Dimensional Assessment with SVARAD in Clinical Practice

  • Massimo BiondiEmail author
  • Martina Valentini
  • Corinna Pancheri
  • Daria Piacentino
  • Massimo Pasquini
  • Angelo Picardi


Findings from our work can be summarised as follows:
  1. 1.

    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.

  2. 2.

    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.

  3. 3.

    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.

  4. 4.

    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.



Psychopathology Dimensional profiles Diagnosis Dimensional assessment Personalised treatments Precision psychiatry 


  1. 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: Scholar
  2. 2.
    Andrews G, Charney D, Sirovatka PJ, Regier D. Stress-induced and fear circuitry disorders. Arlington VA: American Psychiatric Association; 2009.Google Scholar
  3. 3.
    Wolkowitz OM, Pickar D. Benzodiazepines in the treatment of schizophrenia: a review and reappraisal. Am J Psychiatry. 1991;148(6):714–26. Available from: Scholar
  4. 4.
    APA. Diagnostic and statistical manual of mental disorders, Fifth Edition (DSM-5). Arlington VA: APA; 2013.Google Scholar
  5. 5.
    Lavender JM, Goodman EL, Culbert KM, Wonderlich SA, Crosby RD, Engel SG, et al. Facets of impulsivity and compulsivity in women with anorexia nervosa. Eur Eat Disord Rev. 2017;25(4):309–13. Available from: Scholar
  6. 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: Scholar
  7. 7.
    Maser JD, Cloninger RD. Comorbidity of mood and anxiety disorders. London: American Psychiatric Press, Inc.; 1990. 888 p.Google Scholar
  8. 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: Scholar
  9. 9.
    APA. Diagnostic and Statistical manual of mental disorders - 4th ed. Text Rev. (DSM IV-TR). Washington, DC: APA; 2000.Google Scholar
  10. 10.
    WHO. International statistical classification of diseases and related health problems, 10th Revision (ICD-10). Geneva: WHO; 1992.Google Scholar
  11. 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. 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. 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. 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: CrossRefPubMedPubMedCentralGoogle Scholar
  15. 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: Scholar
  16. 16.
    Piacentino D, Pasquini M, Tarsitani L, Berardelli I, Roselli V, Maraone A, et al. The association of anger with symptom subtypes in severe obsessive-compulsive disorder outpatients. Psychopathology. 2016;49(1):40–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Fava GA, Freyberger HJ, Bech P, Christodoulou G, Sensky T, Theorell T, et al. Diagnostic criteria for use in psychosomatic research. Psychother Psychosom. 1995;63(1):1–8. Available from: Scholar
  18. 18.
    Picardi A, Viroli C, Tarsitani L, Miglio R, de Girolamo G, Dell’Acqua G, et al. Heterogeneity and symptom structure of schizophrenia. Psychiatry Res. 2012;198(3):386–94. Available from: CrossRefPubMedGoogle Scholar
  19. 19.
    Stoffers JM, Lieb K. Pharmacotherapy for borderline personality disorder—current evidence and recent trends. Curr Psychiatry Rep. 2015;17(1):534. Available from: Scholar
  20. 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
  21. 21.
    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(6):587–94.CrossRefPubMedGoogle Scholar
  22. 22.
    Pincus HA, Tew JD, First MB. Psychiatric comorbidity: is more less? World Psychiatry. 2004;3(1):18–23. Available from: Scholar
  23. 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: Scholar
  24. 24.
    Gorman JM. Comorbid depression and anxiety spectrum disorders. Depress Anxiety. 1996;4(4):160–8. Available from: Scholar
  25. 25.
    Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Munoz R. Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry. 1972;26:57–63.CrossRefPubMedGoogle Scholar
  26. 26.
    Spitzer RL, Robins E. Research diagnostic criteria: rationale and reliability. Arch Gen Psychiatry. 1978;35(6):773–82.CrossRefPubMedGoogle Scholar
  27. 27.
    Andreasen NCDSM. the death of phenomenology in america: an example of unintended consequences. Schizophr Bull. 2006;33(1):108–12. Available from: Scholar
  28. 28.
    Pancheri P. Approccio dimensionale ed approccio categoriale alla diagnosi psichiatrica. G Ital di Psicopatol. 1999;38:1–14.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Massimo Biondi
    • 1
    Email author
  • Martina Valentini
    • 2
  • Corinna Pancheri
    • 2
  • Daria Piacentino
    • 3
  • Massimo Pasquini
    • 2
  • Angelo Picardi
    • 4
  1. 1.Department of Human Neurosciences, Policlinico Umberto I HospitalSapienza University of RomeRomeItaly
  2. 2.Department of Human NeurosciencesSapienza University of RomeRomeItaly
  3. 3.Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS)Sapienza University of RomeRomeItaly
  4. 4.Centre for Behavioural Sciences and Mental HealthItalian National Institute of HealthRomeItaly

Personalised recommendations