Recovery from catatonia follows a hierarchical precision order
- 1Department of Neuropsychiatry, Graduate School of Medicine, Nippon Medical School, Onda-daini Hospital
Abstract
When benzodiazepines fail in catatonia, clinicians know what to escalate to but not what to stabilize first. We asked a narrower question that clinical records can address: does recovery follow a fixed order? We defined five capacities in plain clinical terms and mapped them onto precision domains of hierarchical inference. The domains are theory-derived clinical abstractions, not latent variables estimated from these data. In 25 consecutive inpatients managed without electroconvulsive therapy, an order fixed before coding held without inversion in every patient, and held again when a hypothesis-blind co-author re-rated all milestones according to a pre-registered protocol. In five patients the sequence was completed while hallucinations and delusions persisted, so the order does not follow the resolution of psychotic symptoms. Bush-Francis scores fell from 26.3 to 2.0. This retrospective study shows that the order held, not why. Prospective studies, preferably with blinded daily rating, are needed to corroborate the order.
Related
- Catatonia recovery separates two intervention axes that constrain electroconvulsive therapy
- Persistent Alzheimer-related molecular dysregulation after cerebral ischemia: a hierarchical-circular hypothesis of impaired allostatic recovery
- Oral microalgae-ROS-responsive hierarchical targeting delivery system for precision therapy of ulcerative colitis.
- Enhanced Recovery After Surgery (ERAS) in Cardiac Surgery: From Evidence to Precision Perioperative Medicine
- Beyond IHC-Vicariation duality: precision-stratified rTMS for post-stroke motor recovery
BibTeX
@misc{saito2026recovery,
title = {{Recovery from catatonia follows a hierarchical precision order}},
author = {H. Saito and Y. Takizawa and I. Murata and A. Tateno and J. Theorell and R. Arakawa and M. Tiger},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.13.26360194},
url = {https://www.medrxiv.org/content/10.64898/2026.08.13.26360194v2},
note = {CC BY},
}
RIS
TY - UNPB
TI - Recovery from catatonia follows a hierarchical precision order
AU - H. Saito
AU - Y. Takizawa
AU - I. Murata
AU - A. Tateno
AU - J. Theorell
AU - R. Arakawa
AU - M. Tiger
PY - 2026
DA - 2026/08/13
PB - medRxiv
DO - 10.64898/2026.08.13.26360194
UR - https://www.medrxiv.org/content/10.64898/2026.08.13.26360194v2
AB - When benzodiazepines fail in catatonia, clinicians know what to escalate to but not what to stabilize first. We asked a narrower question that clinical records can address: does recovery follow a fixed order? We defined five capacities in plain clinical terms and mapped them onto precision domains of hierarchical inference. The domains are theory-derived clinical abstractions, not latent variables estimated from these data. In 25 consecutive inpatients managed without electroconvulsive therapy, an order fixed before coding held without inversion in every patient, and held again when a hypothesis-blind co-author re-rated all milestones according to a pre-registered protocol. In five patients the sequence was completed while hallucinations and delusions persisted, so the order does not follow the resolution of psychotic symptoms. Bush-Francis scores fell from 26.3 to 2.0. This retrospective study shows that the order held, not why. Prospective studies, preferably with blinded daily rating, are needed to corroborate the order.
ER -