118

Pharmacopsychiat. 18 (1985) 118-122

© Georg Thieme Verlag Stuttgart . New York

KUSTA (Kurz-Skala StimmunglAktivierung):

A Daily Self-rating Scale for Depressive Patients
G. Wendt, U. Binz, A.A. Miille,

CIBA-GEIGY GmbH, Clinical Research, Frankfurt

Introduction Construction of the rating scale

Accurate evaluation of the course of depressive disorders We call our rating scale KUSTA (Kurz-Skala Stimmung!
and of the therapeutic effects of antidepressant treatments Aktivierung). It was designed to obtain daily self-ratings
calls for frequent rating in depressive patients. Self-assess- from depressive patients, including those with motor in-
ment questionnaires and observer assessment procedures in hibition or low IQ. The aim of KUSTA is to enable the
current use do not~ however, enable measurements to be depressed patient to keep a "diary" of his subjective con-
made frequently enough to describe the course of antide- dition without difficulty and in a form that gives his phy-
pressant treatment fully. Therefore, we developed a self- sician useful information about the course of his emo-

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rating scale for daily use by depressive patients in our tional state.
drug-trial programs. This report describes the scale briefly
and gives some examples of its use.

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Fil. 1 Results of KUSTA for a 58 year old male outpatient with with opipramol (Insidon®) produced a gradual improvement in symp
depressive syndrome. Scores for "mood" (stars) are shown togeth- toms as shown by the curves. The initially high ratings for enxiety
er with scores for "activation" (A) and for "tension/relaxation" declined whereas activation and mood scores increased (i.e. improved
(E) in the curves on the left side and in the center, respectively. The correlation between mood and anxiety was -0.90
Anxiety scores appear in the curve on the right side. Treatment
 . 'i·:·'· . ,·.. ./

KUSTA. A Dally Self-ratina Scale for Depressive Patients Pharmacopsychiat. 18 (198S) 119

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FIg.2 Results of KUSTA for a 52 year old hospitalized female pa- cline in mood (Le. worsening), an increase in activation and a high
tient with endogenous depression. score for anxiety. The conflict situation revealed by the data lead
Symbols as in Fig. 1. The patient received treatment with maprotil ine to psychotherapy. The beneficial effect of treatment shown by
(Ludiomil~). The curves show initial improvement of the symptoms, KUSTA by day 13 agreed with clinical impression. The stabilization
in agr"ment with clinical assessment. The patient's reaction to a po- of mood, activation and tension/relaxation during the last third of
sitive event experienced on day 11 was characterized by a marked de- the observation period was associated with a rapid decline in anxiety
scores

KUSTA begins with three scales in which the patient indi- by the fact that common expressions are used to inquire
cates his "mood", level of "activation", and amount of about symptoms of depression. Its criteria-related validity
"tension/relaxation". Next, the patient indicates whether is indicated by high correlations between KUSTA and
any event affected him particularly during the last 24 hours other ra~ing scales such as Hamilton Rating Scale (max.
and whether that event was pleasant or unpleasant. Then, the r = 0.93), Bf-S (max. r = 0.88), and ESTA (max. r = 0.91).
patient indicates the degree to which he felt happiness, anx-
iety, anger and being hurt (disappointed) during the last Evaluation of data
24 hours. Finally, the patient marks how he slept during Recording of data from KUSTA is carried out by docu-
the night (very well, well, slightly disturbed, seriously dis- ment-reader using a computer The scores for "mood", 0

turbed). "activation" and "tension/relaxation" are displayed graphi-

cally as longitudinal profiles (Figs. 1, 2, 3, 4). Scores for
UseofKUSTA anxiety and quality of sleep are indicated as columns. A
We use KUSTA for depressed inpatients and outpatients plus or minus sign beside the data marks a positive or ne-
(from 16 years old), patients with psychosomatic diseases, gative event recorded by the patient. All data are printed
and patients with depressive states due to chronic physical out in tabular or graphic form with mean values, variances
illnesses (e.g. rheumatoid arthritis, kidney disease requiring and intercorrelations.
haemodialysis, malignant diseases). We found that particu-
larly patients who have previously experienced phases of 7ranslations of KUSTA
depression are able to evaluate their subjective condition
KUSTA and patient information for its use are available
using KUSTA.
in German, English, French, Greek, Dutch, Italian, Portu-
Validity of KUSTA gese, Swedish, Serbian, Spanish, Czech and Hungarian. The
KUSTA was developed on the basis of experience gained KUSTA manual is available in German and English.
in testing depressive patients. Its content validity is assured References in which KUSTA has been successfully applied are list-
ed of page 122.
120 Pharmaeopsyehiat. 18 (1985) G. Wendt, U. Binz, A.A. Müller

PATIE~TE~-~A•

A • AKTIVITAET,
0126

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.OAAELATIO""~: sr Ip'·UNG AKTIVIT. SPINNU"lIG 'AEOD E "GSI wOT H.L.[~T • SC~lAFST.

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FREUOE .87 .83 .8S 1.eo
ANGST .77- .83- .76- .70- 1.00
"UT •• 4- • 4 1- • 4S- .49- .47 1.00
VUL.ENT. .74- .63- .74- .69- .70 .56 1.00
SC"L~'ST • 99.99 99.99 99.99 99.99 99.99 Q9.99 99.99 99.99

• = BF-5 • = HAMD

Fig.3 Results of KUSTA for a 50 year old hospitalized woman
with depression.
Symbols as in Fig. 1. The eurves for this patient treated with oxapro-
tiline reveal a gradual improvement in her depressive state, in aeeord-
anee with elinieal assessment. Intermittent low scores on mood and
activation were assoeiated with negative events. Short-Iasting relapses,
whieh may oeeur even in the eourse of adequately treated depression,
appeared in the daily reeord obtained by KUSTA. They might have
been missed had only weekly ratings of the patients been earried out
with traditional scales, resulting in inadequate therapeutie measures
depending on the day of testing

Mittelwerte: 9.24 8.81 7.59 5.75 4.04 3.87 2.83

Varianzen: 15.77 21.70 10.07 19.16 15.99 16.06 7.72
Korrelationen: Stimmung Aktivität Spannung Freude Angst Wut verl. Ent.
Stimmung 1.00
Aktivität .95 1.00
Spannung
Freude
.50
.86
.47
.83
1.00
.18 1.00
-
N
Iri
I
Angst .72- .65- .61- .50- 1.00 ci
Wut .08- .03- .34- .13 .44 1.00
-
Oll

267=l
verl. Ent. ,13- .06- .21- .04 .34 .71 1.00

Mittelwerte: 11.20 10.94 11.02 8.77 1.82 3.37

Varianzen: 11.36 17.08 8.65 22.06 8.08 17.03 7.67
Korrelatio"en: Stimmung Aktivität Spannung Freude Angst Wut verl. Ent.
Stimmung 1.0
Aktivität .90 1.00 d
Spannung .79 .74 1.00
Freude
Angst
.84
.61-
.86
.40-
.73
.62-
1.0
.28- 1.00 "
ci
I
Wut .00- .06 .31- .15- .12 1.00 co;
verl. Ent. .44- .27- .45- .55- .40 .59 1.00

This Table belongs to Figure 4 (see next page)

KUSTA. A Daily Self-rating Scale for Depressive Patients Pharmacopsychiat. 18 (1985) 121

Dos; erung

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Fig.4 Results of KUSTA for a 36 year old female inpatient with ma-
jor depressive i1lness of bipolar II type. Symbols as in Fig. 1.
This patient experienced a distinct improvement, followed by a stab-
ilization of mood and activation during treatment with lithium sulfate
(3'x 330 mg/day) and chlomipramine (Anafranil®) (75 mg/day). A
change in daily dose of lithium to 4 x 330 mg/day and chlomipramine
to 50 mg/day did not alter the patient's condition. but further reduc-
tion in dosage of ehlomipramine resulted in a new incidence of depres-
sive symptoms. These trends are shown clearly by the KUSTA curves.
After increasing the dosage of chlomipramine to 150 mg/day, the de-
pressive symptoms disappeared whereas a subsequent reduction in
dosage to 100-75 mg/day lead to reappearance of symptoms. I ncreas-
ing the dosage of chlomipramine to 150 mg/day lead to improvement
in the emotional condition of the patient throughout the rest of the ob-
servation period. The results of the daily self·rating with KUSTA in
this patient over about 3 months are in accordance with the c1inician's
assessment of the patient's emotional condition on 8 occasions during
the observation period, and provide additional information on the con-
dition of the patient on days when no c1inical examination was carried
out.
122 Pharmacopsychiat. 18 (1985)
References
Benkert, 0., W. Maier: Biologisch-psychiatrische Forschung und
psychiatrische Pharmakotherapie. Methodenkritische Anmerkun-
gen. Münch. med. Wschr. 123 (1981) 795-799
Binz, U., G. Wendt: Die Eppendorfer Stimmungs- und Antriebsskala
(ESTA) als Beurteilungsverfahren bei der klinischen Prüfung eines
Antidepressivums. Fortsehr. Med. 45 (1982) 2111-2118
Binz, .U., G. Wendt: Die Kurz-Skala Stimmung/Aktivierung (KUSTA)
- Manual Ciba-Geigy GmbH, Medizin, Frankfurf/M., Juni 1983
Heimann. H.: Methodologische Probleme bei der EffIZienzprüfung
von Psychopharmaka. Arch. Psychiat. Nervenkr. 220 (1975) 255-
268
Möller, H.J., O. Benken: Methoden und Probleme der Beurteilung
der Effektivität psycho-pharmakologischer und psychologischer
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