Major depressive disorder (MDD) with psychotic features is relatively frequent among patients with greater depressive symptom severity and is associated with a poorer course of illness and more functional impairment than MDD without psychotic features. Multiple studies have found that patients with psychotic mood disorders demonstrate significantly poorer cognitive performance in a variety of areas than those with nonpsychotic mood disorders. The Mini Mental State Examination (MMSE) and the Dementia Rating Scale (DRS-2) are widely used to measure cognitive functions in research on MDD with psychotic features. Established total raw score cut-offs of 24 on the MMSE and of 137 on the DRS-2 in published manuals suggest possible global cognitive impairment and dementia, respectively. Limited research is available on these suggested cut-offs for patients with MDD with psychotic features. We document the therapeutic benefit of electroconvulsive therapy (ECT), which is usually associated with short-term cognitive impairment, in a 68-year-old woman with psychotic depression whose MMSE and DRS-2 scores initially suggested possible global cognitive impairment and dementia. Over the course of four ECT treatments, this patient’s MMSE scores progressively increased. After the second ECT treatment, the patient no longer met criteria for global cognitive impairment. With each treatment, depression severity, measured by the 24-item Hamilton Rating Scale for Depression, improved sequentially. Thus, the suggested cut-off scores for the MMSE or DRS-2 in patients with MDD with psychotic features may in some cases produce false-positive indications of dementia.

Electroconvulsive therapy (ECT) is a highly effective treatment for certain psychiatric disorders with relatively few serious side effects or complications. Tardive seizures are one of these rare, but potentially fatal complications. Recognizing and treating tardive seizures is essential to prevent prolonged postictal confusion, progression to status epilepticus and associated soft tissue injury, anoxia, aspiration and death. Currently there is an unknown prevalence of their occurrence and an overall lack of clinical description of their phenomenology. We describe a case in which a patient develops a tardive seizure followed by a receptive and expressive aphasia, thought to be a variant of Todd’s postictal paralysis. This case is further unique in that there was a lateralization of a motor seizure presumably to the hemisphere contralateral to the RUL electrode placement.