Multivantaged vs. Conventional Assessment Method

By Martin M. Katz

The Multivantaged Assessment Method (MVAM) of clinical evaluation was adopted to describe an approach to the measurement of the diverse patterns of psychopathology displayed in the various forms of mental disorder and to measure changes in the patterns before and after treatment. The approach assumes that most disorders are comprised of dimensions, components of disturbed affect, behavior and cognition, which interact to define their structure. It is further assumed that no one vehicle of measurement whether the observations of the experts or the subject’s report of the experience is capable of fully or accurately describing the complex nature or the critical facets of the disorder. Because of the many ways that the disorder can be expressed it requires more than one “vantage” on its expression to achieve accurate measurement.  To achieve a more “objective” picture of the behavior, the multivantaged assessement method (MVAM) involves combining such perspectives to achieve a consensual estimate of the type and severity of the behavior or emotion, at issue.  In the case of serious emotional disorders such as “depression”, a collection of valid clinical methods are recommended exemplifying the multivantaged approach, to measure the facets and severity of the disorder and to assess the impact of various interventions on the disorder. This is called the “Multivantaged Assessment Method”. The currently established method for clinical trials of antidepressants relies on a sole method of evaluation, the Hamilton Depression Scale, which measures change in overall severity of the disorder, but which provides no further validated information on the specific clinical actions of the the experimental drug. The MVAM was designed to extend and enhance the conventional assessment by providing, in addition to a measure of overall severity, a profile of the clinical and psychological actions of the trial treatment.

FURTHER ELABORATION OF MVAM

Accurate measurement of the various facets of psychopathology cannot be accomplished through any one vehicle of measurement.  It requires combining the observational ratings, the report of the subject, and the subject’s performance on cognitive and psychomotor tasks. The term “multivantaged” takes on important meaning particularly where observation of behavior and physical expression is concerned since it is known that the perspectives of observers of emotionally charged incidents can vary widely.  The author of the term refers in his book (Katz 2013) to the “Rashomon” effect, best demonstrated in a classic Japanese film, showing how the emotional aspects seriously influence the perceptions of different observers, but in different ways. To achieve a more “objective” picture of the behavior, the MVAM involves combining such perspectives to achieve a consensual estimate of the type and severity of the behavior or emotion, at issue.  In the case of serious emotional disorders such as “depression”, a collection of valid psychological methods are recommended exemplifying the MVAM, to measure the facets and severity of the disorder and to assess the impact of various interventions on the disorder. These methods include the Schedule for Affective Disorders and Schizophrenia-Change version (SADS-C), the Hamilton Depression Rating Scale, the Symptom Checklist (SCL-90), NIMH Mood Scale, Video Interview Behavior Evaluation scales (VIBES), and selected psychomotor tests. This is called the “Multivantaged Assessment Method”.

Descriptions of the MVAM, the rationales for the derivation of the methods, and evidence for their validity are presented in the following references:

Katz MM, Koslow SH, Berman N, Secunda S, Maas JW, Casper R, Kocsis J, Stokes P.A multivantaged approach to the measurement of behavioral and affect states for clinical and psychobiological research. Psychological Reports Monograph 1984; 55, 619-73.

Katz MM, Houston JP, Brannan S, Bowden CL, Berman N, Swann A, Frazer A. A multivantaged behavioral method for measuring onset and sequence of the clinical actions of antidepressants. International Journal of Neuropsychopharmacology 2004; 7: 471-9.

Katz MM. Depression and Drugs: The Neurobehavioral Structure of a Psychological Storm. New York: Springer; 2013.

Martin M. Katz

May 22, 2014