Ifosfamide is a chemotherapy agent commonly used in the treatment of several solid tumors and hematologic malignancies. Common ifosfamide toxicities are bone marrow suppression, alopecia, nausea and vomiting. Less common, but striking, are the rare but dramatic neuropsychiatric toxicities with discrete neurological symptoms and delirium. We report here a case of ifosfamide neuropsychiatric toxicity which presented with an isolated psychotic disorder with delusions, and was successfully treated with methylene blue. Current literature on treatment and prophylaxis of this clinically challenging chemotherapy-induced complication is presented.

In this article we report the first series of Turkish inpatients with late-onset psychosis, and describe our 9-year experience at the only inpatient geriatric psychiatry department in Turkey. Among 420 patients hospitalized between 1993 and 2002, 27 were psychotic. In this group, eight patients were diagnosed as having late-onset schizophrenia (LOS) and six very-late-onset schizophrenia-like psychosis (VLOSLP). Five patients had early-onset schizophrenia and eight had delusional disorder. Females were more frequently seen in the group with LOS and the group with VLOSLP. Except for one patient with LOS, all patients with VLOSLP and LOS had paranoid psychosis. Nihilistic delusions, delusions of poverty or guilt, thought withdrawal, thought insertion, and thought broadcasting were not seen in any of the patients. Additionally, none of the LOS or VLOSLP patients showed erotomanic delusions. Grandiose and mystic delusions were not seen in those with VLOSLP. Treatment results and antipsychotic dosages at discharge were similar to those in previous reports from other cultures.

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