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Mnemonic possession

Vol. 8, No. 1 / January 2009

I was surprised to see my TRAUMA mnemonic featured in the article “Mnemonics in a mnutshell: 32 aids to psychiatric diagnosis” (Current Psychiatry, October 2008) and attributed to the article by Dr. Khouzam. I created my first mnemonic—TRAMA—for posttraumatic stress disorder (PTSD) in 1992. When the clinically significant distress/impaired functioning criterion was included in DSM-IV, I added the “U” for “unable.” I first presented a copyrighted version of TRAUMA in 1994 during a lecture to medical students at Columbia University. Since then I have presented it on numerous occasions.

The authors also did not include my mnemonics for subcriteria corresponding to the 3 symptom clusters of PTSD:

R3D2 (think Star Wars and add an “R”) stands for:

  • Recollections, Recurring, and Reactivity (physiological) in response to cues of the traumatic event
  • Dreams (distressing) and Distress (psychological).

AFRAID equals:

  • Avoid thoughts, feelings, conversations, people, places, or activities associated with the trauma
  • Foreshortened future
  • Recall (inability to)
  • Affect (restricted)
  • Interest (diminished)
  • Detachment.

SCARE represents:

  • Sleep (difficulty falling or staying)
  • Concentration (difficulty)
  • Anger (outbursts or irritability)
  • Really vigilant
  • Exaggerated startle response.

Finally, to accurately quote DSM-IV or DSM-IV-TR, the symptoms you listed in the TRAUMA mnemonic need to persist for “more than 1 month” instead of a “month or more.”

Joseph C. Napoli, MD, DFAPA
Assistant clinical professor of psychiatry
Columbia University
New York, NY

Drs. Caplan and Stern Respond

Although we made a good-faith effort to find the original sources of mnemonics included in our article, we were aware that lore and oral history might not allow us to properly cite the contributions of these innovators. In this case, because to the best of our memory neither of the authors have attended a lecture by Dr. Napoli, our awareness of the TRAUMA mnemonic originated from the cited published article.

Since publication of our article, we also have heard from William Falk, MD, at Massachusetts General Hospital informing us that he created DIG FAST to help remember the criteria for mania. We offer apologies to those ingenious clinicians for not our citing their role in the genesis of these mnemonics, and we are grateful that they have enhanced the accuracy of the information we provided.

We also could say: Some Oversights Shall Occasionally Result in Remorse and Yearning (SO SORRY).

Jason P. Caplan, MD
Assistant clinical professor of psychiatry
Creighton University School of Medicine
Omaha, NE

Theodore A. Stern, MD
Professor of psychiatry
Harvard Medical School
Boston, MA

To comment on articles in this issue or other topics, send letters in care of Erica Vonderheid, Current Psychiatry, 110 Summit Avenue, Montvale, NJ 07645, or click here.

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