxiety and depression.