Evidence-Based Reviews

Mnemonics in a mnutshell: 32 aids to psychiatric diagnosis

Current Psychiatry. 2008 October;7(10):27-33

Jason P. Caplan, MD

Theodore A. Stern, MD

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

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References

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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:

affective disorders (Box 1)^1,2
anxiety disorders (Box 2)^3-6
medication adverse effects (Box 3)^7,8
personality disorders (Box 4)^9-11
addiction disorders (Box 5)^12,13
causes of delirium (Box 6).¹⁴

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