Bush-Francis Catatonia Rating Scale

Assesses catatonia severity and screens for catatonia in psychiatric and neurologic conditions.

Screening questions: if ≥2 are positive, full scale should be completed

Excitement

Extreme hyperactivity, constant motor unrest that appears non-purposeful; not attributed to akathisia or goal-directed agitation

Immobility/stupor

Extreme hypoactivity, immobile, minimally responsive to stimuli

Mutism

Verbally unresponsive or minimally responsive

Staring

Fixed gaze; little or no visual scanning of environment; decreased blinking

Posturing/catalepsy

Spontaneous maintenance of posture(s), including mundane (e.g. sitting or standing for long periods without reacting)

Grimacing

Maintenance of odd facial expressions

Echopraxia/echolalia

Mimicking of examiner’s movements/speech

Stereotypy

Repetitive, non-goal-directed motor activity (e.g. finger-play, repeatedly touching, patting, or rubbing self); abnormality not inherent in act but in its frequency

Mannerisms

Odd, purposeful movements (hopping or walking tiptoe, saluting passers-by, or exaggerated caricatures of mundane movements); abnormality inherent in act itself

Verbigeration

Repetition of phrases or sentences (like a scratched record)

Rigidity

Maintenance of a rigid position despite efforts to be moved; exclude if cog-wheeling or tremor present

Negativism

Apparently motiveless resistance to instructions or attempts to move/examine patient; contrary behavior (does exact opposite of instruction)

Waxy flexibility

During reposturing of patient, patient offers initial resistance before allowing themselves to be repositioned, similar to that of a bending candle

Withdrawal

Refusal to eat, drink, and/or make eye contact

Result:

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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.

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