Evidence-Based Reviews

Mnemonics in a mnutshell: 32 aids to psychiatric diagnosis

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Clever, irreverent, or amusing, a mnemonic you remember is a lifelong learning tool


 

References

From SIG: E CAPS to CAGE and WWHHHHIMPS, mnemonics help practitioners and trainees recall important lists (such as criteria for depression, screening questions for alcoholism, or life-threatening causes of delirium, respectively). Mnemonics’ efficacy rests on the principle that grouped information is easier to remember than individual points of data.

Not everyone loves mnemonics, but recollecting diagnostic criteria is useful in clinical practice and research, on board examinations, and for insurance reimbursement. Thus, tools that assist in recalling diagnostic criteria have a role in psychiatric practice and teaching.

In this article, we present 32 mnemonics to help clinicians diagnose:

We also discuss how mnemonics improve one’s memory, based on the principles of learning theory.

How mnemonics work

A mnemonic—from the Greek word “mnemonikos” (“of memory”)—links new data with previously learned information. Mnemonics assist in learning by reducing the amount of information (“cognitive load”) that needs to be stored for long-term processing and retrieval.15

Memory, defined as the “persistence of learning in a state that can be revealed at a later time,”16 can be divided into 2 types:

  • declarative (a conscious recollection of facts, such as remembering a relative’s birthday)
  • procedural (skills-based learning, such as riding a bicycle).

Declarative memory has a conscious component and may be mediated by the medial temporal lobe and cortical association structures. Procedural memory has less of a conscious component; it may involve the basal ganglia, cerebellum, and a variety of cortical sensory-perceptive regions.17

BOX 1.

MNEMONICS FOR DIAGNOSING AFFECTIVE DISORDERS

Depression
SIG: E CAPS*
Suicidal thoughts
Interests decreased
Guilt
Energy decreased
Concentration decreased
Appetite disturbance (increased or decreased)
Psychomotor changes (agitation or retardation)
Sleep disturbance (increased or decreased)
* Created by Carey Gross, MD
Dysthymia
HE’S 2 SAD2
Hopelessness
Energy loss or fatigue
Self-esteem is low
2 years minimum of depressed mood most of the day, for more days than not
Sleep is increased or decreased
Appetite is increased or decreased
Decision-making or concentration is impaired
Mania
DIG FAST
Distractibility
Indiscretion
Grandiosity
Flight of ideas
Activity increase
Sleep deficit
Talkativeness
Depression
C GASP DIE1
Concentration decreased
Guilt
Appetite
Sleep disturbance
Psychomotor agitation or retardation
Death or suicide (thoughts or acts of)
Interests decreased
Energy decreased
Hypomania
TAD HIGH
Talkative
Attention deficit
Decreased need for sleep
High self-esteem/grandiosity
Ideas that race
Goal-directed activity increased
High-risk activity
Mania
DeTeR the HIGH*
Distractibility
Talkativeness
Reckless behavior
Hyposomnia
Ideas that race
Grandiosity
Hypersexuality
* Created by Carey Gross, MD

Declarative memory can be subdivided into working memory and long-term memory.

With working memory, new items of information are held briefly so that encoding and eventual storage can take place.

Working memory guides decision-making and future planning and is intricately related to attention.18-21 Functional MRI and positron emission tomography as well as neurocognitive testing have shown that working memory tasks activate the prefrontal cortex and brain regions specific to language and visuospatial memory.

The hippocampus is thought to rapidly absorb new information, and this data is consolidated and permanently stored via the prefrontal cortex.22-26 Given the hippocampus’ limited storage capacity, new information (such as what you ate for breakfast 3 weeks ago) will disappear if it is not repeated regularly.17

Long-term memory, on the other hand, is encoded knowledge that is linked to facts learned in the past; it is consolidated in the brain and can be readily retrieved. Neuroimaging studies have demonstrated opposing patterns of activation in the hippocampus and prefrontal cortex, depending on whether the memory being recalled is:

  • new (high hippocampal activity, low prefrontal cortex activity)
  • old (low hippocampal activity, high prefrontal cortex activity).27

Mnemonics are thought to affect working memory by reducing the introduced cognitive load and increasing the efficiency of memory acquisition and encoding. They reduce cognitive load by grouping objects into a single verbal or visual cue that can be introduced into working memory. Learning is optimized when the load on working memory is minimized, enabling long-term memory to be facilitated.28

BOX 2.

MNEMONICS FOR DIAGNOSING ANXIETY DISORDERS

Generalized anxiety disorder
Worry WARTS3
Wound up
Worn-out
Absentminded
Restless
Touchy
Sleepless
Posttraumatic stress disorder
TRAUMA5
Traumatic event
Re-experience
Avoidance
Unable to function
Month or more of symptoms
Arousal increased
Anxiety disorder due to a general medical condition
Physical Diseases That Have Commonly Appeared Anxious:
Pheochromocytoma
Diabetes mellitus
Temporal lobe epilepsy
Hyperthyroidism
Carcinoid
Alcohol withdrawal
Arrhythmias
Generalized anxiety disorder
WATCHERS4
Worry
Anxiety
Tension in muscles
Concentration difficulty
Hyperarousal (or irritability)
Energy loss
Restlessness
Sleep disturbance
Posttraumatic stress disorder
DREAMS6
Disinterest in usual activities
Re-experience
Event preceding symptoms
Avoidance
Month or more of symptoms
Sympathetic arousal

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