Sleep is a vital physiologic process with important restorative functions. Notable qualitative and quantitative changes in sleep occur with age. Moreover, many sleep-related disorders occur with increasing frequency among elderly people. These conditions are often not appreciated by physicians, the associated symptoms ascribed instead to coexistant medical illness. In part 1 of this review, we attempt to summarize several of the most important sleeprelated disorders commonly observed in older patients. In the forthcoming part 2, we will highlight the principles of treatment of these conditions. Age-related sleep changesNormal sleep progresses through several stages in a predictable fashion (Table 1). This cycle repeats several times during the sleep period. With age, important changes in sleep structure occur (Box 1); 1 perhaps most characteristic is a phase advance of the normal circadian cycle. The result is a propensity toward an earlier sleep onset, accompanied by an earlier morning wake signal. Thus, elderly people often go to bed early and report being early risers. With aging, the total amount of time asleep shortens: infants and young children sleep an average of 16-20 hours per day; adults, 7-8; and people over 60 years of age, 6 1 /2 hours daily.2 Delta sleep (stages 3 and 4), the deepest and most refreshing form of sleep, diminishes with age. 2 Sleep pathologies in older patients InsomniaInsomnia, defined as difficulty falling or staying asleep, is frequent in older people.1,2 In some patients, insomnia can be caused by an underlying medical condition or a medication side effect (secondary insomnia). In the absence of a causative factor, it is referred to as primary insomnia. Monane 3 has estimated that insomnia affects nearly half of all those over the age of 65 years. Elderly women tend to report sleep disturbances more frequently than elderly men.4 The sleep changes noted among older women may be partly related to changes in the postmenopausal profile of sex hormones. Estrogen deficiency in particular has been postulated to contribute to the sleep difficulties that women often begin to experience in their perimenopausal period, and then increasingly with age. 5Frequent awakenings are particularly common among elderly people and may be related to their more frequent incidences of concurrent medical conditions. Among the most common causes of secondary insomnia are a variety of musculoskeletal disorders, nocturia related to benign prostatic hypertrophy in men and bladder instability with decreased urethral resistance in women, congestive heart disease, and chronic obstructive lung disease.Depression and anxiety disorders, common among people over 65 years of age, frequently contribute to insomnia. 6Risk factors for depression in older people include loss of a spouse, retirement, social isolation, comorbid disease and onset of dementia.Sleep disturbance or disruption is common among patients experiencing dementia, particularly those with Alzheimer's disease.7 Such patients often have difficulty not on...

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This is the first NMOSD case series in Egypt. Despite some limitation in testing and access to care, there are features of our NMOSD cases that appear to be different from other worldwide cohorts reported in the literature.

Background:The dual diagnosis of substance abuse and severe mental illness has been proposed by some authors to highlight the high frequency of such association. Our objectif was to determine the prevalence of dual diagnosis among mentally ill patients and and particularly schizophrenic patients. as a secondary purpose, to describe the profile of patient at higher risk to develop dual diagnosis.Method:683 mentally ill patients were recruited from el Mamoura Psychiatric Hospital, they were assessed by the Arabic version of 6 item K6 scale, those scoring above 13 were submitted to a structured clininical interview SCID-I module for schizophrenia, urine screening for drugs of abuse and complete history of substance abuse and other medical disciplines.Results:22% of the sample fulfill the diagnosis of dual diagnosis. 28.99% of the sample were schizophrenic, 16.67% among the later were fulfilling diagnosis of dual diagnosis. Results reveals higher risk for dual diagnosis in patients younger in age, single, low socioeconomic state and low level of education. Those having dual diagnosis tend to have early onset, longer duration of illness, poor compliance, higher rate of smoking and increased number of relapses.Conclusion:Double diagnosis is an important issue that needs more focus in mental health services. Awareness of mental health providers about dual diagnosis is highly recommended.

Background and objectives Breast cancer patients are vulnerable to depression with prevalence varying between 11 and 86% in literature with direct and indirect impact on compliance to treatment, quality of life and response to therapeutic course. Our study aims to identifying the profile of patients with cancer breast whom symptoms exceed normal reactive sadness to depressive manifestation necessitating psychiatric and psychological intervention. Methods 100 female patients with breast cancer diagnosis were recruited from Alexandria Police Hospital after consenting they were subject to mammogram, laboratory investigations for calcium, alkaline phosphatase, renal, hepatic functions and complete blood picture and thyroid profile. Hamilton Rating Scale and structured demographic data questionnaire was to collect relevant data. Results The prevalence of moderate to severe depressive symptoms on HAM-D was 52%, Significant statistical association was found between patients with depressive manifestations and postmenopusal state (p<0.001), with widowed and divorced (p<0.001), family history of brease cancer (p<0.001), advanced cancer staging (p<0.001), presence of Infiltrative ductal carcinoma (p<0.001) and type of surgery whether lumbectomy or modifies radical mastectomy (p<0.05). However the presence of brain metastasis, adjuvant chemotherapy or presence of family history of psychiatric illness didn't show statistical difference. Conclusion Depression is a common illness among breast cancer patients with particular vulnerable group among those postmenopausal widowed and divorced with advanced stage having rather infiltrative ductal carcinoma.

Background:The dual diagnosis of substance abuse and severe mental illness has been proposed by some authors to highlight the high frequency of such association. Our objectif was to determine the prevalence of dual diagnosis among mentally ill patients and and particularly mood disorder patients. as a secondary purpose, to describe the profile of patient at higher risk to develop dual diagnosis.Method:683 mentally ill patients were recruited from el Mamoura Psychiatric Hospital, they were assessed by the Arabic version of 6 item K6 scale, those scoring above 13 were submitted to a structured clininical interview SCID-I module for mood disorder, urine screening for drugs of abuse and complete history of substance abuse and other medical disciplines.Results:22% of the sample fulfill the diagnosis of dual diagnosis. 39.68% of the sample had mood disorder, 17.71% among the later were fulfilling diagnosis of dual diagnosis. No difference between MDD and Bipolar disorder regarding rate of dual diagnosis. Results reveals higher risk for dual diagnosis in patients younger in age, single, low socioeconomic state and low level of education. Those having dual diagnosis tend to have early onset, longer duration of illness, poor compliance, higher rate of smoking and increased number of relapses.Conclusion:Double diagnosis is an important issue that needs more focus in mental health services. Awareness of mental health providers about dual diagnosis is highly recommended.

-Background and Objectives: Dopaminergic neurotransmission is implicated in stress responses. The dopamine D2 receptor gene (DRD2) has been studied by the authors to assess its possible role as a predictor of those who are at a higher risk to develop PTSD after major psychological trauma.Methods: Over one year period 75 children and adolescents 6-18 yrs of age who had been exposed to moderate to severe burns were recruited from the burn unit at the Alexandria University Hospital for the study. Patients and their family were interviewed within the first 10 days of exposure. After signing a written consent form a 2 ml blood sample was obtained for genetic studies of the TaqA1/A2 polymorphism site of the DRD2 gene. Patients were reevaluated three and six months later for assessment of PTSD.Results: Among the 75 children recruited in the study, 26 died due to their burn injury, 19 dropped out as parents refused follow up and 30 continued the study follow up visits. Fourteen carried the A1A2 genotype. Of these 11 (78.6%) developed PTSD. Sixteen carried the A2A2 genotype. Of these only one child (6.3%) developed PTSD. The results were significant at p < 0.001 with a relative risk 12.5.Conclusions: Following exposure to severe stress, the presence of the Taq A1 allele of the DRD2 gene results in a significant increase in the risk of developing PTSD.

Background:The dual diagnosis of substance abuse and severe mental illness has been proposed by some authors to highlight the high frequency of such association. Our objectif was to determine the prevalence of dual diagnosis among mentally ill patients and and particularly personality disorder patients. as a secondary purpose, to describe the profile of patient at higher risk to develop dual diagnosis.Method:683 mentally ill patients were recruited from el Mamoura Psychiatric Hospital, they were assessed by the Arabic version of 6 item K6 scale, those scoring above 13 were submitted to a structured clininical interview SCID-II for personality disorder, urine screening for drugs of abuse and complete history of substance abuse and other medical disciplines.Results:22% of the sample fulfill the diagnosis of dual diagnosis. 12% of the sample had personality disorder, 57.32% among the later were fulfilling diagnosis of dual diagnosis. Results reveals higher risk for dual diagnosis in patients younger in age, single, low socioeconomic state and low level of education. No difference between different personality disorder subtypes as regarding rate of dual diagnosis.Conclusion:Double diagnosis is an important issue that needs more focus in mental health services. Awareness of mental health providers about dual diagnosis is highly recommended.