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    Patent Pending

    Bush-Francis Catatonia Rating Scale

    Assesses severity of catatonia.
    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:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Andrew Francis

    About the Creator

    Andrew Francis, MD, PhD, is a professor of psychiatry at Penn State College of Medicine in Hershey, Pennsylvania. He is also the director of electroconvulsive therapy and associate director of residency training at Penn State. Dr. Francis’ primary research is focused on delirium and catatonia.

    To view Dr. Andrew Francis's publications, visit PubMed

    Are you Dr. Andrew Francis? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Dr. George Bush

    About the Creator

    George Bush, MD, is an associate professor of psychiatry at Harvard Medical School in Boston, Massachusetts. He is also the the chief medical officer of MagnetiCare TMS of Long Island. Dr. Bush’s primary research is focused on anxiety, depression, and transcranial magnetic stimulation.

    To view Dr. George Bush's publications, visit PubMed

    Are you Dr. George Bush? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    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