From the moment Max Hamilton started his psychiatric education, he considered psychometrics to be a scientific discipline on a par with biochemistry or pharmacology in clinical research. His clinimetric skills were in operation in the 1950s when randomised clinical trials were established as the method for the evaluation of the clinical effects of psychotropic drugs. Inspired by Eysenck, Hamilton took the long route around factor analysis in order to qualify his scales for anxiety (HAM-A) and depression (HAM-D) as scientific tools. From the moment when, 50 years ago, Hamilton published his first placebo-controlled trial with an experimental anti-anxiety drug, he realized the dialectic problem in using the total score on HAM-A as a sufficient statistic for the measurement of outcome. This dialectic problem has been investigated for more than 50 years with different types of factor analyses without success. Using modern psychometric methods, the solution to this problem is a simple matter of reallocating the Hamilton scale items according to the scientific hypothesis under examination. Hamilton’s original intention, to measure the global burden of the symptoms experienced by the patients with affective disorders, is in agreement with the DSM-IV and ICD-10 classification systems. Scale reliability and obtainment of valid information from patients and their relatives were the most important clinimetric innovations to be developed by Hamilton. Max Hamilton therefore belongs to the very exclusive family of eminent physicians celebrated by this journal with a tribute.

Roth M: Max Hamilton: A life devoted to psychiatric science; in Bech P, Coppen A (eds): The Hamilton Scales. Berlin, Springer, 1990, pp 1–9.
Wilkinson G: Talking about Psychiatry. London, Gaskell, 1993, pp 13–27.
Spearman C: The Abilities of Man. London, MacMillan, 1932.
Eysenck HJ: The Structure of Human Personality. London, Methuen, 1953.
Hamilton M: The personality of dyspeptics with special reference to gastric and duodenal ulcers. Br J Med Psychol 1950;23:182–198.
Hamilton M: Lectures on the Methodology of Clinical Research. Edinburgh, Churchill Livingstone, 1961.
Hamilton M: The assessment of anxiety states by rating. Br J Med Psychol 1959;32:50–55.
Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
Hamilton M: Treatment of anxiety states. Components of anxiety and their response to benactyzine. J Ment Sci 1958;104:1062–1068.
Hamilton M: An experimental approach to the identification of factors. Br J Stat Psychol 1958;11:161–169.
Hamilton M: Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967;6:278–296.
Hamilton M: Diagnosis and rating of anxiety. Br J Psychiatry 1969;3:76–79.
Bech P: Dimensions of depression and mania emerging in the 1980’s; in Ban TA, Healy D, Shorter E (eds): From Psychopharmacology to Neuropsychopharmacology. Budapest, Animula, 2002, pp 122–126.
Bech P: Rating scales for affective disorders. Their validity and consistency. Acta Psychiatr Scand 1981;64(suppl 295):1–101.
Feinstein AR: Clinimetrics. New Haven, Yale University Press, 1987.
Apgar V: A proposal for a new method of evaluation of a newborn infant. Curr Res Anesth Analg 1953;32:260–267.
Hamilton M: Frequency of symptoms in melancholia (depressive illness). Br J Psychiatry 1989;154:201–206.
Bech P, Gram LF, Dein E, Jacobsen O, Vitger J, Bolwig TG: Quantitative rating of depressive states. Acta Psychiatr Scand 1975;51:161–170.
Paykel ES: Use of the Hamilton Depression Scale in general practice; in Bech P, Coppen A (eds): The Hamilton Scales. Berlin, Springer, 1990, pp 40–47.
Guy W: Early Clinical Drug Evaluation (ECDEU) Assessment Manual. Rockville, National Institute of Mental Health, 1976.
Bagby RM, Ryder AG, Schiller DR, Marchall MB: The Hamilton Depression Rating Scale: has the gold standard become a lead weight? Am J Psychiatry 2004;161:2163–2177.
Gerson SC, Plotkin DA, Jarvik LF: Antidepressant drug studies 1964 to 1986: empirical evidence for aging patients. J Clin Psycopharmacol 1988;8:311–322.
Guttman L: A basis for scaling quantitative data. Am Soc Rev 1944;9:139–150.
Borsboom D: Measuring the Mind. Conceptual Issues in Contemporary Psychometrics. Cambridge, Cambridge University Press, 2005.
Berrios GE, Bulbena-Villaresa A: The Hamilton Depression Scale and the numerical description of the symptoms of depression; in Bech P, Coppen A (eds): The Hamilton Scales. Berlin, Springer, 1990, pp 80–92.
Cody RP, Smith JK: Applied Statistics and the SAS Programming Language, ed 4. Upper Saddle Rivers, Prentice Hall, 1997.
Guttman L: Reliability formulas that do not assume experimental independence. Psychometrika 1953;18:225–239.
Raykov T: Bias of coefficient alpha for fixed congeneric measures with correlated errors. Appl Psychol Meas 2001;25:69–76.
Bech P: Diagnostic and classification tradition of mental disorders in the twentieth century in Scandinavia; in Sartorius N (ed): Sources of Diagnosis in Different Cultures. Bern, Hans Huber, 1990, pp 153–169.
Hamilton M: Prediction in practice; in Banks C, Broadhurst PL (eds): Studies in Psychology. London, London University Press, 1965, pp 109–118.
Bech P, Allerup P, Gram LF, Reisby N, Rosenberg R, Jacobsen O, Nagy A: The Hamilton depression scale. Evaluation of objectivity using logistic models. Acta Psychiatr Scand 1981;63:290–299.
Bech P, Allerup P, Reisby N, Gram LF: Assessment of symptom change from improvement curves on the Hamilton Depression Scale in trials with antidepressants. Psychopharmacology 1984;84:276–281.
Santen G, Gomeni R, Danhof M, Pasqua OD: Sensitivity of the individual items of the Hamilton depression rating scale to response and its consequences for the assessment of efficacy. Psychiatr Res 2008;42:1000–1009.
Katona C: New antidepressants for older people: a critical review of the evidence base. Encephale 2008;34(suppl 2):71–76.
Williams JBW: Standardizing the Hamilton Depression Rating Scale: past, present, and future. Eur Arch Clin Neurosci 2001;251 (suppl 2):6–12.
Guy W, Bonato ER: Manual for the ECDEU Assessment Battery. Second Revision. Chevy Chase, National Institute of Mental Health, 1970.
Sackeim HA, Haskett RF, Mulsant BH: Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy. A randomized, controlled trial. JAMA 2001;285:1299–1307.
Beck AT: Depression: Clinical, Experimental, and Theoretical Aspects. New York, Harper, 1967.
Riskind JH, Beck AT, Brown G, Steer RA: Taking the measure of anxiety and depression. Validity of the reconstructed Hamilton Scales. J Nerv Ment Dis 1987;175:474–479.
Hamilton M: The Hamilton Depression Scales; in Sartorius N, Ban TA (eds): Assessment of Depression. Berlin, Springer, 1986, pp 143–152.
Maier W, Buller R, Philipp M, Heuser I: The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. J Affect Disord 1988;14:61–68.
Bech P, Allerup P, Maier W, Albus M, Lavori P, Ayuso JL: The Hamilton Scales and the Hopkins Symptom Checklist (SCL-90). A cross-national validity study in patients with panic disorder. Br J Psychiatry 1992;160:206–211.
Schweizer E, Rickels K: Placebo response in generalized anxiety: its effect on the outcome of clinical trials. J Clin Psychiatry 1997;58(suppl 11):30–38.
Rickels K, Downing R, Schweizer E, Hassman H: Antidepressants for the treatment of generalized anxiety disorder. A placebo-controlled comparison of imipramine, trezodone and diazepam. Arch Gen Psychiatry 1993;50:884–895.
Das-Munshi J, Goldberg D, Bebbington PE, Bhugra DK, Bhugra TS, Dewey ME, Jenkins R, Stewart R, Prince M: Public health significance of mixed anxiety and depression: beyond current classification. Br J Psychiatry 2008;192:171–177.
Bech P, Lunde M, Unden M: An inventory for the measurement of generalized anxiety distress symptoms, the GAD-10 Inventory. Acta Psychiatr Belg 2005;105:111–118.
Snaith RP, Bangh SJ, Clayden AD, Husain A, Sipple MA: Clinical Anxiety Scale: an instrument derived from the Hamilton Anxiety Scale. Br J Psychiatry 1982;141:518–523.
Meoni P, Salinas E, Brault Y, Hackett D: Pattern of symptoms improvement following treatment with venlafaxine XR in patients with generalized anxiety disorder. J Clin Psychiatry 2001;62:888–893.
Bech P: Dose-response relationship of pregabalin in patients with generalized anxiety disorder. A pooled analysis of four placebo-controlled trials. Pharmacopsychiatry 2007;40:163–168.
Zitman FG, Mennen MF, Griez E, Hooijer C: The different versions of the Hamilton Depression Rating Scales; in Bech P, Coppen A (eds): The Hamilton Scales. Berlin, Springer, 1990, pp 28–34.
Hamilton M: Assessment of psychopathology; in Hindmarch I, Stonier PD (eds): Human Psychopharmacology. Measures and Methods. Chichester, Wiley, 1987, pp 1–18.
Bech P, Kastrup M, Rafaelsen OJ: Mini-compendium of rating scales for states of anxiety, depression, mania and schizophrenia. Acta Psychiatr Scand 1986;73(suppl 326):1–37.
D’haenen HAH, Verhoeven WMA: Mini-compendium van beoordelingsschalen in de psychiatrie. Brussels, VUB Press, 1989.
Pichot P, Chambon O, Poncet F, Kiss L: Échelles d’anxieté, de manie, de dépression, de schizophrénie. Correspondance avec le DSM-III, ed 2. Paris, Masson, 1991.
Maier W, Gastpar M, Bech-Andersen G: Minikompendium psychiatrischer Ratingskalen. Berlin, Springer, 1991.
Fava GA, Grandi S: Mini compendio delle scale de valutazione de stati di ansia, depressione, mania, schizophrenia con le corrispondenti sindromi del DSM-III. Milano, Cedrim,1988.
Ballus C, Tressera J: Breve compendio de las escales de evaluacio para los estados de ansiedad, depression, mania y esquizofrenia con los sindroms correspondientes en el DSM-III. Barcelona, Espanx, 1988.
Sartorius N, Knyken W: Translation of health status instruments; in Orley J, Knyken W (eds): Quality of Life Assessment. International Perspectives. Berlin, Springer, 1994, pp 3–19.
Uher R, Farmer A, Maier W, Rietchel M, Hauser J, Marusic A, Mors O, Elkin A, Williamson RJ, Schmael C, Henigsberg N, Perez J, Mendlewicz J, Janzing JG, Zobel A, Skibinska M, Kozel D, Stamp AS, Bajs M, Placentino A, Barreto M, McGuffin P, Aitchison KJ: Measuring depression: comparison and integration of three scales in the GENDER study. Psychol Med 2008;38:289–300.
Hordern A: Some experiences in clinical psychopharmacology; in Ban TA, Healy D, Shorter E (eds): From Psychopharmacology to Neuropsychopharmacology in the 1980s. Budapest, Animula, 2002, pp 206–210.
Hordern A, Burt CG, Holt NF: Depressive States – a Pharmacotherapy Study. Springfield, Thomas, 1965.
Barbui C, Hotopf M: Amitriptyline versus the rest. Still the leading antidepressant after 40 years of randomised controlled trials. Br J Psychiatr 2001;178:129–144.
Paykel ES: The Clinical Interview for Depression. Development, reliability and validity. J Affect Disord 1985;9:85–96.
Chipman A, Paykel ES: How ill is the patient at this time? J Consult Clin Psychol 1974;42:669–674.
Fava GA, Lisansky J, Kellner R, Zielezny M: Treatment responses in primary and secondary melancholia: a preliminary report. J Clin Psychiatry 1985;46:332–334.
Fava GA, Ruini C, Rafanelli C, Finos L, Salmaso L, Mangelli L, Sirigatti S: Well-being therapy of generalized anxiety disorder. Psychother Psychosom 2005;74:26–30.
Paykel ES, Klerman GL, Prusoff BA: Treatment setting and clinical depression. Arch Gen Psychiatry 1970;22:11–21.
Hargreaves GR, Hamilton M, Roberts JM: Treatment of anxiety states. Clinical trials of benactyzine in anxiety states. J Ment Sci 1958;104:1056–1061.
Hays RD, Morals LS, Reise SP: Item response theory and health outcome measurement in the 21st century. Med Care 2000;38(suppl 2):28–42.
Hays RD, Hadorm D: Responsiveness to change: an aspect of validity, not a separate dimension. Qual Life Res 1992;1:73–75.
Murphy PM, Murphy DL: Drug response and psychiatric nosology. Psychol Med 1978;8:667–681.
Miller GA: The magical number of seven, plus or minus two. Psychol Rev 1956;63:81–97.
Hamilton M: Lectures on the Methodology of Clinical Research, ed 2. Edinburgh, Churchill Livingstone, 1974, pp 139–145.
Hordern A: Tranquillity Denied. Stress and Its Impact Today. Melbourne, Rigby, 1976.
Pichot P: Quantification of the psychological stress responses; in Levi L (ed): Society, Stress and Disease. The Psychological Environment and Psychosomatic Diseases. London, Oxford University Press, 1971, vol 1, pp 49–52.
Watson D: Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V. J Abnorm Psychol 2005;114:522–536.
Judd LL, Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, Paulus MP, Kunovac JL, Leon AC, Mueller TI, Rice JA, Keller MB: A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry 1998;55:694–700.
Ghaemi SN, Baldessarini RJ: The manic-depressive spectrum and mood stabilization: Kraepelin’s ghost. Psychother Psychosom 2007;76:65–69.
Guilford JP: The Nature of Human Intelligence. New York, McGraw-Hill, 1967.
Angst J: Psychiatric diagnoses: the weak component of modern research. World Psychiatry 2007;6:94–95.
Walsh BT, Seidman SN, Sysko R, Gould M: Placebo response in studies of major depression. JAMA 2002;287:1840–1847.
Pichot P: The problem of quantifying the symptomatology of depression; in Kielholz P (ed): Depressive Illness. Bern, Hans Huber, 1972, pp 74–81.
Eysenck HG: Four ways five factors are not basic. Pers Individ Differ 1992;13:667–673.
O’Sullivan RL, Fava M, Agustin C, Baer L, Rosenbaum JF: Sensitivity of the six-item Hamilton Depression Scale. Acta Psychiatr Scand 1997;95:379–384.
Bent-Hansen J, Lauritzen L, Clemmesen L, Lunde M, Kørner A: A definite and a semidefinite questionnaire version of the Hamilton/melancholia (HDS/MES) scale. J Affect Disord 1995;33:43–150.
Fava M, McCall WV, Krystal A, Wessel T, Rubens R, Caron J, Amato D, Roth T: Exzopiclone co-administrated with fluoxetine in patients with insomnia coexisting with major depression. Biol Psychiatry 2006;59:1052–1060.
Fava GA, Rafanelli C, Tossani E, Grandi S: Agoraphobia is a disease: a tribute to Sir Martin Roth. Psychother Psychosom 2008;77:133–138.
Sirri L, Grandi S, Fava G: The Illness Attitude Scales. A clinimetric index for assessing hypochondriacal fears and beliefs. Psychother Psychosom 2008;77:337–350.
de Figueiredo JM: Demoralization and psychotherapy: a tribute to Jerome D. Frank, MD, PhD (1909–2005). Psychother Psychosom 2007;76:129–133.
Nierenberg AA, Sonino N: From clinical observations to clinimetrics: a tribute to Alvan R. Feinstein, MD. Psychother Psychosom 2004;73:131–133.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. First Edition (DSM-I). Washington, American Psychiatric Association, 1952.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Second Edition (DSM-II). Washington, American Psychiatric Association, 1968.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Third Edition (DSM-III). Washington, American Psychiatric Association, 1980.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Third Revised Version (DSM-III-R). Washington, American Psychiatric Association, 1987.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition (DSM-IV). Washington, American Psychiatric Association, 1994.
World Health Organization: Manual of the International Statistical Classification of Diseases. Seventh Revision (ICD-7). Geneva, World Health Organization, 1955.
World Health Organization: Manual of the International Statistical Classification of Diseases. Eighth Revision (ICD-8). Geneva, World Health Organization, 1967.
World Health Organization: Glossary of Mental Disorders and Guide to Their Classification for Use in Conjunction with the International Classification of Diseases. Eighth Revision. Geneva, World Health Organization, 1974.
World Health Organization: Glossary of Mental Disorders and Guide to Their Classification in Accordance with Ninth Revision of the International Classification of Diseases. Geneva, World Health Organization, 1978.
World Health Organization: International Classification of Diseases. Tenth Revision. The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. Geneva, World Health Organization, 1992.
World Health Organization: International Classification of Diseases. Tenth Revision (ICD-10). Diagnostic Criteria for Research. Geneva, World Health Organization, 1993.
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