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NOVEMBERDECEMBER 1971
PSYCHOSOMATICS
OFFICIAL JOURNAL OF THE ACADEMY OF PSYCHOSOMATIC MEDICINE
WK.
ZUNG,
M.D.
PSYCHOSOMATICS
LIEF (4)
icOLIl (3)
AFFECTIVE SHlPTOHS
Apprehensiol', utlcasincss,
anticipation of danger,
ilelplessness
Apprehension
Fear of death
>h.-> rvousness
60.7*
41. 8
87.6
Trel:lbling
Shakiness
53.5
46.5
SY:IPTOMS
Musculoskeletal $vstem
~uscle
Tremor,
tightness,
tremors, spasms,
painful movements,
Increased tension,
tremors, stiffn"ss
Tension headache.
h'~akness,
h'eakness,
k",stlessgess
Restlessness
Headache
58.3
easil~..
95.0
Weakness
Fatigued all
the time
56.0
Palpitation
96.7
Dizziness
Faintness
llreathlessness
Breath
78.3
Tires
45.1
I'!!.d.!o~'!.s cUl-,!,--S ys t em
l'alpitation,
rapid heartbeat
Palpitation, throbbing
pain in chest
Dizziness,
Rapid or irr~gu13r
breathing
B-e_,~p.iJ-,,-ton'
Sys tem
Hyperv",ntilation:
dizziness,
fainting,
shortne::;s of breatil,
:::;lll.)rtness of ureath)
f",eling of choking,
Lvnstriction in chest,
pressure on tilorax,
parestllesias
unsatisfactpry
Paresthesias
70.0
90.0
52.7
58.2
and
vonlitill~
vonliting,
diarrheu,
dllllrt'xia
~uusea,
Xausea, vomiling,
diarrhea
\'omiting and
diarrhea
Anorexia
14.0
12.3
Frequency
18.6
~L:n_i_t.9-u_~~.!!...a_ ~~ t ~~~.
frequenc~'
Incre3sed desire to
urinate
rrillary frequellcy,
urgcIH':y
Urinary
Skin
rac,", f 1uSiled,
perspiration
flushing of f:lce,
Flushing or
in constant
:lbsent "'inded
Sensation of heat
~3llor,
Flushing
36.2
Sweating
44.9
Insomnia
52.7
~ightmares
If!. 3
S~i.-~
daz~,
1.3ck 0f concentration,
J~cr~ased
memory,
defects,
irritabilitv
Difficulty in falling
:l~l"eJl, fitful sle"p,
p0rc~ptu:ll
Di fficulty in
falling asleep,
f":lrful dre:lms
372
ul1pl~asant
dreams
Sleep Jisturhililces
Volume XII
RATING INSTRUMENT-ZUNG
AFFECTIVE :<
SDrl<\TIC SYNPTONS
OF ANXIETY
SEVERITY OF OBSERVED
OR
NONE
MILD
HOD
SEV
I. Anxiousness
.',
2. Fear
.',
J. Panic
.',
.',
.',
Have
had times when you felt yourself
trem ling? shaking?
.',
.',
8. Easy fatiguability,
weakness
.',
9. Rest lessness
.',
.',
.',
Mental disintegratior
H~lvc
5. Apprehension
hOU
6. Tremors
7. Body aches
'-.
pains
10. Palpitation
II. Dizziness
12. Faintness
13. Dyspnea
I.',. Paresthesias
.',
.',
17. Sweating
19. Insomnia
20. Nightmares
IS. Nausea
& vomiting
November-December 1971
373
PSYCHOSOMATICS
c.
NAME,
AGE,
NO.
None OR
A little
of the time
SEX: M
DATE
Some
of the time
F
_
Good part
of the time
Most OR AlII
of the time
~m bothered by stomachaches
or indigestion
bl~dder
often
374
Volume XII
RATING INSTRUMENT-ZUNG
problem or present
B. Patient gives no information relevant
to an item
C. Response is ambiguous even after suitable probing
A total raw score is obtained by a summation of the rated responses obtained for
each of the 20 items.
Self-rating Anxiety Scale (SAS)
For the purpose of constructing the SAS,
TABLE IV -
of the time
Some
of the time
:.
reason at all
:.
.:.
:2
-,
:2
4. I
no
Good part
of the time
Most OR All
of the time
:2
.:.
7. I am bothered by headaches,
neck 3nd bilck pilins
.:.
.:.
.:.
:2
.:.
"
.:.
:.
:.
.:.
'+
10. I
C.:10
November-December 1971
375
PSYCHOSOMATICS
TABLE V
TABLE VI
ASI
ASI
&
&
ASI
&
AGE
Raw
SAS
Raw
SAS
Raw
SAS
Score
Index
Score
Index
Score
llIdex
20
25
40
50
60
75
40 - 64
21
26
41
51
61
76
65
22
28
42
53
62
78
23
29
43
54
63
79
SEX
24
30
44
55
64
80
25
31
56
65
81
Males
Females
26
33
58
66
83
27
34
59
35
29
36
61
67
68
69
84
28
45
46
47
48
49
86
30
38
50
63
70
88
60
85
31
39
51
64
71
89
32
40
52
72
90
33
41
53
43
54
73
74
91
34
65
66
68
92
35
44
45
55
69
75
94
56
70
76
95
46
57
71
77
96
48
49
58
73
74
78
98
59
36
37
38
39
376
79
99
80
100
19 & under
20 - 39
& over
8
97
112
8
3.6
43.1
49.7
3.6
225
100.0
175
50
225
DIAGNOSES
Mental Retardation
Organic Brain Syndrome
Schizophrenia
Anxiety Disorder
Depressive Disorder
5
25
22
96
54
Psychophysiologic Disorders
Transient Situational
Disturbances
0.4
2.2
11.1
9.8
42.9
3.2
24.2
0.9
12
5.3
100.0
No Psychiatric Diagnosis
225
Volume XII'
RATING INSTRUMENT-ZUNG
Data CoIIection
The data for this study were obtained as
follows: all new patients admitted to the psychiatric in-patient service of the hospital for
15 consecutive months, and all new patients
seen at the out-patient clinic for 4 consecutive
months were seen and tested. Patients were
first given the self-rating form of the anxiety
scales (SAS and TMAS), after which an interview was conducted to complete the interview-rating form of the anxiety scale (ASI).
TABLE VII
1
2
3
4
5
ASI Z Score
Mean & S.D.
22
25
96
54
62.0
49.4
49.9
52.6
12
42.0 +
Diagnosis
Anxiety Disorder
Schizophrenia
Depressive Disorder
Personality Disorder
Transient Situational
Disturbances
13.8
15.9
12.5
13.6
8.1
TABLE VIII
1
2
3
4
5
Diagnosis
Anxiety Disorder
Schizophrenia
Depressive Disorder
Personality Disorder
Transient Situational
Disturbances
Controls
November-December 1971
SAS Index
Mean & S.D.
22
25
96
54
08.7
46.4
50.7
51.2
12
45.8 11.9
209
100
33.8
13.5
12.9
13.4
13.2
5.9
Subjects Tested
A total of 225 patients were tested during
the period of study. The inpatient population
(N=152) were all men, whose ages ranged
from 22 to 75 years (m=45). The out-patient population (N=73) had 23 men and
50 women, whose ages ranged from 14 to 72
years old (m=32). The total mean age for
all 225 subjects was 41 years old. Each patient was given a diagnosis at the time of discharge by his psychiatrist, and was done
without any knowledge of the scale results.
The distribution of all patients tested by their
age, sex and diagnoses are presented in
Table VI.
A total of 100 normal adult subjects were
tested. There were 57 men and 43 women.
Their ages ranged from 18 to 62 years old
(m=34).
PSYCHOSOMATICS
Item
No.
Items: in Decreasing
Order of Severity
2.8
2.8
4
6
2.6
2.5
Mental disintegration
Tremors
Body aches and pains
Anxiousness
Apprehension
Nausea and vomiting
Fear
Panic
Palpitation
Paresthesias
Urinary frequency
Sweating
Fatigue
Dyspnea
Nightmares
Restlessness
Dizziness
Faintness
Rank
Order
2.5
2.5
4
7
5
15
2.4
2.4
2.4
10
2.4
14
2.4
2.2
16
17
2.1
2.1
13
2.1
20
2.0
2.0
11
2.0
12
2.0
2.0
18
19
Face Blushing
Insomnia
TABLE X
1
2
3
4
5
378
Diagnosis
Anxiety Disorder
Schizophrenia
Depressive Disorder
Personality Disorder
Transient Situational
Disturbances
22
TMASScore
Mean & S.D.
13.5
13.5
54
31.0
23.0
25.1
31.7
12
29.3
7.0
25
96
15.3
10.8
as being the worst (upper third) the following affective symptoms: feelings of mental
disintegration, anxiousness and apprehension,
and somatically: symptoms referable to the
musculoskeletal and gastrointestinal systems.
By comparison, Wheeler et al.5 noted in their
study that the most frequent complaints by
patients with anxiety neurosis as involving
the cardiovascular and respiratory systems
(see Table I).
RATING INSTRUMENT-ZUNG
3.
4.
5.
6.
7.
8.
SYNOPSIS
9.
November-December 1971
10.
11.
37~