BFCRS Catatonia Rating Scale: Screen and Severity

What it measures

The Bush-Francis Catatonia Rating Scale (BFCRS) is a standardized bedside examination for catatonia, rated on observed behavior. The tool has two tabs. The Catatonia Screening Instrument uses the first 14 items (immobility/stupor, mutism, staring, posturing, grimacing, echopraxia/echolalia, stereotypy, mannerisms, verbigeration, rigidity, negativism, waxy flexibility, withdrawal, and excitement), each marked present or absent. The Full Rating Scale rates all 23 items, adding impulsivity, automatic obedience, passive obedience (Mitgehen), muscle resistance (Gegenhalten), ambitendency, grasp reflex, perseveration, combativeness, and autonomic abnormality.

Scoring

The screen is positive when 2 or more of the 14 items are present. On the full scale, most items are rated 0–3, but items 12 and 17–21 are binary and scored 0 or 3 only. The total is the sum of all 23 items, from 0 to 69. Once all 23 items are rated, the tool shows a descriptive band:

Total (items 1–23)	Descriptive band
0	No catatonia detected
1–10	Mild
11–20	Moderate
21–30	Severe
31–69	Extreme

These bands are not validated cut-offs. Bush and colleagues (1996) defined the screen and the 0–69 total but no mild, moderate, or severe thresholds, so the validated decision point is the screen. The total is most useful tracked over time, for example across a lorazepam challenge.

Subtype and malignant catatonia warning

The tool compares a retarded/withdrawn group (items 1, 2, 3, 4, 10, 13) with an excited group (items 6, 7, 8, 14, 15, 22) and reports the predominant subtype, or "mixed" when they are equal. If excitement (item 14) and autonomic abnormality (item 23) are both rated above 0, it shows a warning to evaluate for malignant catatonia as a medical emergency.

What the report includes

Each tab has its own copy button. The screening report lists each of the 14 items as present or absent, the count, and the result. The full report lists each item score, the total, items present out of 23, screening items positive out of 14, the descriptive band, the subtype, any malignant catatonia warning, and scoring notes. Unrated items count as 0, so rate every item before interpreting.