Bush-Francis Catatonia Rating Scale (BFCRS)
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1. Excitement (extreme hyperactivity, constant motor unrest apparently non-purposeful; not attributed to akathisia or goal-directed agitation)
Absent
Excessive motion, intermittent
Constant motion, hyperkinetic without rest periods
Full-blown catatonic excitement, endless frenzied motor activity
2. Immobility/stupor (extreme hypoactivity, immobile, minimally responsive to stimuli)
Absent
Sits abnormally still, may interact briefly
Virtually no interaction with external world
Stuporous, non-reactive to painful stimuli
3. Mutism (verbally unresponsive or minimally responsive)
Absent
Verbally unresponsive to majority of questions, incomprehensible whisper
Speaks < 20 words/5 min
No speech
4. Staring (fixed gaze, little or no visual scanning of environment, decreased blinking)
Absent
Poor eye contact, repeatedly gazes < 20 sec between shifting of attention, decreased blinking
Gaze held > 20 sec, occasionally shifts attention
Fixed gaze, non-reactive
5. Posturing/catalepsy (spontaneous maintenance of posture, including mundane, such as sitting or standing for long periods without reacting)
Absent
< 1 min
> 1 min to < 15 min
Bizarre posture, or mundane > 15 min
6. Grimacing (maintenance of odd facial expressions)
Absent
< 10 sec
< 1 min
Bizarre expression, or maintained > 1 min
7. Echopraxia/echolalia (mimicking of examiner's movements/speech)
Absent
Occasional
Frequent
Constant
8. Stereotypy (repetitive, non-goal-directed motor activity, such as finger-play, repeatedly touching, patting, or rubbing self; abnormality not inherent in act but in its frequency)
Absent
Occasional
Frequent
Constant
9. Mannerisms (odd, purposeful movements, such as hopping or walking tiptoe, saluting passers-by, or exaggerated caricatures of mundane movements; abnormality inherent in act itself)
Absent
Occasional
Frequent
Constant
10. Verbigeration (repetition of phrases or sentences, like a scratched record)
Absent
Occasional
Frequent, difficult to interrupt
Constant
11. Rigidity (maintenance of a rigid position despite efforts to be moved; exclude if cogwheeling or tremor is present)
Absent
Mild resistance
Moderate
Severe, cannot be repostured
12. Negativism (apparently motiveless resistance to instructions or attempts to move/examine patient; contrary behavior, does exact opposite of instruction)
Absent
Mild resistance and/or occasionally contrary
Moderate resistance and/or frequently contrary
Severe resistance and/or continually contrary
13. Waxy flexibility (during reposturing of patient, patient offers initial resistance before allowing themselves to be repositioned, similar to that of a bending candle)
Absent
Present
14. Withdrawal (refusal to eat, drink, and/or make eye contact)
Absent
Minimal oral intake/interaction for < 1 day
Minimal oral intake/interaction for > 1 day
No oral intake/interaction for ≥ 1 day
15. Impulsivity (patient suddenly engages in inappropriate behavior, such as runs down hallway, starts screaming, or takes off clothes, without provocation; afterwards can give no, or only a facile explanation)
Absent
Occasional
Frequent
Constant or not redirectable
16. Automatic obedience (exaggerated cooperation with examiner's request or spontaneous continuation of movement requested)
Absent
Occasional
Frequent
Constant
17. Mitgehen ("Anglepoise lamp" arm raising in response to light pressure of finger, despite instructions to the contrary)
Absent
Present
18. Gegenhalten (resistance to passive movement proportional to strength of the stimulus; appears automatic rather than willful)
Absent
Present
19. Ambitendency ([atient appears motorically "stuck" in indecisive, hesitant movement)
Absent
Present
20. Grasp reflex (per neurological examination)
Absent
Present
21. Perseveration (repeatedly returns to same topic or persists with movement)
Absent
Present
22. Combativeness (usually in an undirected manner, with no, or only a facile explanation afterwards)
Absent
Occasionally strikes out, low potential for injury
Frequently strikes out, moderate potential for injury
Serious danger to others
23. Autonomic abnormality (temperature, blood pressure, pulse, respiratory rate, diaphoresis)
Normal
Abnormality of 1 parameter excluding preexisting hypertension)
Abnormality of 2 parameters
Abnormality of ≥ 3 parameters
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