Frontotemporal dementia — structured clinical viva

Formulate as probable bvFTD (Rascovsky): multiple core behavioural features with progressive functional change and imaging support for frontotemporal involvement — not "treatment-resistant bipolar" until a neurodegenerative work-up is complete. Psychiatric misdiagnosis is well documented before FTD is recognised.^[1][3][7]

Genetics: paternal MND plus behavioural FTD phenotype prioritises C9orf72 expansion counselling/testing; still mention MAPT and GRN as the exam triad.^[2][7] Examine carefully for ALS-FTSD motor signs and co-manage with neurology.^[8]

Management: non-drug behavioural strategies and carer support first; limited symptomatic roles for SSRIs/trazodone; avoid routine AChEI in pure FTD; antipsychotics only if severe risk, short course, mortality counselling.^[4][5][7] Capacity is decision-specific (Appelbaum); advise on driving and finances early.^[6]