Dimensional Assessment with SVARAD in Clinical Practice
The SVARAD can be successfully adopted in routine clinical practice; it is easy to learn, quick to use (about 3–5 min for each patient), optimised for a busy clinical setting, and well accepted by clinicians, as it requires minimal effort for data interpretation.
Several SVARAD dimensions were present in many diagnostic DSM-IV TR categories, suggesting that they can act as “trans-diagnostic” descriptors, for example, Apprehension/Fear, Sadness/Demoralisation, Anger/Aggressiveness, Apathy, Impulsivity, and Activation.
The SVARAD provides generalised psychopathological profiles of major diagnostic categories, according to its ten descriptive dimensions, with dimensional profiles for each DSM-IV TR diagnostic clinical group.
The SVARAD is useful for exploring dimensional profiles of descriptive psychopathology within individual diagnostic categories. Patients within the same diagnostic category fit the specific DSM-IV or ICD-10 criteria, following a hierarchical exclusion tree; however, SVARAD findings in two large samples of acute inpatients and outpatients suggest that they might differ clinically to a consistent degree within the same category, resulting in slight to moderate differences in presentation according to SVARAD dimensional scores. The dimensional assessment approach, such as by SVARAD, could easily integrate and enrich the classical diagnostic DSM-IV or DSM-5 assessment to provide a more accurate profile of suffering for each patient and lead to more tailored treatments. Multivariate studies are needed to explore further aspects of this kind of dimensional analysis and its limitations, as well as its potential role in optimising personalised psychiatric treatments.
KeywordsPsychopathology Dimensional profiles Diagnosis Dimensional assessment Personalised treatments Precision psychiatry
- 1.Pancheri P, Biondi M, Gaetano P, Picardi A, Pasquini M. Use of the scale for the rapid dimensional assessment SVARAD in a sample of 1,124 psychiatric outpatients. Riv Psichiatr. 2001;36:4. Available from: http://www.rivistadipsichiatria.it/allegati/00186_2001_04/fulltext/204-216.pdf.Google Scholar
- 2.Andrews G, Charney D, Sirovatka PJ, Regier D. Stress-induced and fear circuitry disorders. Arlington VA: American Psychiatric Association; 2009.Google Scholar
- 4.APA. Diagnostic and statistical manual of mental disorders, Fifth Edition (DSM-5). Arlington VA: APA; 2013.Google Scholar
- 6.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(2–3):133–9. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0165032702001039.CrossRefPubMedGoogle Scholar
- 7.Maser JD, Cloninger RD. Comorbidity of mood and anxiety disorders. London: American Psychiatric Press, Inc.; 1990. 888 p.Google Scholar
- 8.Pasquini M, Picardi A, Speca A, Orlandi V, Tarsitani L, Morosini P, et al. Combining an SSRI with an anticonvulsant in depressed patients with dysphoric mood: an open study. Clin Pract Epidemiol Ment Heal. 2007;3(1):3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17288584.CrossRefGoogle Scholar
- 9.APA. Diagnostic and Statistical manual of mental disorders - 4th ed. Text Rev. (DSM IV-TR). Washington, DC: APA; 2000.Google Scholar
- 10.WHO. International statistical classification of diseases and related health problems, 10th Revision (ICD-10). Geneva: WHO; 1992.Google Scholar
- 11.Sartorius N, Andreoli V, Cassano G, Eisenberg L, Kielholz P, Pancheri P, et al. Anxiety psychobiological and clinical perspective. New York, NY: Hemisphere Publishing Corporation; 1990.Google Scholar
- 12.Roth M, Mountjoy C. The distinction between anxiety states and depressive disorders. In: Paykel E, editor. Handbook of affective disorders. Edinburgh: Churchill Livingstone; 1982. p. 70–92.Google Scholar
- 13.Jablensky A. Approaches to the definition and classification of anxiety and related disorders in European psychiatry. In: Anxiety and the anxiety disorders. Hillsdale, NJ: Lawrence Erlbaum; 1985. p. 735–58.Google Scholar
- 14.Johansson R, Carlbring P, Heedman Å, Paxling B, Andersson G. Depression, anxiety and their comorbidity in the Swedish general population: point prevalence and the effect on health-related quality of life. PeerJ. 2013;1:e98. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23862109 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Möller H-J, Bandelow B, Volz H-P, Barnikol UB, Seifritz E, Kasper S. The relevance of “mixed anxiety and depression” as a diagnostic category in clinical practice. Eur Arch Psychiatry Clin Neurosci. 2016;266(8):725–36. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27002521.CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Goldberg D, Kendler K, Sirovatka P, DA R. Diagnostic issues in depression and generalised anxiety disorder. Arlington VA: American Psychiatric Association; 2010.Google Scholar
- 23.Clarke DE, Narrow WE, Regier DA, Kuramoto SJ, Kupfer DJ, Kuhl EA, et al. DSM-5 field trials in the United States and Canada, Part I: study design, sampling strategy, implementation, and analytic approaches. Am J Psychiatry. 2013;170(1):43–58. Available from: http://psychiatryonline.org/doi/abs/10.1176/appi.ajp.2012.12070998.CrossRefPubMedGoogle Scholar
- 28.Pancheri P. Approccio dimensionale ed approccio categoriale alla diagnosi psichiatrica. G Ital di Psicopatol. 1999;38:1–14.Google Scholar