Mnemonics In A Mnutshell: 32 Aids To Psychiatric Diagnosis
Mnemonics in a mnutshell:32 aids to psychiatric diagnosisClever, irreverent, or amusing,a mnemonic you rememberis a lifelong learning toolea yHnenlowdse o Dultahnyrig r persopoCForom SIG: E CAPS to CAGE and WWHHHHIMPS,mnemonics help practitioners and trainees recallimportant lists (such as criteria for depression,screening questions for alcoholism, or life-threateningcauses of delirium, respectively). Mnemonics’ efficacyrests on the principle that grouped information is easier to remember than individual points of data.Not everyone loves mnemonics, but recollectingdiagnostic criteria is useful in clinical practice andresearch, on board examinations, and for insurancereimbursement. Thus, tools that assist in recalling diagnostic criteria have a role in psychiatric practice andteaching.In this article, we present 32 mnemonics to help clinicians diagnose: affective disorders (Box 1, page 28)1,2 anxiety disorders (Box 2, page 29)3-6 medication adverse effects (Box 3, page 29)7,8 personality disorders (Box 4, page 30)9-11 addiction disorders (Box 5, page 32)12,13 causes of delirium (Box 6, page 32).14We also discuss how mnemonics improve one’smemory, based on the principles of learning theory.How mnemonics work JUPITER IMAGESFiaedMhltJason P. Caplan, MDAssistant clinical professor of psychiatryCreighton University School of MedicineOmaha, NEChief of psychiatrySt. Joseph’s Hospital and Medical CenterPhoenix, AZTheodore A. Stern, MDProfessor of psychiatryHarvard Medical SchoolChief, psychiatric consultation serviceMassachusetts General HospitalBoston, MAA mnemonic—from the Greek word “mnemonikos”(“of memory”)—links new data with previously learnedinformation. Mnemonics assist in learning by reducingthe amount of information (“cognitive load”) that needsCurrent PsychiatryVol. 7, No. 1027For mass reproduction, content licensing and permissions contact Dowden Health Media.27 CPSY1008 279/12/08 3:20:58 PM
Mnemonicsto be stored for long-term processing andretrieval.15Memory, defined as the “persistence oflearning in a state that can be revealed at alater time,”16 can be divided into 2 types: declarative (a conscious recollection offacts, such as remembering a relative’sbirthday) procedural (skills-based learning, suchas riding a bicycle).Declarative memory has a consciouscomponent and may be mediated by themedial temporal lobe and cortical association structures. Procedural memory has lessof a conscious component; it may involvethe basal ganglia, cerebellum, and a varietyof cortical sensory-perceptive regions.17Declarative memory can be subdivided intoworking memory and long-term memory.With working memory, new items of information are held briefly so that encodingand eventual storage can take place.Working memory guides decisionmaking and future planning and is intricately related to attention.18-21 FunctionalMRI and positron emission tomographyas well as neurocognitive testing haveshown that working memory tasks activate the prefrontal cortex and brainregions specific to language and visuospatial memory.The hippocampus is thought to rapidlyabsorb new information, and this data isconsolidated and permanently stored viathe prefrontal cortex.22-26 Given the hippocampus’ limited storage capacity, new information (such as what you ate for breakfast3 weeks ago) will disappear if it is not repeated regularly.17BOX 1. MNEMONICS FOR DIAGNOSING AFFECTIVE DISORDERSDepressionSIG: E CAPS*Suicidal thoughtsInterests decreasedGuiltEnergy decreasedConcentration decreasedAppetite disturbance(increased or decreased)Psychomotor changes(agitation or retardation)Sleep disturbance(increased or decreased)DysthymiaHE’S 2 SAD2HopelessnessEnergy loss or fatigueSelf-esteem is low2 years minimum of depressedmood most of the day, for moredays than notSleep is increased or decreasedAppetite is increased or decreasedDecision-making or concentrationis impairedManiaDIG FASTDistractibilityIndiscretionGrandiosityFlight of ideasActivity increaseSleep deficitTalkativenessHypomaniaTAD HIGHTalkativeAttention deficitDecreased need for sleepHigh self-esteem/grandiosityIdeas that raceGoal-directed activity increasedHigh-risk activityManiaDeTeR the HIGH*DistractibilityTalkativenessReckless behaviorHyposomniaIdeas that raceGrandiosityHypersexuality* Created by Carey Gross, MDDepressionC GASP DIE1Concentration decreasedGuiltAppetiteSleep disturbancePsychomotor agitation or retardationDeath or suicide (thoughts or acts of)Interests decreasedEnergy decreased28* Created by Carey Gross, MDCurrent PsychiatryOctober 200828 CPSY1008 289/12/08 3:21:03 PM
Long-term memory, on the other hand, isencoded knowledge that is linked to factslearned in the past; it is consolidated inthe brain and can be readily retrieved.Neuroimaging studies have demonstrated opposing patterns of activation in thehippocampus and prefrontal cortex, depending on whether the memory beingrecalled is: new (high hippocampal activity, lowprefrontal cortex activity) old (low hippocampal activity, highprefrontal cortex activity).27Mnemonics are thought to affect workingmemory by reducing the introduced cognitive load and increasing the efficiency ofmemory acquisition and encoding. Theyreduce cognitive load by grouping objects into a single verbal or visual cue thatcan be introduced into working memory.Learning is optimized when the load onBOX 2. MNEMONICS FOR DIAGNOSING ANXIETY DISORDERSGeneralized anxiety disorderWorry WARTS3Wound raumatic stress disorderTRAUMA5Traumatic eventRe-experienceAvoidanceUnable to functionMonth or more of symptomsArousal increasedGeneralized anxiety disorderWATCHERS4WorryAnxietyTension in musclesConcentration difficultyHyperarousal (or irritability)Energy lossRestlessnessSleep disturbancePosttraumatic stress disorderDREAMS6Disinterest in usual activitiesRe-experienceEvent preceding symptomsAvoidanceMonth or more of symptomsSympathetic arousalClinical PointAnxiety disorder due to ageneral medicalTKconditionClinicalPointPhysical DiseasesThat HaveCommonly Appeared Anxious:TKPheochromocytomaDiabetes mellitusTemporal lobe epilepsyHyperthyroidismCarcinoidAlcohol withdrawalArrhythmiasBOX 3. MNEMONICS FOR DIAGNOSING MEDICATION ADVERSE EFFECTSAntidepressant discontinuationsyndromeFINISH7Flu-like symptomsInsomniaNauseaImbalanceSensory disturbancesHyperarousal (anxiety/agitation)Neuroleptic malignant syndromeFEVER8FeverEncephalopathyVital sign instabilityElevated WBC/CPKRigidityWBC: white blood cell countCPK: creatine phosphokinaseSerotonin syndromeHARMEDHyperthermiaAutonomic sisCurrent PsychiatryVol. 7, No. 1029 CPSY1008 29299/16/08 12:06:16 PM
Mnemonicsworking memory is minimized, enablinglong-term memory to be facilitated.28Mnemonics may use rhyme, music, orvisual cues to enhance memory. Most mnemonics used in medical practice and education are word-based, including: Acronyms—words, each letter of whichstands for a particular piece of informationto be recalled (such as RICE for treatmentof a sprained joint: rest, ice, compression,elevation). Acrostics—sentences with the first letter of each word prompting the desiredrecollection (such as “To Zanzibar by motor car” for the branches of the facial nerve:temporal, zygomatic, buccal, mandibular,cervical). Alphabetical sequences (such as ABCDEof trauma assessment: airway, breathing,circulation, disability, exposure).29An appropriate teaching tool?Dozens of mnemonics addressing psychiatric diagnosis and treatment have beenpublished, but relatively few are widelyused. Psychiatric educators may resistteaching with mnemonics, believing theymight erode a humanistic approach to patients by reducing psychopathology to “alaundry list” of symptoms and the art ofpsychiatric diagnosis to a “check-box” endeavor. Mnemonics that use humor maybe rejected as irreverent or unprofessional.30 Publishing a novel mnemonic may beviewed with disdain by some as an “easy”way of padding a curriculum vitae.Entire Web sites exist to share mnemonics for medical education (see RelatedResources, page 33). Thus it is likely thattrainees are using them with or withouttheir teachers’ supervision. Psychiatric ed-BOX 4. MNEMONICS FOR DIAGNOSING PERSONALITY DISORDERSParanoid personality disorderSUSPECT9Spousal infidelity suspectedUnforgiving (bears grudges)SuspiciousPerceives attacks (and reactsquickly)Enemy or friend? (suspectsassociates and friends)Confiding in others is fearedThreats perceived in benigneventsSchizotypal personality disorderME PECULIAR9Magical thinkingExperiences unusual perceptionsParanoid ideationEccentric behavior or appearanceConstricted or inappropriate affectUnusual thinking or speechLacks close friendsIdeas of referenceAnxiety in social situationsRule out psychotic or pervasivedevelopmental disordersBorderline personality disorderIMPULSIVE10ImpulsiveMoodinessParanoia or dissociation under stressUnstable self-imageLabile intense relationshipsSuicidal gesturesInappropriate angerVulnerability to abandonmentEmptiness (feelings of)Schizoid personality disorderDISTANT9Detached or flattened affectIndifferent to criticism or praiseSexual experiences of little interestTasks done solitarilyAbsence of close friendsNeither desires nor enjoysclose relationshipsTakes pleasure in few activitiesAntisocial personality disorderCORRUPT9Cannot conform to lawObligations ignoredReckless disregard for safetyRemorselessUnderhanded (deceitful)Planning insufficient (impulsive)Temper (irritable and aggressive)Borderline personality disorderDESPAIRER*Disturbance of identityEmotionally labileSuicidal behaviorParanoia or dissociationAbandonment (fear of)ImpulsiveRelationships unstableEmptiness (feelings of)Rage (inappropriate)* Created by Jason P. Caplan, MD30Current PsychiatryOctober 200830 CPSY1008 309/12/08 3:21:12 PM
ucators need to be aware of the mnemonicstheir trainees are using and to: screen these tools for factual errors(such as incomplete diagnostic criteria) remind trainees that although mnemonics are useful, psychiatrists should approach patients as individuals without theprejudice of a potentially pejorative label.Our methodologyIn preparing this article, we gatherednumerous mnemonics (some publishedand some novel) designed to capture thelearner’s attention and impart information pertinent to psychiatric diagnosis andtreatment. Whenever possible, we creditedeach mnemonic to its creator, but—giventhe difficulty in confirming authorship of(what in many cases has become) oral his-tory—we’ve listed some mnemonics without citation.Our list is far from complete because welikely are unaware of many mnemonics,and we have excluded some that seemedobscure, unwieldy, or redundant. We havenot excluded mnemonics that some mayview as pejorative but merely report theirexistence. Including them does not meanthat we endorse them.This article lists 32 mnemonics relatedto psychiatric diagnosis. Thus, it seemsodd that an informal survey of 60 residents at the Massachusetts General Hospital (MGH)/McLean Residency TrainingProgram in Psychiatry revealed that mostwere aware of only 2 or 3 psychiatric mnemonics, typically: SIG: E CAPS (a tool to recall the criteriafor depression)continuedHistrionic personality disorderPRAISE ME9Provocative or seductive behaviorRelationships considered moreintimate than they areAttention (need to be the center of)Influenced easilyStyle of speech (impressionistic,lacking detail)Emotions (rapidly shifting, shallow)Make up (physical appearanceused to draw attention to self)Emotions exaggeratedNarcissistic personality disorderGRANDIOSE11GrandioseRequires attentionArrogantNeed to be specialDreams of success and powerInterpersonally exploitativeOthers (unable to recognizefeelings/needs of)Sense of entitlementEnviousDependent personality disorderRELIANCE9Reassurance requiredExpressing disagreement difficultLife responsibilities assumed by othersInitiating projects difficultAlone (feels helpless anduncomfortable when alone)Nurturance (goes to excessivelengths to obtain)Companionship sought urgentlywhen a relationship endsExaggerated fears of being leftto care for selfHistrionic personality disorderACTRESSS*Appearance focusedCenter of attentionTheatricalRelationships (believed to bemore intimate than they are)Easily influencedSeductive behaviorShallow emotionsSpeech (impressionistic and vague)Avoidant personality disorderCRINGES9Criticism or rejection preoccupiesthoughts in social situationsRestraint in relationships due tofear of shameInhibited in new relationshipsNeeds to be sure of being likedbefore engaging sociallyGets around occupational activitieswith need for interpersonal contactEmbarrassment prevents newactivity or taking risksSelf viewed as unappealing or inferiorObsessive-compulsive personalitydisorderSCRIMPER*StubbornCannot discard worthless objectsRule obsessedInflexibleMiserlyPerfectionisticExcludes leisure due to devotionto workReluctant to delegate to others* Created by Jason P. Caplan, MD* Created by Jason P. Caplan, MDCurrent PsychiatryVol. 7, No. 1031 CPSY1008 31319/12/08 3:21:17 PM
Mnemonics DIG FAST (a list of criteria for diagnosing mania) WWHHHHIMPS (a tool for recallinglife-threatening causes of delirium).Although this unscientific survey maybe biased because faculty or trainees atMGH created the above 3 mnemonics,it nonetheless begs the question of whatqualities make a mnemonic memorable.Learning theory provides several clues.George Miller’s classic 1956 paper, “Themagical number seven, plus or minus two:some limits on our capacity for processinginformation,” discussed the finding that 7seems to be the upper limit of individualpieces of data that can be easily remem-bered.31 Research also has shown that recruiting the limbic system (potentiallythrough the use of humor) aids in the recallof otherwise dry, cortical information.32,33Intuitively, it would seem that nonrepeating letters would facilitate the recall ofthe linked data, allowing each letter to provide a distinct cue, without any cloudingby redundancy. Of the 3 most popular psychiatric mnemonics, however, only DIGFAST fits the learning theory. It contains 7letters, repeats no letters, and has the limbic cue of allowing the learner to imagine aperson with mania digging furiously.SIG: E CAPS falls within the range of7 plus or minus 2, includes a limbic cueBOX 5. MNEMONICS FOR DIAGNOSING ADDICTION DISORDERSSubstance dependenceADDICTeD12Activities are given up or reducedDependence, physical: toleranceDependence, physical: withdrawalIntrapersonal (Internal)consequences, physical orpsychologicalCan’t cut down or control useTime-consumingDuration or amount of use is greaterthan intendedSubstance abuseWILD12Work, school, or home roleobligation failuresInterpersonal or social consequencesLegal problemsDangerous useAlcohol abuseCAGE13Have you ever felt you shouldCUT DOWN your drinking?Have people ANNOYED youby criticizing your drinking?Have you ever felt bad orGUILTY about your drinking?Have you ever had a drink firstthing in the morning to steadyyour nerves or get rid of ahangover (EYE-OPENER)?BOX 6. MNEMONICS FOR DIAGNOSING DELIRIUMCausesI WATCH DEATHInfectionWithdrawalAcute metabolicTraumaCNS pathologyHypoxiaDeficienciesEndocrinopathiesAcute vascularToxins or drugsHeavy metals32Life-threatening causesWWHHHHIMPS*Wernicke’s encephalopathyWithdrawalHypertensive crisisHypoperfusion/hypoxia of the brainHypoglycemiaHyper/hypothermiaIntracranial process/infectionMetabolic/meningitisPoisonsStatus epilepticus* Created by Gary W. Small, MDDeliriogenic medicationsACUTE CHANGE IN MS14AntibioticsCardiac drugsUrinary incontinence drugsTheophyllineEthanolCorticosteroidsH2 blockersAntiparkinsonian drugsNarcoticsGeriatric psychiatric drugsENT drugsInsomnia drugsNSAIDsMuscle relaxantsSeizure medicinesCurrent PsychiatryOctober 200832 CPSY1008 329/12/08 3:21:21 PM
(although often forgotten, it refers to theprescription of energy capsules for depression), but repeats the letter S.WWHHHHIMPS, with 10 letters, exceeds the recommended range, repeats theW (appearing twice) and the H (appearing4 times), and provides no clear limbic cue.It may be that recruiting the limbic system provides the greatest likelihood ofrecall. Recruiting this system may add increased valence to a particular mnemonicfor a specific individual, but this samelimbic valence may limit its usefulness ina professional context.ReferencesRelated Resources Free searchable database of medical mnemonics. www.medicalmnemonics.com. Robinson DJ. Mnemonics and more for psychiatry. PortHuron, MI: Rapid Psychler Press, 2001.15. Sweller J. Cognitive load theory, learning difficulty, andinstructional design. Learn Instr 1994;4:295-312.16. Squire LR. Memory and brain. New York, NY: Oxford UniversityPress; 1987.17. DeLuca J, Lengenfelder J, Eslinger P. Memory and learning.In: Rizzo M, Eslinger P, eds. Principles and practice of behavioralneurology and neuropsychology. Philadelphia, PA: Saunders;2004:251.18. Dash PK, Moore AN, Kobori N, et al. Molecular activityunderlying working memory. Learn Mem 2007;14:554-63.19. Awh E, Vogel EK, Oh SH. Interactions between attention andworking memory. Neuroscience 2006;139:201-8.1. Abraham PF, Shirley ER. New mnemonic for depressivesymptoms. Am J Psychiatry 2006;163(2):329-30.20. Knudson EI. Fundamental components of attention. Ann RevNeurosci 2007;30:57-78.2. Christman DS. “HE’S 2 SAD” detects dysthymic disorder.Current Psychiatry 2008;7(3):120.21. Postle BR. Working memory as an emergent property of themind and brain. Neuroscience 2006;139:23-36.3. Coupland NJ. Worry WARTS have generalized anxietydisorder. Can J Psychiatry 2002;47(2):197.22. Fletcher PC, Henson RN. Frontal lobes and human memory:Insights from functional neuroimaging. Brain 2001;124:84981.4. Berber MJ. WATCHERS: recognizing generalized anxietydisorder. J Clin Psychiatry 2000;61(6):447.5. Khouzam HR. A simple mnemonic for the diagnostic criteriafor post-traumatic stress disorder. West J Med 2001;174(6):424.6. Short DD, Workman EA, Morse JH, Turner RL. Mnemonicsfor eight DSM-III-R disorders. Hosp Community Psychiatry1992;43(6):642-4.23. Miller EK, Cohen JD. An integrative theory of prefrontalcortex function. Ann Rev Neurosci 2001;24:167-202.24. Schumacher EH, Lauber E, Awh E, et al. PET evidence for amodal verbal working memory system. Neuroimage 1996;3:7988.25. Smith EE, Jonides J, Koeppe RA. Dissociating verbal andspatial working memory using PET. Cereb Cortex 1996;6:11-20.7. Berber MJ. FINISH: remembering the discontinuationsyndrome. Flu-like symptoms, Insomnia, Nausea, Imbalance,Sensory disturbances, and Hyperarousal (anxiety/agitation).J Clin Psychiatry 1998;59(5):255.26. Wager TD, Smith EE. Neuroimaging studies of workingmemory: a meta-analysis. Cogn Affect Behav Neurosci 2003;3(4):255-74.8. Christensen RC. Identify neuroleptic malignant syndromewith FEVER. Current Psychiatry 2005;4(7):102.27. Frankland PW, Bontempi B. The organization of recent andremote memories. Nat Rev Neurosci 2005;6:119-30.9. Pinkofsky HB. Mnemonics for DSM-IV personality disorders.Psychiatr Serv 1997;48(9):1197-8.28. Sweller J. Cognitive load during problem solving: effects onlearning. Cogn Sci 1988;12(1):257-85.10. Senger HL. Borderline mnemonic. Am J Psychiatry 1997;154(9):1321.29. Beitz JM. Unleashing the power of memory: the mightymnemonic. Nurse Educ 1997;22(2):25-9.11. Kim SI, Swanson TA, Caplan JP, eds. Underground clinicalvignettes step 2: psychiatry. 4th ed. Philadelphia, PA: LippincottWilliams & Wilkins; 2007:130.30. Larson EW. Criticism of mnemonic device. Am J Psychiatry1990;147(7):963-4.12. Bogenschutz MP, Quinn DK. Acronyms for substance usedisorders. J Clin Psychiatry 2001;62(6):474-5.31. Miller GA. The magical number seven, plus or minus two:some limits on our capacity for processing information.Psychol Rev 1956;63:81-97.13. Ewing JA. Detecting alcoholism. The CAGE questionnaire.JAMA 1984;252(14):1905-7.32. Schmidt SR. Effects of humor on sentence memory. J ExpPsychol Learn Mem Cogn 1994;20(4):953-67.14. Flaherty JH. Psychotherapeutic agents in older adults.Commonly prescribed and over-the-counter remedies: causesof confusion. Clin Geriatr Med 1998;14:101-27.33. Lippman LG, Dunn ML. Contextual connections withinpuns: effects on perceived humor and memory. J Gen Psychol2000;127(2):185-97.Clinical PointWe included somemnemonics thatmay be viewed aspejorative, but thatdoes not meanwe endorse themBottom LineRecollecting diagnostic criteria is useful in clinical practice, on board examinations,and for insurance reimbursement. Mnemonics are well-suited to learning andrecalling lists of signs and symptoms required for accurate psychiatric diagnosis.Current PsychiatryVol. 7, No. 1033 CPSY1008 33339/12/08 3:21:26 PM
32 aids to psychiatric diagnosis Clever, irreverent, or amusing, a mnemonic you remember is a lifelong learning tool Jason P. Caplan, MD Assistant clinical professor of psychiatry Creighton University School of Medicine Omaha, NE Chief of psychiatry St. Joseph’s Hospital and Medical Center
Simplified Mnemonics for PowerPC Instructions Rotate and Shift Simplified Mnemonics 3 Rotate and Shift Simplified Mnemonics Rotate and shift instructions provide powerful, general ways to manipulate register contents, but can be
3) Movement 3 — Review the mnemonics that gave you the most trouble. 4) Finale — Go through the Question Section. 5) First Encore — Review the questions you got wrong and re-memorize the mnemonics if necessary. 6) Grand Finale — We have placed the questions themselves in the Answer Section as a convenience, so you do not need to
names of the players in your favorite sports team, or the words to a favorite song, or the names of the characters in your favorite TV show. (Mnemonics do not, in fact, play a role when you have that depth of knowledge. Once you know something at the l
Pharmacology Mnemonics and Short Notes By Muhammad Ramzan Ul Rehman s General Concepts Pharmacology Study of substance that interact with living systems through clinical processes especially by binding to regulatory molecule Pharmacopeia are the
Pharmacology Mnemonics for the Nurse Practitioner is a general guide to pharmacology, meaning it will help you no matter your specialty. It is a bit of a cross between what you would expect from a book for nurses and one geared toward physicians.
Jul 09, 2017 · makes it is easier to remember that a numismatist is a coin collector. d. How about using a bad joke to help you remember? Picture an image of two numismatists having a drink for “old dime’s sake.” orny? Yes, but cornography often makes things easier to remember. 8. Connections Mnemonics
2016 Pieper Bar Review 1 . CONTRACTS MNEMONICS . 1) The ingredients for a valid contract are TACO: T - Definite TERMS, express or implied A - ACCEPTANCE of terms C - CONSIDERATION O - OFFER inviting acceptance . 2) An offer expires when it gets TIRED: T - Reasonable TIME after an offer is made, or after expiration date expressly stated in an offer
Spring Awakening [1891/1906]. Translated by Jonathan Franzen. Faber & Faber 2007. [on loan from NYU Berlin] o Oskar Kokoschka. Murderer, Hope of Women In: Plays and Poems [1907/1910. ]. Translated by Michael Mitchell. Ariadne Press 2001. pp. 21 – 28. [course reader] o David F. Kuhns. German Expressionist Theatre: The Actor and the Stage .
