UKU-Side Effect Rating Scale

Main reference

Lingjærde O, Ahlfors UG, Bech P, Dencker SJ, Elgen K. The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients.  Acta Psychatr Scand 1987; 76; Suppl. 334.

Comments to the scale 

UKU-SERS is a clinician-rated (observer) scale (semi-structured interview). It is available in most major languages in the world and all Nordic languages (Danish, Finnish, Icelandic, Norwegian, Swedish) as well. It was developed to provide a comprehensive side effect rating scale with well-defined and operationalized items to assess the side effects of psychopharmacological medications. The interviewer may also obtain information from other  relevant sources. In case of discrepancies among the reports, the clinician's observations are given more weight than patient reports.

The time period covered by the scale is the past 3 days (for some symptoms even longer), but ratings can also be made on the basis of a here and now assessment, or “time since last visit”. However, as for all scales, the longer the observation period, the lower validity of the scores (underreporting; attribution of symptoms of other etiology to the use of drugs).

The scoring sheet includes 48 items. There is a separate list of item descriptions to be consulted when applying the interview. The time needed for conducting the interview varies from 10-30 minutes depending on the number of symptoms reported; their complexity and the patient’s ability to provide good report.   

Rating is independent of whether the symptom is regarded as being drug-induced. Probability of the causal relationship (or lack of it) of each item to the medication in question is indicated in a separate column, which makes it useful for determining subsequent course of action. Subscales can be useful in assessing differential side effect profiles. Thus the scale can be used in both clinical practice and trials. A list of some more recent studies using the UKU-SERS is found below.

A Simpson-Angus index may be extracted as a subscale from the UKU scale: 2.1 dystonia; 2.2. rigidity; 2.3 decreased mobility; 2.5 tremor; 3.2 increased salivation; 

Reliable and valid use of the scale requires trained mental health professional. Due to the many medical oriented items, valid scores are most likely to be achieved by trained physicians (psychiatrists). However, studies comparing the validity of scores obtained by physicians compared to that of other mental health professionals are not published.

The potential psychometric reliability of the scale has been found to be acceptable to good, but as for other scales, inter-rater reliability must be established whenever used in studies or as part of routine clinical practice.

A patient-rated version of the scale is available (click here). Comparative studies indicate that patients to some degree may report more symptoms than checked by the physician, and more subjective impairment from side-effects. 

Some recent studies applying the UKU-scale 

• Allain H, et al. Double blind study of tiapride versus haloperidol and placebo in agitation and aggressiveness in elderly patients with cognitive impairment. Psychopharmacology (Berl). 2000 Mar;148(4):361-6
• Atmaca M, et al. A new atypical antipsychotic: quetiapine-induced sexual dysfunctions. Int J Impot Res. 2005 Mar-Apr;17(2):201-3.
• Barcia D, et al. Risperidone in the treatment of psychotic, affective and behavioral symptoms associated to Alzheimer's disease. Actas Esp Psiquiatr. 1999 May-Jun;27(3):185-90. Spanish.
• Bobes J et al, Weight gain in patients with schizophrenia treated with risperidone, olanzapine, quetiapine or haloperidol: results of the EIRE study. Schizophr Res. 2003 Jul 1;62(1-2):77-88
• Cabesa IG, et al. Factors related to treatment adherence in schizophrenic patients] Actas Esp Psiquiatr. 1999 Jul-Aug;27(4):211-6. Spanish.
• Cabesa IG, et al.  Subjective response to antipsychotics in schizophrenic patients: clinical implications and related factors. Schizophr Res. 2000 Jan 21;41(2):349-55.
• Casas M, et al. Risperidone in the treatment of psychotic patients with opiate abuse and dependence. Actas Esp Psiquiatr. 2001 Nov-Dec;29(6):380-5. (Spanish).
• Chin CN, et al.  A double blind comparison of zuclopenthixol acetate with haloperidol in the management of acutely disturbed schizophrenics. Med J Malaysia. 1998 Dec;53(4):365-71.
• Demyttenaere K, et al. What happens with adverse events during 6 months of treatment with selective serotonin reuptake inhibitors? J Clin Psychiatry. 2005 Jul;66(7):859-63.
• Dreher J,et al.  A self-rating scale for adverse drug effects and its application in a study of antidepressants. Fortschr Neurol Psychiatr. 1999 Apr;67(4):163-74. German
• Ekselius E, et al. A double-blind multicenter trial comparing sertraline and citalopram in patients with major depression treated in general practice. Int Clin Psychopharmacol. 1997 Nov;12(6):323-31
• Ekselius E, von Knorring L.  Effect on sexual function of long-term treatment with selective serotonin reuptake inhibitors in depressed patients treated in primary care. J Clin Psychopharmacol. 2001 Apr;21(2):154-60
• El-Giamal N, et al.  Reboxetine in the treatment of bulimia nervosa: a report of seven cases.
• Int Clin Psychopharmacol. 2000 Nov;15(6):351-6.
• Franco MA, et al. Risperidone in the treatment of psychotic disorders associated with mental retardation. Actas Esp Psiquiatr. 2000 Jul-Aug;28(4):251-6. Spanish.
• Gasto C, et al. Single-blind comparison of venlafaxine and nortriptyline in elderly major depression. J Clin Psychopharmacol. 2003 Feb;23(1):21-6.
• Gerstenberg G, et al. Relationship between clinical effects of fluvoxamine and the steady-state plasma concentrations of fluvoxamine and its major metabolite fluvoxamino acid in Japanese depressed patients. Psychopharmacology (Berl). 2003 Jun;167(4):443-8
• Gothelf D, et al. Olanzapine, risperidone and haloperidol in the treatment of adolescent patients with schizophrenia. J Neural Transm. 2003 May;110(5):545-60.
• Guelfi JD, et al.  Mirtazapine versus venlafaxine in hospitalized severely depressed patients with melancholic features. J Clin Psychopharmacol. 2001 Aug;21(4):425-31.
• Gutierrez M et al, [Risperidone in the treatment of acute exacerbation of schizophrenia symptoms]
• Actas Luso Esp Neurol Psiquiatr Cienc Afines. 1998 Mar-Apr;26(2):83-9. Spanish
• Harrison CL, et al. Tolerability of high-dose venlafaxine in depressed patients. J Psychopharmacol. 2004 Jun;18(2):200-4
• Hofer A, et al. Attitudes toward antipsychotics among outpatient clinic attendees with schizophrenia. J Clin Psychiatry. 2002 Jan;63(1):49-53.
• Hofer A, et al.  The safety of clozapine in the treatment of first- and multiple-episode patients with treatment-resistant schizophrenia. Int J Neuropsychopharmacol. 2003 Sep;6(3):201-6
• Hofer A, et al. Quality of life in schizophrenia: the impact of psychopathology, attitude toward medication, and side effects. J Clin Psychiatry. 2004 Jul;65(7):932-9.
• Holzinger A, et al.  Subjective illness theory and antipsychotic medication compliance by patients with schizophrenia. J Nerv Ment Dis. 2002 Sep;190(9):597-603.
• Horne RL, et al. Safety and efficacy of switching psychiatric patients from a delayed-release to an extended-release formulation of divalproex sodium. J Clin Psychopharmacol. 2003 Apr;23(2):176-81
• Hummer M, et al. Attitudes of patients with schizophrenia toward placebo-controlled clinical trials. J Clin Psychiatry. 2003 Mar;64(3):277-81.
• Jensen HV, et al. Double-blind comparison of the side-effect profiles of daily versus alternate-day dosing schedules in lithium maintenance treatment of manic-depressive disorder. J Affect Disord. 1996 Jan 22;36(3-4):89-93.
• de Jesus Mari J, et al. The prevalence of tardive dyskinesia after a nine month naturalistic randomized trial comparing olanzapine with conventional treatment for schizophrenia and related disorders. Eur Arch Psychiatry Clin Neurosci. 2004 Dec;254(6):356-61.
• Kurtzhaler I, et al. Risk profile of SSrIs in elderly depressive patients with co-morbid physical illness. Pharmacopsychiatry. 2001 May;34(3):114-8.
• Lambert TJ, et al. Measurement of antipsychotic-induced side effects: support for the validity of a self-report (LUNSERS) versus structured interview (UKU) approach to measurement. Hum Psychopharmacol. 2003 Jul;18(5):405-11
• Lane HY, et al. Repeated ingestion of grapefruit juice does not alter clozapine's steady-state plasma levels, effectiveness, and tolerability. J Clin Psychiatry. 2001 Oct;62(10):812-7
• Lindstrøm E, et al. Patient-rated versus clinician-rated side effects of drug treatment in schizophrenia. Clinical validation of a self-rating version of the UKU Side Effect Rating Scale (UKU-SERS-Pat). Nord J Psychiatry. 2001;55 Suppl 44:5-69.
• Lopez-Ibor JJ, et al. [Risperidone in the treatment of chronic schizophrenia: multicenter study comparative to haloperidol] Actas Luso Esp Neurol Psiquiatr Cienc Afines. 1996 Jul-Aug;24(4):165-72. Spanish.
• Louza MR, et al. Conjugated estrogens as adjuvant therapy in the treatment of acute schizophrenia: a double-blind study. Schizophr Res. 2004 Feb 1;66(2-3):97-100
• Malt UF, et al.  The Norwegian naturalistic treatment study of depression in general practice (NORDEP)-I: randomised double blind study. BMJ. 1999 May 1;318(7192):1180-4.
• Mayour PM, et al. Discontinuation of antidepressant drugs during electroconvulsive therapy: a controlled study. J Affect Disord. 2000 Apr;58(1):37-41.
• McConville BJ, et al.  Pharmacokinetics, tolerability, and clinical effectiveness of quetiapine fumarate: an open-label trial in adolescents with psychotic disorders. J Clin Psychiatry. 2000 Apr;61(4):252-60.
• Metin O, et al. Amisulpiride augmentation in treatment resistant obsessive-compulsive disorder: an open trial. Hum Psychopharmacol. 2003 Aug;18(6):463-7.
• Mihara H, et al. No pharmacokinetic but pharmacodynamic interactions between cisapride and bromperidol or haloperidol. Ther Drug Monit. 1999 Jun;21(3):297-300.
• Mihara H, et al. Relationship between plasma concentrations of trazodone and its active metabolite, m-chlorophenylpiperazine, and its clinical effect in depressed patients. Ther Drug Monit. 2002 Aug;24(4):563-6.
• Muller MJ, et al. Therapeutic drug monitoring of tricyclic antidepressants: how does it work under clinical conditions? Pharmacopsychiatry. 2003 May;36(3):98-104.
• Oscanai T, et al. Effect of itraconazole on the pharmacokinetics and pharmacodynamics of a single oral dose of brotizolam. Br J Clin Pharmacol. 2004 Nov;58(5):476-81
• Otsubo T, et al. A comparative study of the efficacy and safety profiles between fluvoxamine and nortriptyline in Japanese patients with major depression. Pharmacopsychiatry. 2005 Jan;38(1):30-5.
• Parellada E , et al. Risperidone in the treatment of patients with delirium. J Clin Psychiatry. 2004 Mar;65(3):348-53.
• Potgin SG, et al. The safety and pharmacokinetics of quetiapine when coadministered with haloperidol, risperidone, or thioridazine. J Clin Psychopharmacol. 2002 Apr;22(2):121-30
• Potkin SG, et al. Effect of fluoxetine and imipramine on the pharmacokinetics and tolerability of the antipsychotic quetiapine. J Clin Psychopharmacol. 2002 Apr;22(2):174-82
• Romain JL, et al. Efficacy of zuclopenthixol acetate on psychotic anxiety evaluated in an open study. Encephale. 1996 Jul-Aug;22(4):280-6. French
• Suzuki A, et al. Histamine H1-receptor antagonists, promethazine and homochlorcyclizine, increase the steady-state plasma concentrations of haloperidol and reduced haloperidol. Ther Drug Monit. 2003 Apr;25(2):192-6.
• Spivak M, et al. Zuclopenthixol treatment of behavioral disturbances in mentally retarded children and adolescents: an open-label study. J Child Adolesc Psychopharmacol. 2001 Fall;11(3):279-84.
• Udina AC, et al.  Long-term relapse prevention with risperidone in 215 schizophrenic patients.  Actas Esp Psiquiatr. 2001 Jul-Aug;29(4):243-9. (Spanish)
• Vieta E, et al.  Efficacy and safety of risperidone in the treatment of schizoaffective disorder: initial results from a large, multicenter surveillance study. Group for the Study of Risperidone in Affective Disorders (GSRAD). J Clin Psychiatry. 2001 Aug;62(8):623-30.
• Vieta E, et al. Risperidone safety and efficacy in the treatment of bipolar and schizoaffective disorders: results from a 6-month, multicenter, open study. J Clin Psychiatry. 2001 Oct;62(10):818-25. Erratum in: J Clin Psychiatry 2002 Jan;63(1):79
• Vieta E, et al. Acute and continuation risperidone monotherapy in mania. Hum Psychopharmacol. 2004 Jan;19(1):41-5.
• Yamada K, et al. Prediction of medication noncompliance in outpatients with schizophrenia: 2-year follow-up study. Psychiatry Res. 2005
• Yen UC, et al. Adverse effects of risperidone and haloperidol treatment in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry. 2004 Mar;28(2):285-90
• Yoon S, et al. Risperidone use in Korean patients with Alzheimer's disease: optimal dosage and effect on behavioural and psychological symptoms, cognitive function and activities of daily living. Hum Psychopharmacol. 2003 Dec;18(8):627-33
• Yurekli U, et al.Comparison of regional cerebral blood flow in deficit and nondeficit schizophrenic patients. Turk Psikiyatri Derg. 2003 Winter;14(4):255-62. (Turkish).