Bush-Francis Catatonia Rating Scale

Observe patient for excessive, non-purposeful motor activity. Look for constant movement that appears driven but lacks clear goal or purpose. Differentiate from akathisia or purposeful agitation.

Assess patient's level of activity and responsiveness. Note duration of immobility and response to various stimuli (verbal, tactile). Document any periods of complete lack of movement.

Attempt conversation with patient using various topics and question styles. Count actual verbal responses over a 5-minute period. Note any whispered, mumbled, or minimal vocalizations.

Observe patient's eye contact and blinking patterns. Note if gaze appears fixed, distant, or unresponsive. Count blink rate and assess eye appearance.

Observe patient's body position and limb placement. Test for waxy flexibility by gently moving limbs and noting if position is maintained. Look for uncomfortable or unusual postures.

Observe facial expressions during interview. Note any distorted, inappropriate, or uncomfortable-appearing facial movements or expressions.

Make simple gestures or movements and observe if patient copies them. Speak phrases and note if patient repeats words or phrases back to you.

Observe for repetitive movements that serve no apparent purpose. Note frequency and duration of repetitive behaviors.

Observe patient's movements and gestures. Look for exaggerated, peculiar, or stylized versions of normal behaviors.

Listen for repetitive speech patterns, phrases, or words that are repeated without apparent purpose or meaning.

Test muscle tone by passively moving patient's limbs. Look for sustained resistance throughout range of motion. Exclude parkinsonian rigidity.

Give simple commands and observe response. Note active resistance or complete lack of response to reasonable requests.

Gently move patient's arms or legs into different positions. Note if limbs remain in the position placed with a waxy, moldable quality.

Assess overall level of consciousness and environmental engagement. Note absence of goal-directed behavior or environmental interaction.

Give simple commands and observe for excessive compliance or continuation of movements beyond what was requested.

Instruct patient to resist movement, then apply light pressure to move limb or body. Note if patient moves despite instruction to resist.

Apply varying degrees of pressure when moving patient's limbs. Note if resistance increases proportionally to your effort.

Observe patient's movements for hesitation, starting and stopping, or appearing "stuck" between conflicting motor impulses.

Place your fingers in patient's palm and apply gentle pressure. Note if patient reflexively grasps your hand.

Note if patient continues responses or movements beyond what is appropriate for the situation.

Note any aggressive or combative behavior, particularly when approached or during examination attempts.

Check vital signs including temperature, blood pressure, heart rate, and respiratory rate. Note any significant abnormalities.

Assess patient's willingness to engage in basic activities like eating, drinking, or making eye contact. Note level of social withdrawal.