Other / General Medicine
Eduardo A. Acevedo-Rosario, MD
Resident Physician
Memorial Hospital System
Fort Lauderdale, Florida, United States
Margaret Sweeney, DO
Resident Physician PGY-2
Memorial Healthcare System
Miami, Florida, United States
Ariel Inocentes, MD
Medical Director
Broward Health Rehabilitation Institute
Parkland, Florida, United States
Eduardo A. Acevedo-Rosario, MD
Resident Physician
Memorial Hospital System
Fort Lauderdale, Florida, United States
ICU-associated Catatonia
A 42-year-old woman presented one week postpartum with acute dyspnea. Workup revealed multifocal pneumonia, and elevated pro-BNP. Her respiratory status deteriorated rapidly, requiring intubation and ECMO consideration. After extubation, she exhibited altered mental status with the absence of agitation or psychosis. Her condition progressed to near-complete mutism, inability to follow commands, passive induction of posture which remained held against gravity and profound motor inactivity—clinical features consistent with catatonia. She showed rapid and dramatic improvement within 24 hours of initiating diazepam, regaining speech and affect. However, she continued to experience significant generalized weakness, ataxia, dysphagia and cognitive impairments.
She was then admitted to inpatient rehabilitation, where she progressed from maximal to minimal assistance in most mobility tasks and ADL’s. Interventions were focused on gait training with load-bearing, balance and coordination retraining, cognitive therapy and ADL training.
Catatonia is a neuropsychiatric syndrome marked by a range of psychomotor disturbances, traditionally associated with psychiatric disorders, but also seen in ICU patients. It may coexist with delirium and is often underdiagnosed due to overlapping features and polypharmacy in critical care.
Diagnosis is clinical, with improved accuracy when ≥4 signs are present. Our patient met criteria with mutism, staring, catalepsy, and negativism. Benzodiazepines are the first-line treatment, often yielding dramatic responses. However, catatonia and ICU-acquired conditions (e.g., deconditioning, dysphagia, cognitive deficits) frequently result in functional impairments that persist post-resolution of the catatonic state. In such cases, rehabilitation is essential to regain independence.
This case highlights the critical role of inpatient rehabilitation in addressing multifactorial deficits following ICU-associated catatonia. Catatonia is treatable—but recovery goes beyond pharmacology. Rehabilitation bridges the gap between medical stability and functional independence. Early, targeted rehabilitation can significantly improve outcomes, especially in previously healthy individuals who must regain full function—not only for self-care, but also for parenting responsibilities.
