Publications by authors named "Rajesh Sagar"

204 Publications

Effectiveness of Metacognitive Therapy in Patients With Depression and Comorbid Anxiety Symptoms: A Case Series From India.

Cureus 2022 Apr 18;14(4):e24229. Epub 2022 Apr 18.

Psychiatry/Clinical Psychology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND.

Metacognitive therapy (MCT) is a transdiagnostic intervention used to treat different psychiatric disorders. This intervention is based on the concept that persistent emotional distress is a consequence of a particular way of responding to negative thoughts and emotions. MCT for depression and anxiety aims at targeting rumination, worry, and the dysfunctional metacognitive beliefs underlying these thought processes. The purpose of this study was to explore MCT as a treatment for adult patients with depression (either major depressive disorder (MDD) or recurrent depressive disorder, dysthymia, or mixed anxiety depressive disorder) with comorbid anxiety symptoms. Four men diagnosed with depressive disorder with comorbid anxiety symptoms seeking treatment from the outpatient clinic of the Department of Psychiatry at the All India Institute of Medical Sciences, New Delhi, were recruited for the study. Each patient received 10 individual weekly sessions of MCT, lasting up to 1 hour each. Participants were assessed at baseline, post-intervention (right after completing MCT), and at one-month and two-month follow-ups. Primary outcome measures were a reduction in the severity of depression, anxiety, worry, and rumination. Secondary outcome measures were changes in dysfunctional metacognitive beliefs about worry and rumination. All outcomes were assessed via self-report using standardized questionnaires at baseline, post-intervention, one-month, and two-month follow-up. Data for all the outcome measures (at baseline, post-intervention, one month, and two-month follow-up) were plotted on a graph for visual examination. Additionally, we calculated clinically significant change (≥50% reduction in symptom severity and one other standardized criteria for clinically significant changes) for all the primary outcome measures across the above-mentioned four time points. All four men were single, well-educated, and had a mean age of 25.5±4.79 years. Their mean illness duration was 21±0.64 months. None of them had ever received any psychotherapy for their current illness. They had severe depressive and anxiety symptoms at baseline. Three participants had high scores on the rumination and worry scales. At post-intervention, all the participants had significant improvement on all the primary outcome measures, and they maintained their gains on follow-up assessments. Our study generated preliminary evidence supporting the effectiveness of MCT in treating depressive disorders with comorbid anxiety symptoms in the Indian context.
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http://dx.doi.org/10.7759/cureus.24229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9115621PMC
April 2022

Mental Health Care Act, 2017: How to organize the services to avoid legal complications?

Indian J Psychiatry 2022 Mar 22;64(Suppl 1):S16-S24. Epub 2022 Mar 22.

Department of Psychiatry, Bundelkhand Medical College, Jabalpur, Madhya Pradesh, India E-mail:

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http://dx.doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_743_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9122135PMC
March 2022

National Tele-Mental Health Program in India: A step towards mental health care for all?

Indian J Psychiatry 2022 Mar-Apr;64(2):117-119. Epub 2022 Mar 24.

Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India.

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http://dx.doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_145_22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9045352PMC
March 2022

Prevalence of psychological outcomes and its associated factors in healthcare personnel working during COVID-19 outbreak in India.

Indian J Psychiatry 2022 Mar-Apr;64(2):151-158. Epub 2022 Mar 24.

Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.

Background: Care of COVID-19 patients has been shown to affect the mental health of healthcare personnel (HCP), however, there is little data reflecting psychological health of HCP in India.

Aims: The present study was undertaken to assess the prevalence of psychological outcomes and its association with various sociodemographic and occupational factors among the HCP in India.

Methodology: A cross-sectional, online survey, using snowball sampling method was conducted between June 1, 2020, and June 22, 2020. The HCP working in COVID-19 designated hospitals across India were invited to participate. Patient Health Questionnaire-4 and 19-item stress-related questionnaire were used to evaluate symptoms of overall anxiety, depression, COVID-19 infection specific anxiety, exhaustion, and workload.

Results: In this cross-sectional study with 2334 HCP from 27 states and 7 union territories of India; 17.9% of participants had depression, 18.7% had overall anxiety, 26.5% had exhaustion, 30.3% reported heavy workload, and 25.4% had COVID-19 infection-specific anxiety, respectively. The HCP working in states with higher caseload was a common risk factor for overall anxiety (odds ratio [OR], 1.7; P < 0.001), depression (OR, 1.6; P < 0.001), COVID-19 infection-specific anxiety (OR, 2.5; P < 0.001), exhaustion (OR, 3.1; P < 0.001), and heavy workload (OR, 2.6; P < 0.001). Nurses were more at risk for depression (OR, 2.2; P < 0.001), anxiety specific to COVID-19 infection (OR, 1.3; P = 0.034), and heavy workload (OR, 2.9; P < 0.001); while doctors were more at risk for overall anxiety (OR, 2.0; P = 0.001) and exhaustion (OR, 3.1; P < 0.001).

Conclusions: Frontline workers, specifically nurses and doctors, and those working in states with high COVID-19 caseload are more at risk for adverse psychological outcomes. The relatively less prevalence compared with other countries, is perhaps a reflection of measures undertaken, including early lockdown, ensuring better all-round preparedness and social norms.
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http://dx.doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_60_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9045337PMC
March 2022

The Scope of Metacognitive Therapy in the Treatment of Psychiatric Disorders.

Cureus 2022 Mar 23;14(3):e23424. Epub 2022 Mar 23.

Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, IND.

Metacognitive therapy (MCT) is a novel and promising transdiagnostic psychotherapy intervention based on the Self-Regulatory Executive Function model of conceptualizing emotional disorders. It was developed by Adrian Wells in 2009. Its therapeutic response occurs by reducing dysfunctional metacognitive beliefs regarding worry and rumination, often seen in patients with psychiatric disorders. Since its inception, it has been increasingly applied to a wide spectrum of psychiatric illnesses, but mainly focusing on mood and anxiety disorders. To our knowledge, no study has detailed its existing therapeutic scope in psychiatry. In this comprehensive narrative review, we describe the various psychiatric illnesses in which MCT has been used, the advantages of MCT, and the limitations of the MCT research. In addition, we propose some solutions to systematically examine its place in psychiatry. We encountered its potential role in treating trauma and stress-related disorders, obsessive-compulsive spectrum disorders, personality disorders, psychotic disorders, substance use disorders, and sexual disorders.
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http://dx.doi.org/10.7759/cureus.23424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9030663PMC
March 2022

Evaluation of Sympathetic and Parasympathetic Tone and Reactivity in Adolescents with Specific Learning Disorder (Dyslexia).

Indian J Pediatr 2022 Apr 20. Epub 2022 Apr 20.

Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.

Objectives: To evaluate the autonomic function in specific learning disorder (SLD) and comorbid SLD attention-deficit hyperactivity disorder (SLD-ADHD).

Methods: A cross-sectional study was conducted in a tertiary care hospital with 20 adolescent subjects each of confirmed SLD, SLD-ADHD, and healthy control (mean age 15.32 y). Heart-rate variability and autonomic-function tests were carried out using standard protocols.

Results: Heart-rate variability parameters, viz., mean RR interval, number of RR intervals which differ by ≥ 50 ms (NN50), percentage NN50, standard deviation of differences between adjacent RR intervals, root square of mean of the sum of the squares of differences between adjacent RR intervals, coefficient of variance and absolute power of high-frequency band (HF) recorded apparently lower levels in SLD and SLD-ADHD as compared to healthy control indicating lower parasympathetic tone. Whereas, higher absolute power of low- frequency band (LF) in SLD and SLD-ADHD than healthy control indicated enhanced sympathetic activity. Higher LF/HF and lower SD1/SD2 ratios in SLD and SLD-ADHD than healthy control indicated higher sympathetic tone over parasympathetic tone. Values of autonomic-function tests such as E:I ratio, change in heart rate during deep-breathing test, 30:15 ratio, and Valsalva ratio showed a decrease in SLD and SLD-ADHD as compared to healthy control implying reduction in parasympathetic reactivity. Increased values for rise in diastolic blood pressure in the isometric handgrip test and cold pressor test recorded in SLD as compared to healthy control, revealed the increased sympathetic reactivity.

Conclusion: Overall, results of heart-rate variability and autonomic-function tests imply dysregulation of sympathetic and parasympathetic activities with sympathetic dominance in SLD and SLD-ADHD.
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http://dx.doi.org/10.1007/s12098-022-04156-6DOI Listing
April 2022

Quality of web-based information on attention deficit hyperactivity disorder.

Asian J Psychiatr 2022 May 12;71:103071. Epub 2022 Mar 12.

Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India. Electronic address:

Background And Objective: The limited literature available on quality of online health information about attention deficit hyperactivity disorder (ADHD), reported mixed findings and was more than five years old. This study aimed to assess the content quality, readability, aesthetics, and interactivity of current web-based information on ADHD.

Methods: We screened first 50 links obtained on searching for ADHD using two popular search engines (Google and Bing), out of which 44 websites were selected for quality assessment. They were analysed using pre-decided study Performa, which included previously validated DISCERN instrument for content quality. Flesch-Kincaid grade level score and Flesch-Kincaid readability index were calculated for assessing readability.

Results: About 61.4% of websites had DISCERN score ≥40, suggestive of good content quality. However, only 38.6% and 13.6% of websites were written at recommended reading level of eighth and sixth grade respectively. The DISCERN score had significant positive correlation with aesthetics and interactivity scores. Websites with the Health On Net (HON) label had better content quality. No significant difference in the readability, aesthetics, and interactivity of websites with and without the HON label.

Conclusion: This study underscores the need for improving readability of web-based information on ADHD, and highlight important areas for improving the overall quality of websites. The use of HONCode label might guide general public in gauging the content quality of online health information, but not its readability or presentation.
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http://dx.doi.org/10.1016/j.ajp.2022.103071DOI Listing
May 2022

Comparison of extended totally extra peritoneal (eTEP) vs intra peritoneal onlay mesh (IPOM) repair for management of primary and incisional hernia in terms of early outcomes and cost effectiveness-a randomized controlled trial.

Surg Endosc 2022 Mar 11. Epub 2022 Mar 11.

Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India.

Background: There are no randomized controlled trials comparing the eTEP with IPOM repair and this randomized study was designed to compare the two techniques in terms of early pain, cost effectiveness, and quality of life.

Method: This was a prospective randomized trial with intention to treat analysis. The primary outcome was immediate post-operative pain scores. Operative time, conversions, peri operative morbidity, hospital stay, return to daily activities, incremental cost effectiveness ratio and quality of life (WHO-QOL BREF) were secondary outcomes.

Results: Sixty patients were randomized equally. Early post-operative pain scores and seroma rates were significantly lower and with a significantly earlier return to activity in eTEP group (p value < 0.05). With negative costs and positive effects, eTEP group was 2.4 times more cost effective.

Conclusion: eTEP repair is better in terms of lesser early post-operative pain, earlier return to activities and cost effectiveness in small and medium size defects.
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http://dx.doi.org/10.1007/s00464-022-09180-3DOI Listing
March 2022

Evaluation of Cognitive Deficits in Adults with Type 1 Diabetes Stratified by the Age of Diabetes Onset: A Cross-Sectional Study.

Adv Ther 2022 Apr 19;39(4):1711-1723. Epub 2022 Feb 19.

Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India.

Introduction: Type 1 diabetes (T1DM) is associated with cognitive deficits, and age at diagnosis is thought to play a substantial role. However, there are limited data for the cognitive performance in young adults, in relation to the age of diabetes onset. The lack of information is particularly striking in the context of developing regions.

Methods: This cross-sectional study was performed from August 2018 to July 2020. We included adult participants with T1DM, stratified by the age of diabetes onset (till 6 years of age, between 7 to 12 years of age, and 13 to < 18 years of age) and compared them with the control group (no diabetes or pre-diabetes). We filled a structured case record proforma for all participants and recorded relevant socio-demographic and medical details. Detailed neuropsychological assessment with 13 psychological tests representing four cognitive domains was carried-(1) attention, working memory and executive functions; (2) learning and memory; (3) visuoperceptual functions; and (4) information processing speed.

Results: We evaluated 100 individuals, 73 (men 48.0%) with T1DM and 27 (men 51.9%) without T1DM. After adjustment for age, gender and education, the mean differences in composite Z scores (for the four cognitive domains) between participants with T1DM and without T1DM were 0.08 for attention, working memory and executive functions (p = 0.614); 0.07 for learning and memory (p = 0.694); 0.05 for visuoperceptual (p = 0.784); and 0.22 for information processing speed (p = 0.305). No significant differences were found for the three subgroups of individuals with T1DM, when compared with the control group. Effect size (Cohen's d) for the individual tests (n = 13) ranged from - 0.36 to + 0.39, and none of the comparisons were statistically significant. Amongst the participants with T1DM, higher education had a significant positive association with three of the four cognitive domains evaluated.

Conclusions: To conclude, our findings suggest minimal differences in the cognitive functioning of patients with T1DM with different age of onset of diabetes compared to healthy controls, when evaluated in early adulthood. This is possibly the first study from South Asia with an in-depth and comprehensive assessment of cognitive functions in patients with T1DM, using a detailed neuropsychological battery.
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http://dx.doi.org/10.1007/s12325-022-02063-yDOI Listing
April 2022

Modified psychological first aid during COVID-19.

WHO South East Asia J Public Health 2021 Jan-Jun;10(1):53-54

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/WHO-SEAJPH.WHO-SEAJPH_21_21DOI Listing
January 2022

Longitudinal assessment of disability amongst patients of bipolar and unipolar depressive disorders presenting to a tertiary care center in North India.

Int J Soc Psychiatry 2022 Jan 7:207640211070158. Epub 2022 Jan 7.

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.

Objectives: To assess and compare the changes in disability scores associated with Bipolar Depression (BD) and Unipolar Depression (UD) over 1 year.

Methods: A longitudinal study was taken up in adults diagnosed with unipolar or bipolar depressive disorder with current depressive episode. Diagnosis was made according to Schedule for Clinical Assessment in Neuropsychiatry. Severity scoring was done using Hamilton's Depression (HAM-D) rating scale and Hamilton's Anxiety (HAM-A) rating scale. Disability was assessed using Indian Disability Evaluation and Assessment Scale (IDEAS) and London handicap Scale (LHS) at baseline, 6 and 12 months.

Results: Sixty participants were recruited (42 UD and 18 BD). No significant differences were seen in socio-demographic parameters, except higher education levels and males being overrepresented in UD. Significant differences at baseline were seen in HAM-D ( = .001) and HAM-A ( = .003) scores. The extent of disability was seen to correlate with severity of illness only in case of BD at baseline. No significant differences were seen in the IDEAS scores at baseline. IDEAS score improved at each follow-up assessment ( < .001). LHS showed significant improvement over time in UD ( < .001), but not BD ( = .076). Percentage individuals meeting cut-off for benchmark disability (>40%) were comparable at baseline but were significantly more in the BD at 12-months ( = .049).

Conclusion And Implications: Disability in psychiatry occurs equally amongst unipolar and bipolar depressive disorders and tends to improve over time, although the level of improvement may differ. It may not always correspond to severity of illness. These factors should be considered while certifying disability.
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http://dx.doi.org/10.1177/00207640211070158DOI Listing
January 2022

A parent-child conjoint psychological intervention for children in maintenance phase of acute lymphoblastic leukemia: Feasibility and preliminary outcomes from a randomized control pilot trial.

Arch Pediatr 2022 Feb 23;29(2):145-152. Epub 2021 Dec 23.

Office of the Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.

Objective: To develop and test a brief Composite Intervention Module for Pre-adolescents with Acute Lymphoblastic Leukemia (CIMPALL).

Design: Single-center randomized controlled design.

Setting: A tertiary care center of national importance PARTICIPANTS: A total of 36 children with acute lymphoblastic leukemia in the maintenance phase of the treatment.

Intervention: A five-session (540 min) brief, multidomain, audiovisually aided, therapist-facilitated conjoint intervention module for children with cancer and their parents.

Main Outcome Measures: Standardized psychological tools for children including CBCL, CPSS (Child Posttraumatic Stress Disorder Symptoms Scale), PedsQol (Pediatric Quality of Life), and NIMHANS (National Institute of Mental Health and Neurosciences) neuropsychological battery and parents including PTSD CC (Posttraumatic Stress Disorder Civilian Checklist), CHIP (Coping Health Inventory for Parents), CBS (Caregiver Burden Scale), and SRQ (Self-Reporting Questionnaire).

Results: A total of 36 patients were randomized to an experimental or a control group. Over 80% agreement was observed on indices of expert evaluation; 100% of participants found the sessions to be helpful, useful, appropriate in terms of time, duration, and place, and interventionist. The participation rate in the sessions was 94% and the study flow was smooth; 97.3% eligible candidates agreed to participate. Furthermore, 100% agreement on performance of activities was observed and the attrition rate was 5.26%.

Conclusion: This pilot study presents the CIMPALL, which to the best of our knowledge is the first of its kind in India. The data suggest that the CIMPALL intervention is feasibly delivered by a clinical psychologist and that the CIMPALL intervention has an impact on important psychosocial variables for children with acute lymphoblastic leukemia and their parents.
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http://dx.doi.org/10.1016/j.arcped.2021.11.004DOI Listing
February 2022

Effect of a collaborative care model on anxiety symptoms among patients with depression and diabetes in India: The INDEPENDENT randomized clinical trial.

Gen Hosp Psychiatry 2022 Jan-Feb;74:39-45. Epub 2021 Nov 27.

Department of Psychiatry and Behavioral Sciences, University of Washington, 325 Ninth Avenue, Box 359911, Seattle, WA 98104, USA. Electronic address:

Objective: We assessed the impact of a collaborative care intervention on anxiety symptoms among participants in India with comorbid depression, poorly controlled diabetes, and moderate to severe anxiety symptoms.

Method: We analyzed data from a randomized controlled trial conducted at four diabetes clinics in India. Participants received either collaborative care or usual care. We included only participants who scored ⩾10 on the Generalized Anxiety Disorder-7 (GAD-7) at baseline. We estimated the effect of the intervention on clinically significant reduction in anxiety symptoms; we considered several potential baseline moderators and mediation by anti-depressant use.

Results: One hundred and seventy-two participants scored 10 or above on the GAD-7 at baseline. Collaborative care participants were more likely than control participants to achieve a clinically significant reduction in anxiety symptoms at 6 and 12 months (65.7% vs. 41.4% at 12 months, p = 0.002); these differences were not sustained at 18 or 24 months. There was little evidence of moderation by participant characteristics at baseline, and effects were not mediated by anti-depressant use.

Conclusions: Collaborative care for the treatment of depression and type 2 diabetes can lead to clinically significant reductions in anxiety symptoms among patients with anxiety. Effects were notable during the active intervention period but not over the year post-intervention.
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http://dx.doi.org/10.1016/j.genhosppsych.2021.11.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8934572PMC
March 2022

Effect of short-term meditation training in central serous chorioretinopathy.

Indian J Ophthalmol 2021 Dec;69(12):3559-3563

Vitreo-Retina, Uvea and ROP Services; Dr. Rajendra Prasad Center for Ophthalmic Sciences; All India Institute of Medical Sciences (AIIMS), New Delhi, India.

Purpose: Stress and Type A personality are established risk factors for the development of central serous chorioretinopathy (CSC). Meditation is known to have a positive effect on reducing stress levels. This study aimed to assess the effect of short-term meditation training in patients of CSC.

Methods: A pilot study was conducted where 40 patients diagnosed with acute and non-resolving CSC were randomly assigned to either of two groups - meditation training and routine care (without meditation). The primary outcome measure was time to resolution of CSC based on optical coherence tomography and fluorescein angiography. Secondary outcome measures were changes in anxiety score (State-Trait Anxiety Inventory [STAI] scores) and blood pressure. The patients were followed up for a minimum period of 4 months.

Results: Twenty cases were included in each group. The demographic pattern, baseline swept-source optical coherence tomography parameters, and STAI scores were similar in both groups. The time to disease resolution was 9.4 ± 4.22 weeks in the meditation group and 19.5 ± 2.79 weeks in the nonmeditation group (P < 0.001). At 4 months, CSC had failed to resolve in 60% of patients with routine care compared with 8% in cases following short-term meditation training. STAI scores showed a reduction in stress levels in the meditation group. Furthermore, statistically significant improvement in systolic and diastolic blood pressures was also observed following meditation training.

Conclusion: Short-term meditation training may be a useful approach in the management of patients with CSC as it tends to reduce stress and prehypertension, and promotes earlier resolution of the condition. However, patient's motivation to complete and pursue the meditation training is a significant barrier.
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http://dx.doi.org/10.4103/ijo.IJO_3499_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8837379PMC
December 2021

Tele mental health helplines during the COVID-19 pandemic: Do we need guidelines?

Asian J Psychiatr 2022 01 6;67:102916. Epub 2021 Nov 6.

Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India. Electronic address:

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http://dx.doi.org/10.1016/j.ajp.2021.102916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572038PMC
January 2022

Association of Stressful Life Events with Dementia in North Indian Populations.

Neurol India 2021 Sep-Oct;69(5):1326-1330

Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

Background: Chronic stress is known to be associated with dementia.

Aim: This study looked for major stressors and their associations with dementia in the elderly demented population.

Methods: Case group consisted of 60 subjects (age group 55-75 years; M:F = 7:3) with postscreening for mild cognitive impairment (MCI) and mild Alzheimer's type dementia. Control group consisted of two subgroups: related (N = 60) and not-related (N = 60) subjects screened and confirmed not to be suffering from cognitive impairment. Sociodemographic variables were collected using a personal data sheet. The severity of cognitive impairment was assessed using the Clinical Dementia Rating (CDR) Scale. Subjects with a CDR score of range 0.5-1 were included in mild cognitive impairment and mild Alzheimer's type dementia. Stressful life events were evaluated using the Presumptive Stressful Life Event Scale (PSLES). A present stress level of caregivers was evaluated using Depression Anxiety Stress Scales (DASS). Assessed stress level scores were compared and validated with serum and plasma levels of cortisol and ACTH respectively.

Results: Different groups exhibited distinct PSLES and DASS scores with statistical significance. It was also observed that Cortisol and ACTH levels were elevated in case group as compared with that of both sub-group controls.

Conclusions: The outcome measures of this study projected that neural degeneration leading to mild cognitive impairment and dementia may be due to accumulative cortisol hormone associated with stressful life events.
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http://dx.doi.org/10.4103/0028-3886.329601DOI Listing
November 2021

Substance use and its associated factors among school students.

Natl Med J India 2021 Mar-Apr;34(2):79-83

National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi 110029, India.

Background: . There is lack of comprehensive data on substance use and associated factors among school students in Delhi, India.

Methods: . We used a cluster sampling method based on sections of classes in schools to conduct this study in two government-run schools in Delhi. All enrolled students from 8th, 9th and 11th grades participated (n = 405). The WHO Student Drug Use questionnaire was administered in a single session for a class section for assessing substance use.

Results: . The participation rate was 90.6%. The rates of past 12 months' use of tobacco, alcohol, cannabis and inhalants were 22%, 12.1%, 12.1% and 8.6%, respectively, while rates for 'sedatives and tranquillizers' were 4.9%, opium 2.7% and other opioids 1.2%. Lifetime use of heroin was reported by two students and use in the past 12 months by one student. Multiple substance use was high. Higher age was associated with the use of alcohol and cannabis. According to logistic regression model results, use by a family member significantly increased the probability of using tobacco (adjusted odds ratio [AOR] 11.3; 95% confidence interval (CI) 3.4-37.8) and alcohol (AOR 3.75; 95% CI 5.1-1059.3). Similarly, use by peers significantly increased the probability of tobacco (AOR 7.7; 95% CI 2.0-29.8) and cannabis use (AOR 5.7; 95% CI 1.5-21.5). Having poor harm perception significantly increased the chances of inhalant use by students (AOR 5.5; 95% CI 1.5-20.1).

Conclusion: . The study results bring to attention the prevalent and important problem of substance use among schoolchildren. We recommend that (i) intervention strategies for school settings are important and need to factor in the use of illicit substances (cannabis); (ii) psychosocial intervention by trained school counsellors in school settings is the mainstay for intervention for cannabis and inhalants; and (iii) heroin users should be referred to healthcare facilities for detoxification.
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http://dx.doi.org/10.4103/0970-258X.326747DOI Listing
October 2021

A critical look at online survey or questionnaire-based research studies during COVID-19.

Asian J Psychiatr 2021 Nov 9;65:102850. Epub 2021 Sep 9.

Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India. Electronic address:

In view of restrictions imposed to control COVID-19 pandemic, there has been a surge in online survey-based studies because of its ability to collect data with greater ease and faster speed compared to traditional methods. However, there are important concerns about the validity and generalizability of findings obtained using the online survey methodology. Further, there are data privacy concerns and ethical issues unique to these studies due to the electronic and online nature of survey data. Here, we describe some of the important issues associated with poor scientific quality of online survey findings, and provide suggestions to address them in future studies going ahead.
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http://dx.doi.org/10.1016/j.ajp.2021.102850DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8426323PMC
November 2021

School Bullying: Cause or Consequence?

Indian J Pediatr 2021 10 16;88(10):955-956. Epub 2021 Aug 16.

Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.

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http://dx.doi.org/10.1007/s12098-021-03930-2DOI Listing
October 2021

Psychological Impact of COVID-19 on Children and Adolescents: A Systematic Review.

Indian J Psychol Med 2021 Jul 29;43(4):294-299. Epub 2021 Jun 29.

Dept. of Psychiatry, All India Institute of Medical Sciences, New Delhi, Delhi, India.

Background And Aims: The outbreak of COVID-19 led to a significant psychological impact on individuals, particularly those belonging to vulnerable groups. This study aimed to synthesize literature on the psychological impact of COVID-19 among children and adolescents.

Methods: Electronic search engines were used to identify studies till March 2021 that reported symptoms of psychological origin in children and adolescents. Information was extracted using a predefined template, and qualitative analysis was conducted using STROBE.

Results: One hundred and two relevant papers were identified. Most of the studies were conducted online or telephonically. The study designs were primarily single group cross-sectional, though a few prospective/retrospective designs were also identified. Studies assessing emotional distress showed variable levels of anxiety and depressive symptoms in the study population, with greater severity of anxiety symptoms among females and older adolescents. Reduced physical activity; delayed sleep time; increased sleep duration, screen time, internet use, and sedentary habits, poor quality of life were other notable findings, often correlating with anxiety/depression. Efforts to address bias, discussion on generalizability of their results, and sample size calculation were not reported in most studies.

Conclusion: Psychological impact on children/adolescents is significant, either due to the fear of the illness or social isolation related to COVID-19. One may focus on improving sleep habits and physical activity and regulating internet use for maintaining psychological well-being.
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http://dx.doi.org/10.1177/02537176211021789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327877PMC
July 2021

Prevalence of Common Mental Disorders among pregnant women-Evidence from population-based study in rural Haryana, India.

J Family Med Prim Care 2021 Jun 2;10(6):2319-2324. Epub 2021 Jul 2.

Centre for Community Medicine, AIIMS, New Delhi, India.

Background: Mental disorders during pregnancy is one of the major public health problem because of its effect on both mother and child.

Objectives: The objective of the study was to assess the burden of common mental disorders (CMDs) among pregnant women in rural Haryana, North India.

Methods: A community-based cross-sectional study was conducted in 28 villages of rural Haryana in 2016. Pregnant women in the study area with period of gestation 25-34 weeks were enrolled and assessed for presence of CMDs in two phases. Primary Care Evaluation of Mental Disorders-Patient Health Questionnaire was used for screening and Mini International Neuropsychiatric Interview (MINI) for diagnosis of CMDs.

Results: A total of 457 pregnant women were included in the study. Mean age of pregnant women was 23.9 years (SD- 3.9). Prevalence of CMDs was 15.3% (95% CI, 12.0-18.6). Of these, major depression was 2.8% (95% CI, 1.4- 4.4), and Generalized Anxiety Disorder was 15.1% (95% CI, 11.8-18.4) as per MINI. On multivariate analysis, no statistically significant association was found between CMDs during pregnancy with any obstetric, sociodemographic determinants, and child health outcomes.

Conclusion: High prevalence of CMDs, especially anxiety, observed among pregnant women in rural area necessitates the need for integration of screening of CMDs during routine antenatal care in India.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_2485_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284220PMC
June 2021

Yoga in major depressive disorder: molecular mechanisms and clinical utility.

Front Biosci (Schol Ed) 2021 06;13(1):56-81

Laboratory for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences, 110029 New Delhi, India.

Major depressive disorder (MDD) is a mind-body disorder. Cellular aging has been implicated in the pathogenesis of MDD with the altered mind-body communication markers like stress response, immune response, nutrition sensing, and a range of other regulatory feedback systems. In this age of super specializations, one specific target and interventions (preferably a drug) on it are being rigorously sought by the health care community and industry, but have failed in it in the last fifty years in spite of advances in technology. Since, depression is a complex disorder associated with increased incidence of other complex disorders, it must be treated by an integrated holistic approach that can address the complexity of MDD. Interventions targeting accelerated biological aging to increase cellular health in whole body have potential to manage complex conditions like MDD and its overlapping symptoms and comorbidities. Yoga has the potential to be the nexus between, clinical management of MDD and other lifestyle diseases.
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http://dx.doi.org/10.52586/S553DOI Listing
June 2021

Experience of conducting MD examinations in the mid of COVID-19 crisis.

Indian J Psychiatry 2021 Mar-Apr;63(2):201-203. Epub 2021 Apr 14.

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail:

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http://dx.doi.org/10.4103/psychiatry.IndianJPsychiatry_509_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214127PMC
April 2021

Relationship between alexithymia and depression: A narrative review.

Indian J Psychiatry 2021 Mar-Apr;63(2):127-133. Epub 2021 Apr 14.

Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

Alexithymia has been described as difficulty in expressing as well as experiencing feelings. It has been studied in relation with medical as well as psychological conditions and has been seen to impact treatment outcomes. The current review focuses on the relationship of alexithymia with depression and the role of culture in this relationship. The keywords for literature included terms such as depression, alexithymia, depression and alexithymia, Toronto Alexithymia Scale, assessing alexithymia and depression, and alexithymia as a trait. The main findings of the review were that alexithymia and depression are highly correlated, and severity of depression and gender are independently associated with alexithymia and may interfere with treatment outcomes.
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http://dx.doi.org/10.4103/psychiatry.IndianJPsychiatry_738_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214133PMC
April 2021

Mobile phone use screening test: Development, validation, and implications for screening excessive mobile use.

Ind Psychiatry J 2020 Jul-Dec;29(2):279-284. Epub 2021 Mar 15.

Service for Healthy Use of Technology (SHUT) Clinic, Department of Clinical Psychology, Bengaluru, Karnataka, India.

Background: Early identification for the addictive use of smartphones would enable timely intervention to minimize suffering from compromised functioning and associated psychological problems. This study is the first such attempt to develop a test for addictive/excessive use of the mobile phone in the Indian context. The present study aims to develop and validate the mobile phone use screening test (MUST) for the Indian subcontinent.

Materials And Methods: Five hundred individuals aged 18-40 years, residing in the South Indian city of Bangalore participated in the study. The sociodemographic datasheet and the newly developed test were administered on these individuals to gather demographic information and patterns of excessive mobile phone use.

Results: The developed test has 18-items which use a self-report Likert-type scale format. The test-retest reliability was 0.93 and the Cronbach's alpha was found to be 0.86. The scoring criterion for the overall score was: <30 = mild use; 31-49 = moderate use; and 50 and above = excessive/addictive smartphone use. The scale has four components: craving, loss of control, coping, and consequences.

Conclusions: The MUST can be used for the identification of addictive/excessive use of mobile phone among adolescents and young adult groups.
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http://dx.doi.org/10.4103/ipj.ipj_174_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188935PMC
March 2021

Association of cognitive impairment with sleep quality, depression and cardiometabolic risk factors in individuals with type 2 diabetes mellitus: A cross sectional study.

J Diabetes Complications 2021 08 28;35(8):107970. Epub 2021 May 28.

Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India.

Aim: The aim of this study was to evaluate the association of cognitive impairment with sleep quality, depression, and cardiometabolic risk factors among participants with type 2 diabetes mellitus.

Methods: Subjects underwent clinical interview to capture socio-demographic details, medical history, sleep quality, presence of depression, along with anthropometric and biochemical measurements. A detailed neuropsychological assessment [Montreal cognitive assessment scale (MoCA), Trail making A and B, Digit span, Spatial span, Letter Number Sequencing] was done. Cognitive impairment was defined as MoCA score of <23.

Results: Participants (n=250, 50% women, 63.6% middle-age) had a mean (±SD) age of 53.6 (±9.1) years and HbA1c of 55.1±6.8mmol/mol (7.2±0.6%). Cognitive impairment was present in 57 (22.8%) participants. In the middle-age subgroup, cognitive impairment was higher (23.9%) than those in the fourth decade (6.3%), but comparable (24.0%) to the older age (60-70years) individuals. Diabetes-related vascular complications [Odds ratio (95% CI) 2.03 (1.05, 3.94)]; hypertension [2.00 (1.04, 3.84)], depression [2.37 (1.24, 4.55)] and lower education [2.73 (1.42, 5.23)] had a significant association with cognitive impairment on multivariate logistic regression analysis.

Conclusion: The high burden of cognitive impairment calls for an urgent need to establish longitudinal cohorts in midlife to understand this population's cognitive trajectories and see the influence of various bio-psychosocial variables.
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http://dx.doi.org/10.1016/j.jdiacomp.2021.107970DOI Listing
August 2021

Psychosis susceptibility Zinc Finger Protein 804A (ZNF804A) gene polymorphism in Schizophrenia patients treated with Olanzapine in North Indian population.

Int J Neurosci 2021 Apr 19:1-9. Epub 2021 Apr 19.

Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, India.

The Zinc finger protein 804 A (ZNF804A) is a potential schizophrenia candidate gene that has emerged from genome-wide association studies. The aim of the study is to investigate whether this gene variant influences the response of positive or negative symptoms to antipsychotic drug olanzapine in North Indian schizophrenia patients. Our study involved 184 unrelated schizophrenia cases (114 males and 70 females; mean age: 52.8 ± 11.6 years) and 300 normal controls (168 males and 132 females; mean age: 54.9 ± 6.9 years). At the start of treatment and after four weeks, we assessed the response of positive and negative symptoms by positive and negative syndrome scale (PANSS). Olanzapine drug level was estimated using HPLC Method and Genotyping was performed using PCR-Snap Shot technique.: Significant differences were observed in the genotype distribution (χ2 = 6.10, d.f. = 2,  = 0.04) and allele frequencies (χ2 = 5.14, d.f. = 1,  = 0.02; odds ratio =0.57, 95% confidence interval =1.09-3.48) between schizophrenia patients and controls group. The improvement of positive and negative schizophrenia symptoms after 4 weeks of treatment with olanzapine was assessed. Patients homozygous for the ZNF804A risk allele for AA show poorer improvement of positive symptoms compared to patients with a protective allele. Our findings indicate that ZNF804A gene polymorphism plays a significant role in the treatment of schizophrenia, suggesting that ZNF804A may be an effective marker for schizophrenia treatment.
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http://dx.doi.org/10.1080/00207454.2021.1916742DOI Listing
April 2021

Multidimensional scale for child sexual abuse (MSCSA): Development and psychometric properties.

Asian J Psychiatr 2021 Jun 8;60:102643. Epub 2021 Apr 8.

Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India. Electronic address:

Background: In recognition to the rising incidences of child sexual abuse in India, various challenges of existing trauma measures and absence of indigenous efforts at development of comprehensive impact assessment scale, present study was conceptualized.

Objective: To develop and establish psychometric properties of Multidimensional Scale for Children with Sexual Abuse.

Participants And Settings: Outpatient department of government hospitals, non-governmental organizations and child care institutes were primary data setting from which a total of 457 participants were sampled.

Methods: The scale development process consisted of identifying impact themes from 59 qualitative research participants and item pooling from available scales; item writing followed by content and face validity analysis from 18 experts; and pilot testing on 30 children. The scale was then applied to 200 children with CSA and 150 children without sexual abuse. The factor structure of the scale was obtained using exploratory factor analysis. Internal consistency, split-half reliability, and validity (convergent, divergent, discriminant) were evaluated. Cut-off scores were obtained using the receiver operating characteristics curve and percentile analysis.

Results: The scale consisted of 62 items across 5 domains. It has high reliability (Cronbach's α 0.93; split-half reliability 0.89), high content, and discriminant validity. Convergent and divergent validity are satisfactory. Scale cut-off score of 31 has high sensitivity.

Conclusion: To our knowledge, this scale is the first such psychometrically robust self-rated scale for young children with sexual abuse in the Asian country. Available in both Hindi and English language, the scale provides a quick measure of trauma across multidimensional functioning.
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http://dx.doi.org/10.1016/j.ajp.2021.102643DOI Listing
June 2021

Mental health literacy among adolescents: Evidence from a community-based study in Delhi.

Int J Soc Psychiatry 2022 06 10;68(4):791-797. Epub 2021 Apr 10.

Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.

Background: Mental Health Literacy (MHL) is the ability to recognize mental disorders, along with knowledge of professional help available, effective self-help strategies, skills to give support to others, and knowledge of how to prevent mental disorders. Adequate MHL is linked to better health-seeking behavior and management of mental illness.

Aim: To assess the MHL related to depression and anxiety among adolescents of age 15 to 19 years residing in Delhi.

Methods: A survey was conducted among adolescents in southeast Delhi. MHL was assessed using sex-matched vignettes of Common Mental Disorders (CMDs) like depression and anxiety. MHL was assessed under domains of identifications of disorders, help-seeking behavior, knowledge about prevention, and stigmatizing attitude toward the respective illness. Statistical analysis was done in STATA and percentage of participants with adequate MHL in various domains was calculated, and difference between various groups was examined using chi-square test.

Results: A total of 491 adolescents participated (response rate of 87.2%) of whom a 50.3% were girls and 57.8% were 15 to 17 years of age. Only 50 (10.2%) participants identified depression vignette as that of depression and 51 (10.4%) identified vignette of anxiety disorder as the same. No statistically significant gender differential in MHL was seen ( value = .8). The stigmatizing attitude, assessed by asking a series of questions suggesting stigma toward the particular illness, was observed among almost all participants (depression -99.4%, and anxiety disorders -96.1%). 18.3% and 18.7% of participants reported correct knowledge about the prevention of depression and anxiety respectively. Four hundred and twenty-two (86%) identified the need to seek help for symptoms reported in vignettes. Of these, 234 (55%) preferred parents, and 62 (14.7%) look after friends for any help.

Conclusion: Adolescents residing in Delhi reported poor MHL for Common Mental Disorders. High stigma and poor help-seeking behavior was also observed among the participants toward CMDs.
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http://dx.doi.org/10.1177/00207640211006155DOI Listing
June 2022

Prevalence of Depression in Indian Adolescents.

Indian J Pediatr 2021 05 6;88(5):427-428. Epub 2021 Apr 6.

Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.

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http://dx.doi.org/10.1007/s12098-021-03750-4DOI Listing
May 2021
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