Clinical case discussion major depressive disorder with psychotic features may lead to misdiagnosis of dementia

A case report and review of the literature

Gerhardt S. Wagner, Shawn M. Mcclintock, Peter B. Rosenquist, W. Vaughn McCall, David A. Kahn

Research output: Contribution to journalReview article

8 Citations (Scopus)

Abstract

Major depressive disorder (MDD) with psychotic features is relatively frequent in patients with greater depressive symptom severity and is associated with a poorer course of illness and greater 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, Second Edition (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 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, the 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 and the DRS-2 in patients with MDD with psychotic features may in some cases produce false-positive indications of dementia.

Original languageEnglish (US)
Pages (from-to)432-438
Number of pages7
JournalJournal of Psychiatric Practice
Volume17
Issue number6
DOIs
StatePublished - Nov 1 2011

Fingerprint

Major Depressive Disorder
Diagnostic Errors
Dementia
Electroconvulsive Therapy
Depression
Psychotic Affective Disorders
Mentally Ill Persons
Therapeutics
Mood Disorders
Research
Cognition
Cognitive Dysfunction

Keywords

  • Dementia
  • Dementia Rating Scale
  • Major depressive disorder
  • Mini-Mental State Examination
  • Pseudodementia
  • Psychotic features

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Clinical case discussion major depressive disorder with psychotic features may lead to misdiagnosis of dementia : A case report and review of the literature. / Wagner, Gerhardt S.; Mcclintock, Shawn M.; Rosenquist, Peter B.; McCall, W. Vaughn; Kahn, David A.

In: Journal of Psychiatric Practice, Vol. 17, No. 6, 01.11.2011, p. 432-438.

Research output: Contribution to journalReview article

@article{8aab5a9731f74d67a786b10a02404ef7,
title = "Clinical case discussion major depressive disorder with psychotic features may lead to misdiagnosis of dementia: A case report and review of the literature",
abstract = "Major depressive disorder (MDD) with psychotic features is relatively frequent in patients with greater depressive symptom severity and is associated with a poorer course of illness and greater 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, Second Edition (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 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, the 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 and the DRS-2 in patients with MDD with psychotic features may in some cases produce false-positive indications of dementia.",
keywords = "Dementia, Dementia Rating Scale, Major depressive disorder, Mini-Mental State Examination, Pseudodementia, Psychotic features",
author = "Wagner, {Gerhardt S.} and Mcclintock, {Shawn M.} and Rosenquist, {Peter B.} and McCall, {W. Vaughn} and Kahn, {David A.}",
year = "2011",
month = "11",
day = "1",
doi = "10.1097/01.pra.0000407968.57475.ab",
language = "English (US)",
volume = "17",
pages = "432--438",
journal = "Journal of Psychiatric Practice",
issn = "1527-4160",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Clinical case discussion major depressive disorder with psychotic features may lead to misdiagnosis of dementia

T2 - A case report and review of the literature

AU - Wagner, Gerhardt S.

AU - Mcclintock, Shawn M.

AU - Rosenquist, Peter B.

AU - McCall, W. Vaughn

AU - Kahn, David A.

PY - 2011/11/1

Y1 - 2011/11/1

N2 - Major depressive disorder (MDD) with psychotic features is relatively frequent in patients with greater depressive symptom severity and is associated with a poorer course of illness and greater 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, Second Edition (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 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, the 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 and the DRS-2 in patients with MDD with psychotic features may in some cases produce false-positive indications of dementia.

AB - Major depressive disorder (MDD) with psychotic features is relatively frequent in patients with greater depressive symptom severity and is associated with a poorer course of illness and greater 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, Second Edition (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 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, the 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 and the DRS-2 in patients with MDD with psychotic features may in some cases produce false-positive indications of dementia.

KW - Dementia

KW - Dementia Rating Scale

KW - Major depressive disorder

KW - Mini-Mental State Examination

KW - Pseudodementia

KW - Psychotic features

UR - http://www.scopus.com/inward/record.url?scp=84856494424&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84856494424&partnerID=8YFLogxK

U2 - 10.1097/01.pra.0000407968.57475.ab

DO - 10.1097/01.pra.0000407968.57475.ab

M3 - Review article

VL - 17

SP - 432

EP - 438

JO - Journal of Psychiatric Practice

JF - Journal of Psychiatric Practice

SN - 1527-4160

IS - 6

ER -