First Psychiatric Hospitalization for Suicide Attempt in a 75-Year-Old Man With Behavioral Variant Frontotemporal Dementia and Remarkable Response to Electroconvulsive Therapy

Behavioral variant frontotemporal dementia (bvFTD) may present with prominent behavioral symptoms while neuroimaging remains normal in early stages, making diagnosis challenging. We report a 75-year-old man with no prior psychiatric history admitted after repeated suicidal gestures. Over the preceding year, he developed progressive behavioral changes including disinhibition, impulsivity, loss of empathy, stereotyped speech, and hyperorality. Neurocognitive testing prior to electroconvulsive therapy (ECT) revealed marked cognitive deficits (Mini-Mental State Examination [MMSE] 17/30) and comprehensive neuropsychological impairments in executive functions and social cognition consistent with bvFTD. Despite nonspecific MRI and FDG-PET findings, FTDC 2011 criteria for probable bvFTD were met. Severe affective instability and suicidal intent persisted despite multiple pharmacologic treatments. After 15 ECT sessions combined with pharmacotherapy—following an anesthetic adjustment for a peri-procedural asystole—suicidal ideation remitted, mood stabilized, and functional recovery was achieved without cognitive deterioration. This case supports the potential safety and effectiveness of ECT for severe mood disturbances in bvFTD.