Bush-Francis Catatonia Rating Scale (BFCRS)

Bush-Francis Catatonia Rating Scale

This interactive scale helps assess the presence and severity of catatonic signs based on the BFCRS. Rate each item based on observation and examination.

1. Excitement Extreme, non-purposeful hyperactivity, constant motor unrest (not akathisia).
2. Immobility/Stupor Extreme hypoactivity, minimal response to stimuli, immobile.
3. Mutism Verbally unresponsive or minimally responsive.
4. Staring Fixed gaze, little/no visual scanning, decreased blinking.
5. Posturing/Catalepsy Spontaneous or passive maintenance of posture(s) against gravity.
6. Grimacing Maintenance of odd or exaggerated facial expressions.
7. Echopraxia/Echolalia Mimicking examiner’s movements (echopraxia) or speech (echolalia).
8. Stereotypy Repetitive, non-goal-directed motor activity (e.g., finger-play, rubbing).
9. Mannerisms Odd, purposeful movements or exaggerated caricatures of normal actions.
10. Verbigeration Repetition of phrases or sentences like a scratched record.
11. Rigidity Maintenance of rigid position despite efforts to move (exclude cogwheeling).
12. Negativism Apparently motiveless resistance to instructions or external stimuli.
13. Waxy Flexibility Initial resistance followed by yielding to passive movement like a candle.
14. Withdrawal Refusal to eat, drink, or make eye contact.
15. Impulsivity Sudden, inappropriate behaviors without provocation (e.g., running, screaming).
16. Automatic Obedience Exaggerated cooperation or continuation of requested movement.
17. Mitgehen “Anglepoise lamp” arm raising despite contrary instructions.
18. Gegenhalten Resistance proportional to force applied during passive movement.
19. Ambitendency Appearing motorically “stuck” in indecisive, hesitant movement.
20. Grasp Reflex Primitive grasp reflex present on neurological exam.
21. Perseveration Repeatedly returning to the same topic or persisting with movement.
22. Combativeness Undirected striking out or aggression, often with facile explanation.
23. Autonomic Abnormality Abnormal vital signs (Temp, BP, Pulse, Resp Rate) or diaphoresis. Score by number of abnormal parameters.

BFCRS Score

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Total Score

All Scales