Background Postoperative delirium (POD) is a common and serious problem that is characterized by fluctuating symptoms of inattention, disturbance of consciousness, and disorganized thinking. It is associated with adverse outcomes in a number of settings. POD has a multifactorial pathogenesis, and its incidence ranges from 10 to 46% in the general surgical population. Aim of the work The aim of this study was to investigate preoperative, operative, and postoperative factors that predict for POD. Materials and methods Between November 2014 and April 2015, 123 consecutive elective vascular surgery patients were evaluated for the diagnosis of POD. Various risk factors such as preoperative, operative, and postoperative were evaluated. Results Patients who developed delirium were significantly older (66.93 ± 4.80, P < 0.001). Those who developed delirium had a significantly higher frequency of history of diabetes mellitus and renal impairment. The Mini-Mental State Examination indicated that preoperative cognitive functioning was significantly impaired (19.36 ± 1.78, P < 0.001) in patients who had POD. Patients who developed POD were also more likely to report a history of moderate levels of depressive symptoms (22.64 ± 7.91, P < 0.001). Postoperative C-reactive protein was significantly higher (112.86 ± 12.35, P < 0.001) in delirious patients. Tendency for ICU admittance was significantly more frequent [36 (85.7%), P < 0.001] in delirious patients. Also, the prolonged hospital stay was significantly related to POD (9.36 ± 2.69, P < 0.001). Conclusion This study provides evidence that preoperative factors such as age, medical comorbidities (diabetes and renal impairment), cognitive impairment, and presence of depressive symptoms can be used as predictors for an increased risk for POD after vascular surgery. In addition, the type of surgical procedure and other postoperative factors such as high levels of postoperative C-reactive protein, ICU admittance, and prolonged hospital stay can predict POD.

Aim The aim of the study was to describe and reveal an association of social, psychological, and sexual aspects among couples seeking marital therapy. Background There are scanty data in Egypt on social, psychological, and sexual aspects among couples seeking marital therapy. Participants and methods Fifty couples attending the marital counseling clinic in the psychological medicine hospital in Cairo between June 2013 and June 2014 were assessed. Informed consent was given by couples, who were assessed on the basis of the following: (a) psychiatric interview; (b) General Health Questionnaire (GHQ); (c) ICD-10 symptom checklist (positive score on GHQ); (d) structured assessment of personality (negative score on GHQ); (e) sexual function questionnaire; (f) marital silence scale; (g) marital conflicts scale. Statistical analysis was carried out using SPSS version 16. Results At least one or both partners of all couples had a positive score on GHQ. Women showed higher rates of positive score on GHQ than did men. Personality disorders and accentuated traits were highly prevalent in the study sample. Women showed higher rates of depressive episodes, whereas men showed higher rates of substance abuse. Marital conflicts are directly associated with education level and inversely associated with age; marital silence is inversely associated with education level and directly associated with age. Conclusion Marital conflicts and silence are associated with the presence of psychiatric morbidity. Age and level of education are associated with marital conflict and silence.

Introduction Bipolar disorder is one of the most distinct syndromes in psychiatry and has been described in numerous cultures over the course of history. Aim of the work The aim of the current work was to study the neurodevelopmental abnormalities among children of bipolar disorder patients. Participants and methods The participants of the present study were the children of 30 patients diagnosed with bipolar disorder (I or II) according to the DSM-IV criteria. Results An overall 1.8% of children of bipolar patients had delayed motor milestones, 3.6% of them had delayed language development and 8.9% of them had nocturnal enuresis. The mean score of the Waldrop scale among children of bipolar patients was 1.16 ± 1.203, and high arched palate was the most prevalent anomaly (17 out of 56; 30.35%). As regards intelligence, 76.8% of children were of normal intelligence (between 90 and 110), 5.4% of children were dull-normal intelligence (between 80 and 89), and for the remaining children (17.9%) intelligence was not evaluated as they were younger than 4 years. No neuromotor abnormalities and neurological soft signs were observed in children of bipolar patients. Conclusion It is recommended to follow-up these children to observe any neurological soft signs that may develop in them, as well as any disorder that may develop in them later on during adulthood. However, this subject has to be further studied on a wider scale in the near future. Moreover, a controlled study should be conducted.

Objective Enuresis is a common problem in children and adolescents that can be troubling for them and their families. The potential effect of enuresis on the synthesis of identity and self-concept in children and adolescents is still poorly understood. This study aimed to evaluate the probable impact of secondary nocturnal enuresis on the self-concept of Egyptian adolescents. Participants and methods Forty patients aged 10-18 years with a diagnosis of secondary enuresis and 40 control children of the same age range were recruited. A validated Arabic version of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) in addition to the Child Behavior Check List (CBCL) and an Arabic-translated and validated version of the Piers-Harris Children's Self-Concept Scale were applied to evaluate the sample. Results After statistical adjustment for differences in intelligence quotient and socioeconomic status, youth with enuresis showed lower school, social, and total competence scores on CBCL but higher scores in all CBCL problem parameters. Adolescents with enuresis scored lower than control adolescents in all six subscales of the Piers-Harris Children's Self-Concept Scale in addition to the total score. Linear regression was used to adjust the results for significant differences between the two groups regarding intelligence quotient, socioeconomic status, CBCL school competence, CBCL total problems, and diagnosis of attention-deficit hyperactivity disorder and conduct disorder according to the MINI-KID interview. Differences in three subscales - behavior, intellect, and physical appearance - in addition to the total score were still significant after adjustment. Comparison between youth with nocturnal enuresis versus those with combined-type enuresis yielded no significant differences. Conclusion Older children and adolescents with enuresis suffer from high internalizing and externalizing problems, and low competence levels. They also suffer from low self-esteem that is most probably the result of enuresis itself and not due to low competence levels or behavioral problems. Further research is needed to determine the effect of treatment on the self-concept of these children.

Background Competitive sport environment puts athletes under a significant amount of psychological burden and stress. Despite the great effort and recent interest in athletic achievements, studies on the prevalence of mental health disorders in athletes are still lacking. Aim This study aimed to provide an insight into the prevalence of different psychiatric morbidities in a sample of Egyptian competitive athletes and to identify the association of psychiatric morbidity prevalence with the athlete's sex, weekly training hours, sport type, and sport injury as a unique experience facing the athletes. Participants and methods A total of 101 competitive athletes were recruited from some of the sporting clubs in Cairo and Giza by using a stratified random sampling method. They were interviewed using the Structured Clinical Interview for DSM-IV (SCID-I) diagnoses. Results SCID-I showed that 31.6% of the participants had current Axis-I psychiatric diagnosis, whereas 34.7% of them reported a history of past psychiatric morbidity. Phobic and adjustment disorders were the most common current psychiatric disorders among athletes. Depressive disorder not otherwise specified and dysthymia were encountered more in female athletes, and substance use was more common in their male counterparts. Combat players had the highest rate of adjustment disorder (48%), whereas the power games athletes had the highest rate of drug abuse (12%). Significant physical injury during the past year was associated with high rates of dysthymia, post-traumatic stress disorder, and social phobia. Conclusion Athletes in Egypt showed among them a high rate of Axis-I psychiatric diagnoses, which could not be ignored and necessitates professional mental health attention for early detection and intervention.

Objectives There are very few studies, especially in the Indian population, addressing the frequency of sexual dysfunction due to psychotropic medications. Therefore, this study aimed to quantify the frequency of sexual dysfunction and its interference in the patients' daily performance in a hospital-based population taking psychotropic medications. Materials and methods This cross-sectional study was conducted in the psychiatric unit of a Tertiary Care Teaching Hospital in South India over a period of 2 years. The Udvalg for Kliniske Undersogelser side effect rating scale was used to determine sexual dysfunction. A global assessment of interference in daily performance due to side effects was also evaluated. Results The overall incidence of sexual dysfunction was 20.95%. A higher incidence of sexual dysfunction was observed in women [n = 56 (70.88%)] and in the age group 18-29 years [n = 30 (37.9%)]. Amenorrhea [n = 32 (38.5%)] was the most prominently observed sexual dysfunction, followed by galactorrhea [n = 15 (18.07%)] and decreased sexual desire [n = 14 (16.86%)]. Antipsychotics [n = 54 (65.06%)] constituted the most common class of drug implicated in sexual dysfunction, followed by antidepressants [n = 25 (30.12%)]. Withdrawal of the drug [n = 58 (42%)] was the most common intervention for the management of sexual dysfunction. The majority of reports rated interference in daily performance due to side effects as severe [n = 48 (60.75%)], followed by moderate [n = 26 (32.91%)]. Conclusion The incidence rate of sexual dysfunction was 20.95%. Amenorrhea and galactorrhea were the two most prominent sexual dysfunctions affecting the patients with psychotropic medications. Thus it is important for all healthcare professionals to acknowledge and encourage discussion as well as the impact of drugs on sexual function.

Background Several studies have suggested that cortisol level influences the development and functioning of the brain in children and that it is implicated in a variety of processes including memory and attention. Objective This study was conducted to investigate the relation between cortisol level in children with attention-deficit/hyperactivity disorder (ADHD) and their cognitive function profile. Methods The participants of the study, held in Suez Canal University Hospital in Ismailia, were recruited from among those attending the childhood and adolescent psychiatry clinic. They were divided into two groups, the ADHD group [diagnosis based on Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR) through a structured clinical interview], composed of 43 children (pure ADHD children with no comorbid conditions), and the control group, composed of 31 typically developing children. All of them participated voluntarily in this study. The participants' ages ranged from 6 to 12 years; both sexes were included. Early morning awakening salivary cortisol levels were collected on two different days 2 months apart. The Stanford-Binet intelligence test 4th edition, the Wisconsin Card Sorting Test, Conner's test, and the child behavioral checklist were administered on all participants. Results Early morning salivary cortisol levels in both groups showed a statistically significant difference. Comparison shows that there was a statistically significant difference in the mean total score and the mean subdomain score of Stanford-Binet intelligence test 4th edition and Wisconsin Card Sorting Test (total number of errors, perseverative errors) between ADHD children and the comparison group. These results were positively correlated with decrease in mean cortisol awakening response. Conclusion There are significant associations between salivary cortisol levels and cognitive and executive function impairment in children with ADHD.