Think You Know How to Spot Catatonia? Let’s Talk About That

Published 25 years ago, the Bush-Francis Catatonia Rating Scale (BFCRS)¹ has become the most commonly used instrument to identify and score catatonia in both clinical practice and research. In this session, we will explore catatonia assessment by providing a practical review of the BFCRS and its items.



The original BFCRS publication included a brief standardized exam to elicit key features on the scale.¹

1. Dr. Francis (15-20 min) will provide an overview of the scale and discuss its initial development. He will also review evidence on the inter-rater reliability of the BFCRS when used in structured research settings.



One factor contributing to catatonia’s underdiagnosis² is limited awareness.³ To address this, Drs. Wortzel and Oldham collaborated with Dr. Francis to create the BFCRS Training Manual and Coding Guide along with a comprehensive educational module on catatonia assessment (available online⁴). In Oct-Nov 2020, invitations for this IRB-approved online training were sent to ACLP members and to the Listservs of the American Association of Directors of Psychiatry Residency Training and the Association of Directors of Medical Student Education in Psychiatry. The module includes a 50-item multiple-choice test and a standardized patient video depicting catatonia for BFCRS scoring.

2. Dr. Wortzel (15-20 min) will review the results from 482 pre-tests (193 psychiatrists, 252 residents and fellows, 37 medical students). Participants correctly answered only 55% of test items and identified 69% of BFCRS items correctly. After adjusting for demographics, multivariable regression found that, compared to medical students, psychiatrists scored 7 points higher on multiple-choice and identified only 2 more items correctly on the BFCRS.

3. Dr. Oldham (15-20 min) will provide an overview of the BFCRS Training Manual and Coding Guide. He will focus on identifying the items most commonly misidentified on pre-tests (e.g., posturing/catalepsy, negativism, rigidity, mannerisms).



Acute medical settings introduce further complexity to assessing catatonia,⁵ and evaluating for catatonia in patients who have acute encephalopathy (i.e., with delirium or coma)⁶ can be especially challenging.

4. Dr. Wilson (15-20 min) will discuss the challenges to catatonia assessment and review approaches to scoring the BFCRS in this patient population. She will also review common symptom clusters in critical illness.



Panel discussion with Q&A (up to 25 min)



¹Bush. Catatonia. I. Acta Psychiatrica Scandinavica. 1996.

²Van der Heijden. Catatonia. Psychopathology. 2005.

³Cooper. Catatonia education. Academic Psychiatry. 2017.

⁴bfcrs.urmc.edu

⁵Wilson. Delirium and catatonia in critically ill patients. Crit Care Med. 2017.

⁶Slooter. Updated nomenclature. Intensive Care Med. 2020.