title: Rating catatonia in patients with chronic schizophrenia: Rasch analysis of the Bush-Francis Catatonia Rating Scale.
abstract: BACKGROUND
  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, this patient population may need tailor-made rating instruments for catatonia. 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 inpatients.
  
  
  METHODS
  The unidimensionality (optimal number of items; item fit), and the scoring scheme (the optimal number of scoring categories) of the BFCRS were determined in a random sample of 225 patients with chronic schizophrenia applying Rasch analysis. In addition, differential item functioning (DIF) analysis was also performed.
  
  
  RESULTS
  The BFCRS proved to be unidimensional apart from three misfit and one marginally misfit items. The three misfit items were removed from the scale thereby constructing a revised version called BFCRS-R. Since the original BFCRS (BFCRS-O) showed no increase across items across steep gradients (poor endorsability of step calibrations), in BFCRS-R a binary scale ('absent' versus 'present' choices only) was constructed instead of the scoring scheme of 0-3. The 20-item BFCRS-R showed improved psychometric properties in that it had a higher item separation index than BFCRS-O. BFCRS-R mean logit was closer to zero indicating that the items on the scale and the subjects were better matched than in BFCRS-O. DIF analysis showed that certain items of both versions of BFCRS were influenced by the presence of negative symptoms.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Epidemiology and Biostatistics, School of Public Health, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Eric
authors.initials: E
authors.lastname: Wong
authors.forename: Gabor S
authors.initials: GS
authors.lastname: Ungvari
authors.forename: Siu-Kau
authors.initials: SK
authors.lastname: Leung
authors.forename: Wai-Kwong
authors.initials: WK
authors.lastname: Tang
mesh_terms: D017668:Age of Onset; D002389:Catatonia / Q000175:diagnosis* / Q000453:epidemiology*; D002908:Chronic Disease; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012559:Schizophrenia / Q000453:epidemiology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires