The Bush Francis Catatonia Rating Scale (BFCRS) is an excellent tool to measure the severity of the various symptoms of catatonia. In an article from 2011 in the “Tijdschrift voor Psychiatrie” (Journal of Psychiatry), different scales are compared to each other, with the BFRS emerging as the gold standard (Rooseleer et al. 2011).

The BFCRS is also used for screening where an abbreviated version is used and only the presence or absence of the first 14 items is scored (De Waard et al. 2019)

There is a fixed examination procedure (appendix). Screening is positive for ≥2 symptoms for 24 hours. Screening with the BFCRS makes sense to select patients who may have catatonia. The diagnosis is made based on the clinical picture.

I object to part of the standing investigation procedure. Instruction 6 of the test says, “Automatically obey.” Put your hand in your pocket and say, “Stick out your tongue, I want to put a needle in it.” I think this is a curious test and it may increase the patient’s suspicion. “Automatic obeying” can often be clarified by a heteroanamnesis performed by nurses or third parties. Ask whether the behavior has changed when this catatonic symptoms appeared. For example, the partner may say that it is strange that the patient suddenly does exactly what is asked, which was not the case before. The same applies to the symptom ambitendency, examples of which are given in the case study in the section catatonia.

Bush Francis Catatonia Rating Scale


Bron J., de Waard-Alblas Y. & de Kuijper G. Katatonie. Tijdschrift voor Artsen voor Verstandelijk Gehandicapten. 2019. 37(2), 86-93.

Rooseleer, J., Willaert, A., & Sienaert, P. Katatonie meten: welke schaal te kiezen?. Tijdschrift voor Psychiatrie, 2011. 53(5), 287.