This is an unprecedented time. It is the dedication of healthcare workers that will lead us through this crisis. Thank you for everything you do.

      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

    Disease

    Select...

    Specialty

    Select...

    Chief Complaint

    Select...

    Organ System

    Select...

    Patent Pending

    Bush-Francis Catatonia Rating Scale

    Assesses severity of catatonia.
    Favorite
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with or without psychiatric history with characteristic symptoms of catatonia (e.g. altered consciousness, abnormal motor behavior).

    • The most common symptoms of catatonia, which can be considered “red flags” to trigger use of this scale, include staring, mutism, and immobility.

    • May be used both for initial diagnosis and to monitor treatment response. 

    • The full scale is 23 items, with the first 14 questions comprising the screening instrument (Bush-Francis Catatonia Screening Instrument). If ≥2 of the first 14 questions are positive, this indicates a positive screening and should prompt completion of 9 additional items for a total of 23 items (Bush-Francis Catatonia Rating Scale).

    • Takes roughly five minutes to complete. 

    • Many scale items require understanding of traditional psychiatric terminology and how to test them, such as the following:

      • Echopraxia: the provider will need to perform a dramaticized movement such as scratching their head. 

      • Automatic obedience: the provider will need to provide a command that people would not typically follow, such as “stick out your tongue, I'm going to put a pin in it.”

    Catatonia may be hypokinetic or hyperkinetic and occur in psychotic, affective, and general medical conditions. It is commonly underdiagnosed and undertreated. This scale can help identify this syndrome in daily practice, as well as rate the severity of catatonia and monitor response to treatment.

    Screening questions: if ≥2 are positive, full scale should be completed
    Absent
    0
    Excessive motion; intermittent
    +1
    Constant motion; hyperkinetic without rest periods
    +2
    Full-blown catatonic excitement; endless frenzied motor activity
    +3
    Absent
    0
    Sits abnormally still; may interact briefly
    +1
    Virtually no interaction with external world
    +2
    Stuporous; non-reactive to painful stimuli
    +3
    Absent
    0
    Verbally unresponsive to majority of questions; incomprehensible whisper
    +1
    Speaks <20 words per 5 min
    +2
    No speech
    +3
    Absent
    0
    Poor eye contact; repeatedly gazes <20 sec between shifting of attention; decreased blinking
    +1
    Gaze held longer than 20 sec; occasionally shifts attention
    +2
    Fixed gaze; non-reactive
    +3
    Absent
    0
    <1 min
    +1
    >1 min to <15 min
    +2
    Bizarre posture, or mundane >15 min
    +3
    Absent
    0
    <10 sec
    +1
    <1 min
    +2
    Bizarre expression(s) or maintained >1 min
    +3
    Absent
    0
    Occasional
    +1
    Frequent
    +2
    Constant
    +3
    Absent
    0
    Occasional
    +1
    Frequent
    +2
    Constant
    +3
    Absent
    0
    Occasional
    +1
    Frequent
    +2
    Constant
    +3
    Absent
    0
    Occasional
    +1
    Frequent; difficult to interrupt
    +2
    Constant
    +3
    Absent
    0
    Mild resistance
    +1
    Moderate
    +2
    Severe; cannot be repostured
    +3
    Absent
    0
    Mild resistance and/or occasionally contrary
    +1
    Moderate resistance and/or frequently contrary
    +2
    Severe resistance and/or continually contrary
    +3
    Absent
    0
    Present
    +3
    Absent
    0
    Minimal PO intake/interaction for <1 day
    +1
    Minimal PO intake/interaction for >1 day
    +2
    No PO intake/interaction for ≥1 day
    +3

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Management

    First line management for catatonia is a trial of lorazepam, which may be given PO, IM, or IV depending on the patient’s condition (IV having the quickest response time). An accurate lorazepam trial is given as 1-2 mg, then response is monitored over three hours. If there is no response and no adverse effects, such as respiratory depression, sedation, or further impaired consciousness, then another lorazepam dose can be given with response monitored over 3 hours. Decrease in the Bush-Francis Catatonia Rating Scale by 50% indicates positive treatment response (Rasmussen 2016).

    Critical Actions

    Monitor for respiratory depression, sedation, or further impairment in consciousness during medication management of catatonia.

    Content Contributors
    • Brandi Karnes, MD
    Reviewed By
    • Tyler Kimm, MD
    • Vineeth John, MD
    About the Creator
    Dr. Andrew Francis
    Are you Dr. Andrew Francis?
    Dr. George Bush
    Are you Dr. George Bush?
    Content Contributors
    • Brandi Karnes, MD
    Reviewed By
    • Tyler Kimm, MD
    • Vineeth John, MD