Bush-Francis Catatonia Rating Scale

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.