Antipsychotics

Antipsychotics are not commonly used in FTD patients followed up in specialized memory clinics: in California research centers, only 4.5 % of FTD patients received antipsychotics, whereas antidepressants were prescribed in 43.2 % [93]. Neuroleptics such as haloperidol can have severe side effects in FTD patients. Neuroleptic hypersensitivity can range from parkinsonism [94] to neuroleptic malignant syndrome [95] and death [96]. Neuroleptic hypersensitivity may emerge in patients with psychotic mood disorders and long-standing antipsychotic drug therapy who eventually develop FTD [95]. Hypersensitivity, including parkinsonism and cervical dystonia, is also reported with newer antipsychotics [97]. Other side effects include rapid cognitive decline [71]. Positive effects of the newer antipsychotics have only been reported in a few case reports, such as FTLD patients presenting with severe Cotard delusion [98] or sexually inappropriate vocalizations [99].

Oxytocin

The neuropeptide oxytocin is a mediator of social behavior and emotion recognition. Many studies have been performed with intranasal oxytocin in healthy adults and in patients with autism. Oxytocin increases cooperative behavior, ToM performance, and direction of gaze toward the eye region of faces. In a double-blind placebo-controlled trial in 20 patients with FTD, a single dose of 24 IU of intranasal oxytocin improved the NPI scores on the evening of oxytocin administration compared with placebo and baseline ratings. Reduced recognition of angry facial expressions was also observed in treated patients [100]. A double-blind placebo- controlled safety and tolerability study of intranasal oxytocin has been recently performed in 23 FTDs for 1 week. Trends of improvement were observed on the NPI apathy subscale and on the empathic concern scale of the Interpersonal Reactivity Index [101].

 
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