instruments are available for the following disorders. Click on each disorder to view the instruments available, a brief description, and the scoring algorithm. Please read the remainder of this page before accessing or using any of the instruments in order to become more familiar with the spectrum model and concepts.

Many instruments were developed as structured clinical interviews and later converted to a patient self-report format. We believe the structured clinical interview format is useful for clinicians to learn the content and range of responses on each instrument. We suggest you administer the structured clinical interview a few times until you are comfortable with questioning patients in this manner. Only then should you opt to use the self-report version in its place. Then decide which method works best for you, your patients, and your situation.

Why should I use spectrum instruments?

The spectrum instruments have the potential to help health care professionals better understand their patients and patients feel better understood.
The spectrum instruments are:

• Easy to complete, score, and understand
• Acceptable and useful by both patients and clinicians
• Flexibly administered as clinical interviews or self-reports
• Available to assess symptoms over the lifetime, the past month or the past week
• Validated
• Useful in predicting clinical outcomes
• Helpful for health care professionals to distinguish symptoms of physical illnesses that may also be expressions of mental or emotional disturbances
• Useful in the initial stages of treatment planning
• Useful for monitoring change (the weekly and monthly versions)

example of an application for a medical practitioner

A patient presents with unexplained hand dermatitis. After a thorough exam, you prescribe certain lotions to be used daily. When the patient returns one month later for a follow-up, she is no better and you cannot determine the reason. You administer the Obsessive-Compulsive Spectrum Lifetime Self-Report and learn that she endorses many of the items, including contamination fears and frequent hand washing. You refer her to a colleague who diagnoses and treats the obsessive-compulsive symptoms and subsequently the dermatological condition remits.

example of an application for a mental health practitioner

A patient presents himself for treatment of major depressive disorder. He has a history of an inability to tolerate (“is allergic to”) medications. You suspect the patient might have panic-agoraphobic spectrum so you administer the Panic-Agoraphobic Spectrum Lifetime Self-Report. He endorses many items including typical panic symptoms and substance sensitivity. You explain to the patient the concept of panic spectrum and convince him to try another medication beginning with a very low dose and increasing the dosage gradually. The patient is relieved that you understand his concerns and is willing to consider that he’s not allergic.

How long are the spectrum instruments?

Instruments vary in length from 100 to 160 items.

How are the spectrum instruments scored?

Spectrum instruments can be scored in a variety of ways, depending on the needs of the user. Scoring can be either dimensional or categorical. When used dimensionally, scores can constitute a profile of the individual items or of domain subscales. Total spectrum score can also be used as a severity index. Alternatively, a cut-score for spectrum total scores can be used to identify a categorical disorder.

Have these instruments been validated?

Many of the instruments have been validated in psychiatric and non-psychiatric patient populations. Please refer to each individual instrument for this information.

	N of subjects	Test-retest & inter-rater reliability of domains (ICC)	Internal consistency of domains	Discriminant validity of domains: Cases > controls	Discriminant validity: Disorder(s) of interest > other disorders	Concurrent validity: Instruments used	Correlation of domains with other instruments*	Correlation between total scores of structured interview & self-report
Mood Spectrum SCI-MOODS Fagiolini et al., 1999	491	0.93-0.94	0.79-0.92	All	Bipolar vs. unipolar: all manic subdomains		Not assessed	0.94
Panic-Agoraphobic Spectrum SCI-PAS Cassano et al., 1999; Shear et al., 2001	422	0.65-0.89	0.47-0.94	All	Patients with lifetime panic vs. those without lifetime panic: all domains	BAI, Fear, ASI, SASI, PDSS, ASAD	> 0.65 between SCI PAS domains & instruments measuring similar constructs	0.97
Obsessive Compulsive Spectrum SCI-OBS Dell’Osso et al., 2000	254	0.94-0.98	0.61-0.90	All	OCD vs. MDD: all; OCD vs. SP: all domains but "doubt" and "hypercontrol"	COCY-BOCS	0.48-0.71 with COC; 0.39-0.54 with Y BOCS	0.97
Social Phobia Spectrum SCI-SHY Dell’Osso et al., 2000	254	0.97-0.99	0.87-0.94	All	Social phobia vs. OCD: all domains; SP vs. MDD: all domains	LSAS	0.48-0.83	0.96
Anorexic Bulimic Spectrum SCI-ABS Mauri et al., 2000	372	0.84-0.99	0.41-0.93	All	Not assessed	EDI, EAT	0.46-0.77 with EAT; -0.01-0.50 with EDI scales	0.79
Substance Use Spectrum SCI-SUBS Sbrana et al., 2003	100		0.64-0.93
Psychotic Spectrum SCI-PSY Sbrana et al., 2005	459		0.39-0.77			DIB, BPRS
Separation Anxiety SCI-SAS Cyranowski et al., 2002	111		0.85			PDSS, SASI, ASA-CL, ASI	0.81-0.85
*Spearman correlation coefficient ASAD=Adult Separation Anxiety Disorder, SASI=Separation Anxiety Symptoms Inventory, BAI=Beck Anxiety Inventory, ASI=Anxiety Sensitivity Index, FEAR=Fear Questionnaire, PDSS=Panic Disorder Severity Scale, LSAS=Liebowitz Social Anxiety Scale, COC=Checklist for Obsessions and Compulsions, Y-BOCS=Yale-Brown Obsessive-Compulsive Scale, EAT=Eating Attitude Scale, EDI=Eating Disorder Inventory, DIB=Diagnostic Interview for Borderlines, BPRS=Brief Psychiatric Rating Scale, PDSS=Panic Disorder Severity Scale, SASI=Separation Anxiety Symptom Inventory, ASA-CL=Adult Separation Anxiety Checklist, ASI=Anxiety Sensitivity Ind

What are the results of the psychometric tests?

Reliability and Validity Studies

Multi-site studies established the reliability and validity of the structured clinical interviews. See the following articles for details on the reliability and validity studies.

Fagiolini A, Dell’Osso L, Pini S, Armani A, Bouanani S, Rucci P, Cassano GB, Endicott J, Maser J, Shear MK, Grochocinski VJ, Frank E: Validity and reliability of a new instrument for assessing mood symptomatology: the Structured Clinical Interview for Mood Spectrum (SCI MOODS). Int J Meth Psych Res 8:71-81, 1999.

Shear MK, Frank E, Rucci P, Fagiolini A, Grochocinski V, Houck P, Cassano GB, Kupfer DJ, Endicott J, Maser J, Mauri M, Banti S: Panic-agoraphobic spectrum: Reliability and validity of assessment instruments. J Psych Res 35:59-66, 2001.

Cassano GB, Banti S, Mauri M, Dell’Osso L, Miniati M, Maser JD, Shear MK, Frank E, Grochocinski V, Rucci P: Internal consistency and discriminant validity of the Structured Clinical Interview for Panic-Agoraphobic Spectrum (SCI-PAS). Int J Meth Psych Res 8:138-145, 1999.

Dell’Osso L, Cassano GB, Sarno N, Millanfranchi A, Pfanner C, Gemignani A, Maser JD, Shear MK, Grochocinski VJ, Rucci P, Frank E: Validity and reliability of the Structured Clinical Interview for Obsessive-Compulsive Spectrum (SCI-OBS) and of the Structured Clinical Interview for Social Phobia Spectrum (SCI-SHY). Int J Meth Psych Res 9:11-24, 2000.

Mauri M, Borri C, Baldassari S, Benvenuti A, Rucci P, Cassano GB, Shear MK, Grochocinski VJ, Maser JD, Frank E: Acceptability and psychometric properties of the Structured Clinical Interview for Anorexic – Bulimic Spectrum (SCI-ABS). Int J Meth Psych Res 9:68-78, 2000.

What are the procedures for the development of the instruments?

The work of the Spectrum Collaborative Project consisted of converting clinical observations into a systematic inquiry to elicit lifetime symptoms, traits and behaviors occurring commonly in patients with mood, panic-agoraphobia, social phobia, obsessive-compulsive and eating disorders. Structured clinical interviews were developed during a series of meetings, with additional input from experts in each area as needed. Both DSM-IV criterion symptoms and non-DSM features of the five disorders were included. Italian and English versions of the instruments were developed in parallel at meetings of the spectrum group. Based on our combined clinical experience and the bilingual expertise of several members of the group, the translations were deemed adequate (Rucci & Maser, 2000]. Before validation studies were conducted, instruments were pilot-tested with appropriate patient populations and language was adjusted as needed. Multi-center validation studies were then conducted in Italy for each instrument. A separate SCI-PAS validation study was conducted in Pisa, Italy, and Pittsburgh, PA, U.S., to examine further aspects of validity and reliability and to explore cross-cultural differences (Frank et al, 2005). After conducting the validation studies of the structured clinical interviews, which covered symptoms and behaviors over the lifetime, investigators developed lifetime self-report instruments that could be completed by the patients themselves. These easily completed instruments ask patients to answer 'yes' or 'no' to 100-160 questions per spectrum instrument. Then, in order to assess current features of each disorder spectrum, versions were developed for the assessment of symptoms and behaviors over the past month and the past week.

See the following article for a more detailed discussion on the development of the instruments.

Rucci P, Maser JD: Instrument development in the Italy-USA collaborative spectrum project. Epidemiologia e Psichiatria Sociale, 9:249-256, 2000.