"Mrs. R" is a 77-year-old woman with bipolar disorder, hypothyroidism, coronary artery disease, and known left bundle branch block since at least 2003. From 2003 to 2010, her QTc ranged from 436 to 551 msec. Mrs. R's symptoms had been well controlled on haloperidol (1.5 mg), bupropion (200 mg), and mirtazapine (30 mg). Three weeks before admission to the inpatient psychiatry unit, she experienced command auditory hallucinations telling her to not eat or drink, and she became increasingly depressed and withdrawn, possibly indicating a depressive episode with psychotic features. When she was admitted, her QTc was consistently more than 490 msec, and the team discontinued haloperidol and did not add additional antipsychotics for fear of further QTc prolongation and torsade de pointes. In the absence of any antipsychotic drugs (the patient was taking only citalopram, 40 mg/day), her QTc ranged between 458 and 480 msec. As her QTc prolongation occurred with left bundle branch block and a prolonged QRS duration of 152 msec, we consulted cardiology, calculated her JTI to be normal at 102 (prolonged ≥112 msec), and started treatment with aripiprazole (2.5 mg/day). When this was combined with ECT, her auditory hallucinations diminished. Follow-up ECGs showed increased QTc with a JTI in the normal range. Mrs. R resumed eating and drinking, her functioning returned to baseline levels, and she was discharged.