Background: Traditional healers are considered one of the important stages in the pathway to care of schizophrenia patients because of the confidence in the system, affordability and accessibility of the service, exposing patients to hazardous management, delay in seeking psychiatric help and bad prognosis. Aim: To assess the pathway to care of schizophrenia patients and role of traditional healers into it, the sociodemographic and clinical correlates of those patients. Methods: We assessed 232 patients with schizophrenia after confirmation of diagnosis with Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I) research version using a questionnaire designed by authors to assess help seeking behavior in schizophrenia patients and its sociodemographic and clinical correlates. Positive and Negative Syndrome Scale to identify the presence and severity of symptoms. Results: A total of 41.8% sought traditional healers first, 58.1% sought a psychiatric consultation first, main symptoms related to traditional healers seeking were hallucinations in 51.5%, delusions 29.9%, 9.28% bizarre behavior and 9.28% formal though disorder. Main causes of traditional healers’ preference were society acceptance 30.39%, affordability 24.74% and accessibility 16.49%. Conclusion: This study shows that a significant percentage of the patients suffering from schizophrenia prefer to approach faith healers first due to their own beliefs, society acceptance, affordability and easy accessibility.

Introduction:Adolescents with congenital heart disease are at increased risk for developingpsychological distress. Aim of the study: To assess the prevalence of depression and anxiety in adolescents withcongenital heart disease, and to identify the predictors related to thesedisorders. Methods:This is a cross-sectional case-control study. A total of 60 adolescents withCHD aged from 12-18 years and 30 apparently healthy adolescents were recruited.All participants were assessed using a designed questionnaire, the Children'sDepression Inventory (CDI), the Revised Children Manifest Anxiety Scale(RCMAS), and the Mini International Neuropsychiatric Interview for Children andAdolescents (MINI-Kid). Results:Prevalence of depression was higher in adolescents with CHD compared to healthycontrol (18.3% vs. 3.3%, p= 0.048). Moreover, 30% of adolescents with CHD hadanxiety compared to 10% of the control group (p= 0.03). Multivariate analysisof risk factors showed that level of education and symptomatic cardiacfunctional class were the significant predictors of depression in adolescentswith CHD. Likewise, presence of more than one cardiac defect and having morethan one cardiac catheterization were the significant predictors of anxiety inadolescents with CHD. Conclusion: Adolescentswith CHD are at increased risk of having depression and anxiety, especiallythose with low level of education, severe cardiac illness and having multiplecardiac catheterizations. Appropriate psychiatric assessment and earlyintervention can improve the quality of life of adolescents with CHD.

IntroductionAdolescents with congenital heart disease (CHD) are at an increased risk of developing psychological distress. Aim of the study The aim of this study was to assess the prevalence of depression and anxiety in adolescents with CHD, and to identify the predictors related to these disorders. Participants and methods This is a cross-sectional case-control study. A total of 60 adolescents with CHD aged between 12 and 18 years and 30 apparently healthy adolescents were recruited. All participants were assessed using a designed questionnaire, the Children's Depression Inventory (CDI), the Revised Children Manifest Anxiety Scale (RCMAS), and the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). ResultsThe prevalence of depression was higher in adolescents with CHD compared with healthy controls (18.3 vs. 3.3%, P = 0.048). Moreover, 30% of adolescents with CHD had anxiety compared with 10% of the control group (P = 0.03). Multivariate analysis of risk factors showed that the level of education (being illiterate) and the symptomatic cardiac functional class were significant predictors of depression in adolescents with CHD. Likewise, the presence of more than one cardiac defect and having more than one cardiac catheterization were significant predictors of anxiety in adolescents with CHD. Conclusion Adolescents with CHD are at an increased risk of having depression and anxiety, especially those with a low level of education, severe cardiac illness, and multiple cardiac catheterizations. Appropriate psychiatric assessment and early intervention can improve the quality of life of adolescents with CHD.

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Evidence suggests that opioids can modulate gonadal function, with consequent decreased release of sex hormones. We attempted to investigate the sexual function of males using tramadol hydrochloride (HCL) and its relationship to levels of free testosterone, luteinizing hormone, and follicle stimulating hormone, and to compare them with heroin use disorder patients and healthy controls. Our sample consisted of 60 opiate use disorder patients (assessed by Structured Clinical Interview for DSM-IV Axis I) (30 heroin and 30 tramadol) and 30 healthy controls. Sexual dysfunction was assessed using the International Index of Erectile Function. Free testosterone, follicle stimulating hormone, and luteinizing hormone levels were measured in morning blood samples using enzyme-linked immunosorbent assay (ELISA). Results showed that there was a decrease of luteinizing hormone and free testosterone levels in opiate use disorder patients compared with healthy controls, with heroin-dependent patients having significantly lower levels than those using tramadol. Opiates’ effect on follicle stimulating hormone had mixed results. Opioid-dependent patients (both tramadol HCL and heroin using patients) developed sexual dysfunction more than healthy controls, which was generalized, with erectile dysfunction being the most affected domain. These findings are of ultimate importance, considering the fact that people use opioids to enhance their sexual performance in many countries.