ToolsCalculators
Bush-Francis Catatonia Rating Scale
Screens for and grades the severity of catatonia across 23 examination items.
Bush-Francis Catatonia Rating Scale
1. Excitement
Extreme hyperactivity, constant motor unrest that is apparently non-purposeful; not attributable to akathisia or goal-directed agitation.
2. Immobility / stupor
Extreme hypoactivity, minimal spontaneous movement or reaction to stimuli.
3. Mutism
Verbally unresponsive or minimally responsive.
4. Staring
Fixed gaze, little to no visual scanning, decreased blinking.
5. Posturing / catalepsy
Spontaneous maintenance of a posture against gravity.
6. Grimacing
Odd or exaggerated facial expressions held for a period.
7. Echopraxia / echolalia
Mimicking the examiner's movements or speech.
8. Stereotypy
Repetitive, non-goal-directed motor activity.
9. Mannerisms
Odd, exaggerated caricatures of purposeful movements.
10. Verbigeration
Repetition of phrases or sentences.
11. Rigidity
Maintenance of a rigid position despite efforts to be moved.
12. Negativism
Apparently motiveless resistance to instructions or attempts to move the patient.
13. Waxy flexibility
Initial resistance to passive positioning, then maintenance of the new posture.
14. Withdrawal
Refusal to eat, drink, and/or make eye contact.
15. Impulsivity
Sudden, inexplicable, non-goal-directed acts.
16. Automatic obedience
Exaggerated cooperation with, or continuation of, a requested movement.
17. Mitgehen
"Anglepoise lamp" arm raising in response to light pressure, despite instruction to the contrary.
18. Gegenhalten
Resistance to passive movement proportional to the force applied, seemingly involuntary.
19. Ambitendency
Patient appears motorically "stuck" in indecisive, hesitant movements.
20. Grasp reflex
Elicited on neurologic examination.
21. Perseveration
Repeatedly returns to the same topic or movement.
22. Combativeness
Usually undirected, without apparent explanation.
23. Autonomic abnormality
Abnormal temperature, blood pressure, pulse, respiratory rate, or diaphoresis.
Result0 points
Screening negative (0 of 14 screening items present; ≥2 required for catatonia).
- Screening items positive (of 14)
- 0
- Total severity score
- 0 / 69
When to use
- Screening for catatonia in psychiatric, medically ill, or delirious patients with unexplained stupor, excitement, or motor abnormality.
- Quantifying catatonia severity and monitoring response to benzodiazepines or ECT.
Formula
Items 1-14 form the screening instrument; ≥2 items scored >0 for ≥24 hours meets criteria for catatonia. All 23 items are rated 0 (absent) to 3 (constant/severe) for a total severity score of 0-69.
Pearls and pitfalls
- A positive lorazepam challenge (marked reduction in signs after 1-2 mg IV/IM) supports the diagnosis and can guide treatment.
- Catatonia can complicate mood disorders, psychosis, autoimmune/encephalitic illness, and general medical conditions - assess for an underlying cause.