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The SVARAD Scale for Rapid Dimensional Assessment: Development and Applications in Research

  • Massimo Biondi
  • Paola Gaetano
  • Massimo Pasquini
  • Angelo Picardi
Chapter

Abstract

Psychiatric diagnosis is a complex and difficult issue. Ontological and epistemological questions permeate the nosological literature, with innumerable considerations about the uncertain ontological status of psychiatric disorders and the difficulties in providing irreproachable definitions for them. These considerations help to place the issue of nosology into proper context and to appreciate its subtleties and difficulties. Nosological classification is necessary and can be useful despite some inherent flaws and limitations. The current nosology, however, relies on a categorical approach that has been much criticised. The prototype approach, which does not rely on strict operational criteria, has both strong points and potential disadvantages. The dimensional approach represents an alternative that has received empirical support while having its share of difficulties.

In the 1990s, we developed an instrument called the SVARAD (the Italian acronym for “Scala per la VAlutazione RApida Dimensionale”, i.e. “rapid dimensional assessment scale”) that covers ten psychopathological dimensions, selected based on clinical relevance and consistent identification in factor analytic studies. It is an observer-rated scale that consists of ten items (Apprehension/Fear, Sadness/Demoralisation, Anger/Aggressiveness, Obsessiveness, Apathy, Impulsivity, Reality Distortion, Thought Disorganisation, Somatic Preoccupation/Somatisation, and Activation), each scored on a 5-point scale. To enhance ease of use, the scoring instructions are included directly in the scale, rather than being provided in a separate manual. Two decades of clinical and research experience have corroborated the reliability, validity, and acceptability of the SVARAD. It is particularly suitable for clinical and research settings where a reliable, comprehensive, and yet rapid assessment of psychopathology is needed.

Keywords

Ontology Epistemology Nosology Diagnostic categories Protoytpe diagnosis Dimensional psychopathology 

References

  1. 1.
    Marková IS, Berrios GE. Epistemology of psychiatry. Psychopathology. 2012;45:220–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Parnas J, Sass LA, Zahavi D. Rediscovering psychopathology: the epistemology and phenomenology of the psychiatric object. Schizophr Bull. 2013;39:270–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Kendler KS. The nature of psychiatric disorders. World Psychiatry. 2016;15:5–12.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Phillips J, Frances A, Cerullo MA, Chardavoyne J, Decker HS, First MB, Ghaemi N, Greenberg G, Hinderliter AC, Kinghorn WA, LoBello SG, Martin EB, Mishara AL, Paris J, Pierre JM, Pies RW, Pincus HA, Porter D, Pouncey C, Schwartz MA, Szasz T, Wakefield JC, Waterman GS, Whooley O, Zachar P. The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis. Philos Ethics Humanit Med. 2012;7:3.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Phillips J, Frances A, Cerullo MA, Chardavoyne J, Decker HS, First MB, Ghaemi N, Greenberg G, Hinderliter AC, Kinghorn WA, LoBello SG, Martin EB, Mishara AL, Paris J, Pierre JM, Pies RW, Pincus HA, Porter D, Pouncey C, Schwartz MA, Szasz T, Wakefield JC, Waterman GS, Whooley O, Zachar P. The six most essential questions in psychiatric diagnosis: a pluralogue. Part 4: general conclusion. Philos Ethics Humanit Med. 2012;7:14.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Maj M. Are we able to differentiate between true mental disorders and homeostatic reactions to adverse life events? Psychother Psychosom. 2007;76:257–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Zachar P. The practical kinds model as a pragmatist theory of classification. Phil Psychiatry Psychol. 2003;9:219–27.CrossRefGoogle Scholar
  8. 8.
    Zachar P. Real kinds but not true taxonomy. In: Kendler KS, Parnas J, editors. Philosophical issues in psychiatry. Baltimore, MD: Johns Hopkins University Press; 2008.Google Scholar
  9. 9.
    Wakefield JC. The concept of mental disorder. Am Psychol. 1992;47:373–88.CrossRefPubMedGoogle Scholar
  10. 10.
    Jablensky A. Does psychiatry need an overarching concept of “mental disorder”? World Psychiatry. 2007;6:157–8.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Berrios GE. Classifications in psychiatry: a conceptual history. Aust N Z J Psychiatry. 1999;33:145–60.CrossRefPubMedGoogle Scholar
  12. 12.
    Jablensky A. The nature of psychiatric classification: issues beyond ICD-10 and DSM-IV. Aust N Z J Psychiatry. 1999;33:137–44.CrossRefPubMedGoogle Scholar
  13. 13.
    Kendler KS, Zachar P. The incredible insecurity of psychiatric nosology. In: Kendler KS, Parnas J, editors. Philosophical issues in psychiatry. Baltimore, MD: Johns Hopkins University Press; 2008.Google Scholar
  14. 14.
    Kendler KS. The phenomenology of major depression and the representativeness and nature of DSM criteria. Am J Psychiatry. 2016;173:771–80.CrossRefPubMedGoogle Scholar
  15. 15.
    Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatry. 1970;126:983–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Kendler K. Toward a scientific psychiatric nosology: strengths and limitations. Arch Gen Psychiatry. 1990;47:969–73.CrossRefPubMedGoogle Scholar
  17. 17.
    Cohen BM. Embracing complexity in psychiatric diagnosis, treatment, and research. JAMA Psychiat. 2016;73:1211–2.CrossRefGoogle Scholar
  18. 18.
    Kendell R, Jablensky A. Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry. 2003;160:4–12.CrossRefPubMedGoogle Scholar
  19. 19.
    Zachar P, Kendler KS. The removal of Pluto from the class of planets and homosexuality from the class of psychiatric disorders: a comparison. Philos Ethics Humanit Med. 2012;7:4.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Schaffner KFA. philosophical overview of the problems of validity for psychiatric disorders. In: Kendler KS, Parnas J, editors. Philosophical issues in psychiatry. Baltimore, MD: Johns Hopkins University Press; 2008.Google Scholar
  21. 21.
    Schwartz MA, Wiggins OP. Typifications. The first step for clinical diagnosis in psychiatry. J Nerv Ment Dis. 1987;175:65–77.CrossRefPubMedGoogle Scholar
  22. 22.
    Husserl E. Erfahrung und Urteil: Untersuchungen zur Genealogie der Logik. Prague: Academia Verlagsbuchhandlung, 1939. English translation: experience and judgment. Evanston, IL: Northwestern University Press; 1973.Google Scholar
  23. 23.
    Westen D. Prototype diagnosis of psychiatric syndromes. World Psychiatry. 2012;11:16–21.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Morey LC, Ochoa ES. An investigation of adherence to diagnostic criteria: clinical diagnosis of the DSM-III personality disorders. J Pers Disord. 1989;3:180–92.CrossRefGoogle Scholar
  25. 25.
    Schaffner KS. A tail of a tiger. In: Pendler KS, Parnas J, editors. Philosophical issues in psychiatry. Baltimore, MD: Johns Hopkins University Press; 2008.Google Scholar
  26. 26.
    Westen D, Shedler J, Bradley R. A prototype approach to personality disorder diagnosis. Am J Psychiatry. 2006;163:846–56.CrossRefPubMedGoogle Scholar
  27. 27.
    DeFife JA, Peart J, Bradley B, Ressler K, Drill R, Westen D. Validity of prototype diagnosis for mood and anxiety disorders. JAMA Psychiat. 2013;70:140–8.CrossRefGoogle Scholar
  28. 28.
    Maj M. Psychiatric diagnosis: pros and cons of prototypes vs. operational criteria. World Psychiatry. 2011;10:81–2.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Goldberg D. Plato versus Aristotle: categorical and dimensional models for common mental disorders. Compr Psychiatry. 2000;41:8–13.CrossRefPubMedGoogle Scholar
  30. 30.
    Kraemer HC, Noda A, O’Hara R. Categorical versus dimensional approaches to diagnosis: methodological challenges. J Psychiatr Res. 2004;38:17–25.CrossRefPubMedGoogle Scholar
  31. 31.
    Zachar P, Kendler KS. Psychiatric disorders: a conceptual taxonomy. Am J Psychiatry. 2007;164:557–65.CrossRefPubMedGoogle Scholar
  32. 32.
    Van Praag HM, Leijnse B. Neubewertung des syndroms. Skizze einerfunktionellen Pathologie. Psychiatr Neurol Neurochir. 1965;68:50–66.Google Scholar
  33. 33.
    Mundt C. Psychotic continuum or distinct entities: perspectives from psychopathology. In: Marneros A, Andreasen NC, Tsuang MT, editors. Psychotic continuum. Berlin, Heidelberg: Springer; 1995. p. 7–15.CrossRefGoogle Scholar
  34. 34.
    van Praag HM, Korf J, Lakke JPWF, Schut T. Dopamine metabolism in depressions, psychoses, and Parkinson’s disease: the problem of the specificity of biological variables in behaviour disorders. Psychol Med. 1975;5:138–46.CrossRefPubMedGoogle Scholar
  35. 35.
    Van Praag HM, Asnis GM, Kahn RS, Brown SL, Korn M, Friedman JM, Wetzler S. Nosological tunnel vision in biological psychiatry. A plea for a functional psychopathology. Ann N Y Acad Sci. 1990;600:501–10.CrossRefPubMedGoogle Scholar
  36. 36.
    Widiger TA, Simonsen E. Alternative dimensional models of personality disorder: finding a common ground. J Pers Disord. 2005;19:110–30.CrossRefPubMedGoogle Scholar
  37. 37.
    van Os J, Fahy TA, Jones P, Harvey I, Sham P, Lewis S, Bebbington P, Toone B, Williams M, Murray R. Psychopathological syndromes in the functional psychoses: associations with course and outcome. Psychol Med. 1996;26:161–76.CrossRefPubMedGoogle Scholar
  38. 38.
    Peralta V, Cuesta MJ. Exploring the borders of the schizoaffective spectrum: a categorical and dimensional approach. J Affect Disord. 2008;108:71–86.CrossRefPubMedGoogle Scholar
  39. 39.
    Potuzak M, Ravichandran C, Lewandowski KE, Ongür D, Cohen BM. Categorical vs dimensional classifications of psychotic disorders. Compr Psychiatry. 2012;53:1118–29.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Picardi A, Viroli C, Tarsitani L, Miglio R, de Girolamo G, Dell’Acqua G, Biondi M. Heterogeneity and symptom structure of schizophrenia. Psychiatry Res. 2012;198:386–94.CrossRefPubMedGoogle Scholar
  41. 41.
    Helmes E, Landmark J. Subtypes of schizophrenia: a cluster analytic approach. Can J Psychiatry. 2003;48:702–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Lykouras L, Oulis P, Daskalopoulou E, Psarros K, Christodoulou GN. Clinical subtypes of schizophrenic disorders: a cluster analytic study. Psychopathology. 2001;34:23–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Tandon R, Gaebel W, Barch DM, Bustillo J, Gur RE, Heckers S, Malaspina D, Owen MJ, Schultz S, Tsuang M, Van Os J, Carpenter W. Definition and description of schizophrenia in the DSM-5. Schizophr Res. 2013;150:3–10.CrossRefPubMedGoogle Scholar
  44. 44.
    Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K, Sanislow C, Wang P. Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry. 2010;167:748–51.CrossRefGoogle Scholar
  45. 45.
    Fava GA. Road to nowhere. World Psychiatry. 2014;13:49–50.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Kraemer HC. Research Domain Criteria (RDoC) and the DSM – two methodological approaches to mental health diagnosis. JAMA Psychiat. 2015;72:1163–4.CrossRefGoogle Scholar
  47. 47.
    Weinberger DR, Glick ID, Klein DF. Whither Research Domain Criteria (RDoC)?: the good, the bad, and the ugly. JAMA Psychiat. 2015;72:1161–2.CrossRefGoogle Scholar
  48. 48.
    Reed GM, Correia JM, Esparza P, Saxena S, Maj M. The WPA-WHO global survey of psychiatrists’ attitudes towards mental disorders classification. World Psychiatry. 2011;10:118–31.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Phillips J, Frances A, Cerullo MA, Chardavoyne J, Decker HS, First MB, Ghaemi N, Greenberg G, Hinderliter AC, Kinghorn WA, LoBello SG, Martin EB, Mishara AL, Paris J, Pierre JM, Pies RW, Pincus HA, Porter D, Pouncey C, Schwartz MA, Szasz T, Wakefield JC, Waterman GS, Whooley O, Zachar P. The six most essential questions in psychiatric diagnosis: a pluralogue part 3: issues of utility and alternative approaches in psychiatric diagnosis. Philos Ethics Humanit Med. 2012;7:9.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Pancheri P, Biondi M, Gaetano P, Picardi A. Costruzione della SVARAD (Scala di Valutazione Rapida Dimensionale). Riv Psichiatr. 1999;34:72–83.Google Scholar
  51. 51.
    Pancheri P, Picardi A, Gaetano P, Pasquini M, Puzella A, Di Fabio F, Biondi M. Validazione della scala per la valutazione rapida dimensionale SVARAD. Riv Psichiatr. 1999;34:84–93.Google Scholar
  52. 52.
    Aiken LR. Rating scales and checklists. New York, NY: John Wiley & Sons; 1996.Google Scholar
  53. 53.
    Picardi A, Martinotti G, Paci M, Simi C, Caroppo E. Reliability of self-reported attachment style in patients with severe psychopathology. J Pers Assess. 2011;93:491–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Picardi A, Caroppo E, Porcelli P, Di Maria G, Munittola G, Martinotti G. Alexithymia and severe psychopathology: a study on psychiatric inpatients. Psychopathology. 2012;45:159–66.CrossRefPubMedGoogle Scholar
  55. 55.
    Picardi A, Caroppo E, Fabi E, Proietti S, Di Gennaro G, Meldolesi GN, Martinotti G. Attachment and parenting in adult patients with anxiety disorders. Clin Prac Epidemiol Mental Health. 2013;9:157–63.CrossRefGoogle Scholar
  56. 56.
    Pancheri P, Biondi M, Gaetano P, Picardi A, Pasquini M. Impiego della scala per la valutazione rapida dimensionale SVARAD in una popolazione clinica ambulatoriale di 1124 soggetti. Riv Psichiatr. 2001;36:204–16.Google Scholar
  57. 57.
    Biondi M, Picardi A, Pasquini M, Gaetano P, Pancheri P. Dimensional psychopathology of depression: detection of an “activation” dimension in unipolar depressed outpatients. J Affect Disord. 2005;84:133–9.CrossRefPubMedGoogle Scholar
  58. 58.
    Pasquini M, Picardi A, Biondi M, Gaetano P, Morosini P. Relevance of anger and irritability in outpatients with major depressive disorder. Psychopathology. 2004;37:155–60.CrossRefPubMedGoogle Scholar
  59. 59.
    Picardi A, Morosini P, Gaetano P, Pasquini M, Biondi M. Higher levels of anger and aggressiveness in major depressive disorder than in anxiety and somatoform disorders. J Clin Psychiatry. 2004;65:442–3.CrossRefPubMedGoogle Scholar
  60. 60.
    Abraham K. Notes on the psychoanalytical investigation of manic-depressive insanity and allied conditions; in Abraham K: Selected papers of Karl Abraham. London: Hogarth Press; 1948.Google Scholar
  61. 61.
    Freud S. Mourning and melancholia (1917). In: Strachey J, editor. Standard edition of the complete psychological works of Sigmund Freud, vol. 14. London: Hogarth Press; 1957. p. 239–58.Google Scholar
  62. 62.
    Guidano VF. Complexity of the self. New York, NY: Guilford Press; 1987.Google Scholar
  63. 63.
    Van Praag HM. Serotonergic dysfunction and aggression control. Psychol Med. 1991;21:15–9.CrossRefPubMedGoogle Scholar
  64. 64.
    Bowlby J. Attachment and loss. New York, NY: Basic Books; 1980. vol 3: Loss.Google Scholar
  65. 65.
    Pasquini M, Biondi M, Costantini A, Cairoli F, Ferrarese G, Picardi A, Sternberg C. Detection and treatment of depressive and anxiety disorders among cancer patients: feasibility and preliminary findings from a liaison service in an oncology division. Depress Anxiety. 2006;23:441–8.CrossRefPubMedGoogle Scholar
  66. 66.
    Pasquini M, Picardi A, Speca A, Orlandi V, Tarsitani L, Morosini P, Cascavilla I, Biondi M. Combining an SSRI with an anticonvulsant in depressed patients with dysphoric mood: an open study. Clin Pract Epidemiol Ment Health. 2007;3:3.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Piacentino D, Pasquini M, Tarsitani L, Berardelli I, Roselli V, Maraone A, Biondi M. The association of anger with symptom subtypes in severe obsessive-compulsive disorder outpatients. Psychopathology. 2016;49:40–6.CrossRefPubMedGoogle Scholar
  68. 68.
    Rozin P, Lowery L, Imada S, Haidt J. The CAD triad hypothesis: a mapping between three moral emotions (contempt, anger, disgust) and three moral codes (community, autonomy, divinity). J Pers Soc Psychol. 1999;76:574–86.CrossRefPubMedGoogle Scholar
  69. 69.
    Freud S. Notes upon a case of obsessional neurosis (1909). In: Strachey J, editor. Standard edition of the complete psychological works of Sigmund Freud, vol. 10. London: Hogarth Press; 1955. p. 153–249.Google Scholar
  70. 70.
    Pasquini M, Picardi A, Biondi M, Scarciglia P, Pancheri P. Analisi psicopatologica dimensionale del Disturbo Ossessivo-Compulsivo: appartiene ai Disturbi d’Ansia? Riv Psichiatr. 2003;38:86–91.Google Scholar
  71. 71.
    Dazzi F, Picardi A, Orso L, Biondi M. Predictors of inpatient psychiatric admission in patients presenting to the emergency department: the role of dimensional assessment. Gen Hosp Psychiatry. 2015;37:587–94.CrossRefPubMedGoogle Scholar
  72. 72.
    Suozzo AC, Pasquini M, Biondi M. Importance of perspective dimensional psychopathology of depression: a proposal of evaluation for Brazilian patients indifferent settings. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo. 2015;60:44–5.Google Scholar
  73. 73.
    Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46:1417–32.CrossRefPubMedGoogle Scholar
  74. 74.
    Harkness J. In pursuit of quality: issues for cross-National Survey Research. Soc Res Methodol. 1999;2:125–40.CrossRefGoogle Scholar
  75. 75.
    Mohatlane EJ. Back-translation as a quality control mechanism in Sesotho translation. J Soc Sci. 2014;41:167–75.Google Scholar
  76. 76.
    Bulmer M. The problem of exporting social survey research. Am Behav Sci. 1998;42:153–67.CrossRefGoogle Scholar
  77. 77.
    Biondi M, Pasquini M. Dimensional psychopharmacology in somatising patients. Adv Psychosom Med. 2015;34:24–35.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Massimo Biondi
    • 1
  • Paola Gaetano
    • 2
  • Massimo Pasquini
    • 3
  • Angelo Picardi
    • 4
  1. 1.Department of Human Neurosciences, Policlinico Umberto I HospitalSapienza University of RomeRomeItaly
  2. 2.Italian Society of Cognitive and Behavioural TherapyRomeItaly
  3. 3.Department of Human NeurosciencesSapienza University of RomeRomeItaly
  4. 4.Centre for Behavioural Sciences and Mental HealthItalian National Institute of HealthRomeItaly

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