The Spectrum Collaborative Project was established to develop a research agenda based upon Giovanni Cassano's observation that there is a range of common clinical features that accompany each DSM-IV disorder, and that these features have clinical and research implications. A major focus of the project is to develop and test assessment instruments for assessment of the spectrum of clinical features associated with DSM-IV psychiatric disorders.

The spectrum model we propose highlights the significance of non-serious and isolated symptoms which precede, follow, or are manifested in concurrence with the main disorder. In our experience, this subthreshold symptomatology may have important implications for the course of the illness, for the adherence and response to treatment, and for comorbidity with other conditions.

What is the background and history of the spectrum model?

The classification of mental disorders has been cause for great interest over the last three decades. In fact, during this period, relatively simplified prototypes for classifying the disorders haven adopted, as described in the official international systems of classification used today n psychiatry (Diagnostic and Statistical Manual, DSM-IV-TR; and Research Diagnostic Criteria, ICD-10). This important change has produced remarkable progress as far as diagnostic reliability is concerned. Nevertheless, the complex clinical reality can be seen in the different approaches, both with use of polythetic diagnostic criteria and with recognition of the fact that multiple diagnoses and subthreshold syndromes do co-exist. To date, however, a significant discrepancy still persists between clinical reality and the options furnished by the official classifications (DSM-IV and ICD-10). In fact, the lack of correspondence between the current classifications of mental disorders and the psychopathological conditions that can be observed both among the general population and in a clinical environment is related to an incomplete characterization of most of the patients. Moreover, in clinical practice, it is now clear that an approach which focuses solely on the relationship between severity of full-blown syndromes and levels of impairment in the work, family, and social environment is inadequate, since a subject may demonstrate or exhibit marked impairment in adaptation and social functioning with even a partial manifestation of symptoms or with isolated symptoms. The current system of categorization, in fact, does not take into account the continuum between the nuclear symptoms of each disorder and the vast area of prodromic, residual, atypical, and subclinical characteristics. With this in mind, Professor Giovanni B. Cassano and colleagues in Italy and America have proposed the “spectrum” model which has advantages for better understanding of the etiology of mental disorders and for clinical assessment and treatment including subclinical and atypical symptomatology, the importance of which is often underestimated. back

What is the relationship between spectrum and DSM-IV?

DSM-IV is the official nomenclature used to guide psychiatric practitioners in assessment and diagnosis. This categorical diagnostic system is simple, easy to use and has many advantages. However, DSM-IV also has some important limitations. While DSM-IV criteria reliably identify categories of illness, Cassano and colleagues observed that the DSM approach does not provide a good description of the patients who meet these criteria. Spectrum is a complementary way of describing and assessing psychopathology. back

How is spectrum psychopathology assessed?

• Spectrum assessment is based upon a concept that uses individual DSM criterion symptoms as a starting point, and extends the DSM description to encompass the halo of surrounding clinical phenomena. These include associated features described in the DSM as well as symptoms, maladaptive behavioral traits and temperamental features that do not appear in the DSM.
• Spectrum assessment generates a dimensional profile as opposed to a categorical diagnosis, obviating the need for threshold-based definition of caseness.
• According to the spectrum concept, pathological characteristics are viewed on a continuum where even a single symptom can be important. Thus, the threshold for defining a disorder is less important for spectrum than for DSM assessment back

Who are the investigators?

The Spectrum Collaborative Project is an international project that has involved clinicians and researchers from the University of Pisa (Italy) and the University of Pittsburgh, Columbia University, and University of California, San Diego (USA).
Participants in the project include (in alphabetical order):
Susanna Banti, M.D. Psychiatrist, Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa. Dr. Banti is a collaborator of Dr. Cassano's both in research and patient care. She has been part of the Spectrum Collaborative Project from its inception and has contributed substantially to design, implementation, and coordination of most of the Italian studies on spectrum interviews, especially in the multicenter panic-agoraphobic spectrum study and the Pisa-Pittsburgh Cross-Cultural Collaborative Study.
Giovanni B. Cassano, M.D. Professor and Chair, Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology, University of Pisa. Dr. Cassano has an international reputation as a treatment outcome researcher and descriptive psychopathologist. Among the very first clinicians to bring modern psychopharmacology to Italy, he has a nearly forty-year track record of empirical investigation of mood disorders. He has also had a long-standing interest in the description on clinical conditions in a more subtle and clinically useful manner. Most recently, he has devoted intense effort to the codification of these ideas in structured clinical interviews and in the self-report assessments developed on this project.
Liliana Dell'Osso, M.D. Professor and Chief of Psychiatry, Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa. For more than 20 years, Dr. Dell'Osso has worked on problems of mood disorder treatment and description of mood and anxiety psychopathology. She has been involved in the Spectrum Collaborative Project from its inception and has contributed substantially to the development and validation of these instruments.
Jean Endicott, Ph.D. Professor of Clinical Psychology, Department of Psychiatry, College of Physicians and Surgeons, Columbia University and Chief, Department of Research Assessment and Training, New York State Psychiatric Institute. Dr. Endicott contributes expertise in psychometrics and the evaluation of impairment and quality of life.
Andrea Fagiolini, M.D. Associate Professor of Psychiatry, University of Pittsburgh. Dr. Fagiolini, who initially came to the University of Pittsburgh to work on selected aspects of the Spectrum Collaborative Project as a postdoctoral fellow from Dr. Cassano's laboratory, provides a key link between the US and Pisa research centers. Dr. Fagiolini has extensive experience in the conduct of mood and anxiety disorder treatment research protocols.
Ellen Frank, Ph.D. Professor of Psychiatry and Psychology, University of Pittsburgh. Dr. Frank is an internationally recognized expert on the evaluation and treatment of mood and anxiety disorders. In the context of her 35-year career in this area, she and her colleagues have developed new interventions or modified existing interventions for post-rape trauma, recurrent unipolar depression, and bipolar disorder. Dr. Frank has been responsible for important innovations in both the psychotherapy and the pharmacotherapy of mood disorders. Recently, and directly as a result of her collaboration with Dr. Cassano in the development and testing of the spectrum assessments, she has turned her attention to co-occurring mood and anxiety and its treatment as well as the search for treatment-relevant phenotypes using the spectrum instruments.
Victoria J. Grochocinski, Ph.D. Research Data Administrator, University of Pittsburgh Medical Center. Dr. Grochocinski has played an active role in the development of the spectrum instruments in the Spectrum Collaborative Project. She is responsible for maintaining the English versions of the instruments and for maintaining the content of the website. Dr. Grochocinski has acted as database administrator for numerous NIMH-sponsored research projects and programs conducted in the Department of Psychiatry at the University of Pittsburgh.
Jack D. Maser, Ph.D. Professor, Department of Psychiatry, University of California, San Diego. Dr. Maser is an internationally recognized expert in mood, anxiety and personality disorders, and worked for 24 years at the NIMH in these areas. He is especially interested in research related to comorbidity and subsyndromal conditions. He has participated in the Spectrum Collaborative Project since its inception.
Mauro Mauri, M.D. Associate Professor of Psychiatry, Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa. Dr. Mauri is a long-standing collaborator of Dr. Cassano's in his empirical and descriptive work. He has been involved in the Spectrum Collaborative Project from its inception and has contributed substantially to the development and validation of these instruments.
Mario Miniati, M.D. Psychiatrist, Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa. Dr. Miniati is a collaborator of Dr. Cassano's both in research and patient care. He has been involved in the Spectrum Collaborative Project from its inception, and has contributed substantially to the design, implementation, and coordination of most of the Italian studies on spectrum interviews. Dr. Miniati has been especially interested in the study of panic-agoraphobic spectrum symptoms in patients with cardiovascular diseases.
Paola Rucci, Dr.Stat. Visiting Research Assistant Professor, University of Pittsburgh. Dr. Rucci, who also has a fellowship at the University of Pisa, is a biostatistician highly experienced in the design management and analysis of treatment outcome and health services studies. Her main activity consists of testing the validity and reliability of clinical interviews and self-report assessments developed on this Project.
Alfredo Sbrana, M.D. Psychiatrist, Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa. Dr. Sbrana is a collaborator of Dr. Cassano's both in research and patient care. He has involved in the Spectrum Collaborative Project and has contributed substantially in the development and validation of substance use spectrum and psychosis spectrum.
M. Katherine Shear, M.D. Marion Kenworthy Professor of Psychiatry, Columbia University School of Social Work, Adjunct Professor of Psychiatry University of Pittsburgh.  Dr. Shear is an internationally recognized expert and innovator in the assessment and treatment of anxiety disorders. Dr. Shear has made major contributions to the development and testing of treatments for complicated grief and for depression with co-occurring panic symptomatology. Dr. Shear has been involved since the inception the Spectrum Collaborative Project in the development and testing of these instruments and is intimately familiar with the performance of these scales in clinical populations. back