Introduction

Catatonia is a serious yet often underdiagnosed neuropsychiatric condition marked by disturbances in motor behavior, speech, and responsiveness. Despite its clinical significance, limited tools exist for reliably assessing catatonia outside traditional in-person psychiatric evaluations. The need for remote and standardized assessment tools is urgent in underserved areas where face-to-face consultations may not be feasible. The Bush-Francis Catatonia Rating Scale (BFCRS) [Bush, et al. Acta Psychiatrica Scandinavica, 1996;93:129-136] offers a structured, validated approach to quantifying catatonia symptoms that may be adaptable for remote use.

Methods

As part of an ongoing project [Kadubandi, et al. Development of a rating instrument to identify catatonia by virtual viewing of motor assessments. Zenodo, V3, 2025. https://doi.org/10.5281/zenodo.16061703], a team of eight raters trained in the BFCRS independently viewed and scored videos of motor assessment of a male identified only by age and sex. All assessments were based solely on observed motor behavior. Consensus discussions to agree on a score for each item were conducted after individual ratings were submitted to the organizing committee. Statistical analysis, including inter-rater reliability using Fleiss’ Kappa, was conducted using R software.

Results

Six separate assessments were conducted across five video sessions. Each of the seven raters independently scored 23 BFCRS items. Fleiss' Kappa was used to evaluate inter-rater reliability. The calculated Fleiss’ Kappa values across the six assessments were 0.375, 0.556, 0.576, 0.667, 0.590, and 0.578. The average Fleiss’ Kappa was 0.557, indicating moderate inter-rater agreement, which supports the reliability of the BFCRS when used remotely.

Conclusions

The preliminary application of the BFCRS in a remote assessment framework suggests potential for standardizing catatonia evaluations beyond traditional settings. If validated by further statistical analysis, this approach could improve access to timely diagnosis and intervention, particularly in areas with limited psychiatric resources.