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The Bush- Francis Catatonia Rating Scale (BFCRS) is a standardised, quantifiable examination of catatonia designed to screen and diagnose. Page 1. Page 2. The aim of the present study was to examine the suitability and accuracy of using the Bush-Francis Catatonia Rating Scale (BFCRS) in chronic schizophrenia.

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Rating catatonia in patients with chronic schizophrenia: Catatonic signs and symptoms are frequently observed in patients with chronic schizophrenia. Clinical surveys have suggested that the composition of catatonic syndrome occurring in chronic schizophrenia may be different from what is found in acute psychiatric disorders or medical conditions.

Consequently, nush patient population may need tailor-made rating instruments for catatonia. The unidimensionality optimal number of items; item fitand the scoring scheme the optimal number of scoring categories of the BFCRS were determined in a random sample of patients with chronic schizophrenia applying Rasch analysis.

In addition, differential item functioning DIF analysis was also scals. BFCRS-R is shorter and simpler than the original version and having better psychometric properties seems to be better suited for identifying and quantifying catatonia in chronic psychotic patients. Factor analysis of the catatonia rating scale and catatonic symptom distribution across four diagnostic groups. Catatonia is a frequent psychomotor syndrome, which has received increasing recognition over the last decade.

The assessment of the catatonic syndrome requires systematic rating scales that cover the complex spectrum of catatonic motor signs and behaviors.

Bush-Francis Catatonia Rating Scale (BFCRS) – PsychTools

The Catatonia Rating Scale CRS is such an instrument, which has been validated and which has undergone extensive reliability testing. In the present study, to further validate the CRS, the items composing this scale were submitted to principal components factor extraction followed by a varimax rotation. Four factors were extracted, which accounted for The ANOVA revealed that each of the groups showed a distinctive catatonic symptom pattern and that the overlap between diagnostic groups was minimal.

We conclude that this four-factor symptom structure of catatonia challenges the current conceptualization, which proposes only two symptom subtypes. Semantic equivalence processes included four steps: Validation consisted of simultaneous applications of the instrument in Portuguese by two examiners in 30 catatonic and 30 non-catatonic patients.

Total scores averaged catatomia Overall values of inter-rater reliability of bushh instruments were 0. The scale ‘s version in Portuguese proved to be valid and was able to distinguish between catatonic and non-catatonic patients. It was also reliable, with inter-evaluator reliability indexes as high as those of the original instrument.

A validated instrument for measuring catatonic symptoms]. The clinical picture catatoina catatonia includes impressive motor phenomena, such as rigidity, dyskinesia, festination, negativism, posturing, catalepsy, stereotypies and mannerisms, along with affective e.

In English speaking countries seven catatonia rating scales have been introduced, which are widely used in clinical and scientific practice. In contrast, only one validated catatonia rating scale is available in Germany so far. Factor analysis of the NCRS revealed four domains: In conclusion, the NCRS-dv represents a second validated instrument which can be used by German clinicians and scientists for the assessment of catatonic symptoms.

In the new classification of the DSM-V, catatonia is individualized as a disease of its own. It is defined by presence of at least two out of five criteria: The priority is to look first for organic causes: Intoxication may also be found illegal drugs or medicationand the role of neuroleptic malignant syndrome in catatonia remains unclear.


Among the psychiatric causes, first come bipolar disorders, especially mania; then schizophrenia. Idiopathic forms can also be observed.

Epidemiological work on catatonia show highly variable results, highlighting a possible underestimation of the diagnosis. Among the differential diagnoses, which are rare motor syndromes, neuroleptic malignant syndrome and serotonin syndrome are also discussed.

The diagnosis of catatonia is clinical and can be obtained using standardized diagnostic scales. The use of zolpidem provides both a diagnostic and therapeutic guidance for the degree of response to drug treatment. The physiopathological hypotheses describe an intracerebral GABAergic, dopaminergic and glutamatergic dysfunction in catatonic patients. The complete mechanisms are still partly unknown. Benzodiazepines are the first treatment of choice. Electroconvulsive therapy is used secondarily or in severe cases.

First-generation antipsychotics are prohibited, at the risk of worsening the catatonia in becoming malignant and lethal. The renewed interest in the catatonic syndrome during the past recent years has expanded research on the mechanisms of this syndrome and opened the way to new therapeutic catatoniz.

The latest works tend to modulate the strict prohibition of antipsychotic in a catatonic patient. One of the most exciting psychiatric conditions is the bizarre psychomotor syndrome called catatoniawhich may present with a large number of different motor signs and even vegetative instability. Catatonia is potentially life threatening. The use of benzodiazepines and electroconvulsive therapy ECT has been efficient in the majority of patients.

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The rich clinical literature of the past has attempted to capture the nature of catatonia. But the lack of diagnostic clarity and operationalization has hampered research on catatonia for a long time. Within the last decades, it became clear that catatonia had to sca,e separated from schizophrenia, which was finally accomplished in the Diagnostic and Statistical Manual of Mental Catwtonia, Fifth Edition DSM In DSM-5, catatonia syndrome may be diagnosed as a specifier to major mood disorders, psychotic disorders, general medical conditions, and as catatonia not otherwise specified.

Ratign allows diagnosing the syndrome in a large variety of psychiatric disorders. Currently, the pathobiology remains widely unknown. Suspected neurotransmitter systems include gamma-aminobutyric acid GABA and glutamate.

Neuroimaging reports pointed to reduced resting state activity and reduced task activation in motor areas of the ratinng and parietal cortex. The new classification of catatonia will foster more clinical research and neuroscientific approaches by testing catatonia in various populations and applying stringent criteria. The scarce number of prospective trials will hopefully increase, as more trials will be encouraged within a more precise concept of catatonia. Catatonia is a neuropsychiatric syndrome characterized by dysregulation of the motor system.

It is associated with affective disorders, psychosis, and a number of somatic conditions. The condition tends to be undertreated due to under-recognition. This is unfortunate, because various cheap and ratnig treatment methods are widely available. In this clinical lesson, we present case studies of three patients francix schizophrenia and severe catatonic symptoms. They were all treated with lorazepam, in dosages ranging from 2 to 60 mg a day, following which they achieved full remission of their catatonic symptoms.

We recommend being alert for catatonia in patients with or without a psychiatric disorder. Early recognition and treatment is vital for the quality of life of these patients, and may in some cases be life-saving. In addition, we recommend a thorough analysis of possible underlying somatic disorders. Amisulpride Augmentation in Acute Catatonia.

The Detection and Measurement of Catatonia

Benzodiazepines are the first-line treatment of catatoniabut a substantial number of patients do not respond to them. Amisulpride is one of the atypical antipsychotic that has been effective for negative symptoms of schizophrenia.


We examined the effect of augmentation of oral low doses of amisulpride with lorazepam on resolution of catatonic symptoms. Fifteen patients with catatonia were treated with a combination of oral lorazepam mg with amisulpride mg. Catatonic symptoms were rated using the Bush Francis Catatonia Rating Scale at the baseline and daily thereafter. There was complete resolution of catatonic symptoms on the third day in all patients. A comparative study of “Idiopathic catatonia ” with catatonia in schizophrenia.

Catatonia has been defined as a cluster of signs and occurs secondary to or as a subgroup of schizophrenia, mood disorders or organic syndrome. This study specifically examined the distinct variety of catatonia that did not meet any standard psychiatric diagnostic criteria on globally recognised psychiatric rating tools and compared the clinical features with the catatonia that occurred in association with a diagnosis of schizophrenia.

The inpatients in a tertiary psychiatric ward in Ahmedabad, India, between and who presented with two or more catatonic signs present for more than 24h period were assessed on Structured Clinical Interview for DSM IV tool.

The study also supports the current concept that there does exists, a distinct variety of catatonia that probably has its own course and prognosis, which need further consideration and more studies to explore this. Published by Elsevier B. Catatonia in inpatients with psychiatric disorders: A comparison of schizophrenia and mood disorders. This study aimed scsle evaluate the symptom threshold for making the diagnosis of catatonia. Further the objectives were to 1 to study the factor solution of Bush Francis Catatonia Rating Scale BFCRS ; 2 To compare the prevalence and symptom profile of catatonia in patients with psychotic and mood disorders among patients admitted to the psychiatry inpatient of a general hospital psychiatric unit.

By using cluster analysis, discriminant analysis, ROC curve, sensitivity and specificity analysis, data suggested that a threshold of 3 symptoms was able to correctly categorize Prevalence of catatonia was 9. There was no difference in the prevalence rate and symptom profile of catatonia between those with schizophrenia and mood disorders i.

Factor analysis of the data yielded 2 factor solutions, i. To conclude this study suggests that presence of 3 symptoms for making the diagnosis of catatonia can correctly distinguish patients with and without catatonia. This is compatible with ecale recommendations of DSM Prevalence of catatonia is almost equal in patients with schizophrenia and mood disorders. A Clinical Review of the Treatment of Catatonia. At times, gating is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances.

Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia Rating Scalecan guide the clinician through the neuropsychiatric examination.

Frontiers | Prevalence of the Catatonic Syndrome in an Acute Inpatient Sample | Psychiatry

Although severe and life-threatening, catatonia has a good prognosis. Research on the treatment of catatonia is scarce, but there is overwhelming clinical evidence of the efficacy catatnoia benzodiazepines, such as lorazepam, and electroconvulsive therapy.

Catatonia is the psychiatric syndrome of disturbed motor functions amid disturbances in mood and thought first described in After it was tied to schizophrenia as a type in the psychiatric classification, its recognition became increasingly limited and by the s questions were asked as to where the catatonics had gone.