Bush-Francis Catatonia Rating Scale (BFCRS)

The Bush-Francis Catatonia Rating Scale (BFCRS) is a clinical assessment tool designed to identify and quantify the severity of catatonia. Catatonia is a neuropsychiatric syndrome characterised by a range of motor, behavioural, and affective abnormalities. It’s often associated with various psychiatric and medical conditions, such as schizophrenia, mood disorders, and neurological disorders.

The BFCRS is divided into two parts:

1. Screening Instrument: This consists of 14 items, each describing a specific symptom of catatonia. These items include:

• Immobility/stupor: Lack of spontaneous movement or interaction with the environment.
• Mutism: Reduced or absent verbal response.
• Staring: Fixed gaze with reduced blink rate.
• Posturing: Voluntary assumption of inappropriate or bizarre postures.
• Grimacing: Distorted, often grotesque facial expressions.
• Echopraxia: Mimicking another’s movements.
• Echolalia: Repeating another’s words.
• Negativism: Opposition or no response to instructions or external stimuli.
• Waxy flexibility: Slight, even resistance to positioning by examiner.
• Withdrawal: Refusal of food or drink, leading to nutritional problems.
• Excitement: Purposeless and excessive motor activity.
• Impulsivity: Sudden, unprovoked actions.
• Automatic obedience: Exaggerated cooperation with the examiner.
• Combativeness: Aggressive, violent behaviour. Each symptom is rated on a scale from 0 to 3 (0 = absent, 1 = mild, 2 = moderate, 3 = severe). A total score of 2 or more indicates a positive screening for catatonia.

2. Rating Scale: This is an expanded version with 23 items, encompassing the original 14 plus additional symptoms like stereotypy, mannerism, verbigeration, rigidity, and others. The rating scale is more comprehensive and is used to assess the severity and response to treatment.

The Bush-Francis Catatonia Rating Scale (BFCRS) is a valuable tool in both diagnosing catatonia and monitoring its treatment. It helps clinicians to systematically evaluate the presence and severity of catatonic symptoms, which can be crucial for effective management and treatment planning. It’s important to note, however, that a thorough clinical evaluation should accompany the use of this scale, as catatonia can be a complex and multifaceted condition.