Mnemonics for Diagnostic Criteria of DSM V Mental Disorders: a Scoping Review

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Open access Review Gen Psych: first published as 10.1136/gpsych-2019-100109 on 14 May 2020. Downloaded from Mnemonics for diagnostic criteria of DSM V mental disorders: a scoping review

Pavan Kumar Kadiyala ‍

To cite: Kadiyala PK. Mnemonics ABSTRACT the sillier and more ridiculous the mnemonic for diagnostic criteria of DSM A multitude of psychiatric disorders have been is, the better one can remember it.2 3 V mental disorders: a scoping described in classification systems like the Diagnostic review. Mnemonics as narratives or anecdotes are General Psychiatry and Statistical Manual of Mental Disorders Fifth Edition 2020;33:e100109. doi:10.1136/ particularly useful in medicine, where it is gpsych-2019-100109 (DSM V). Diagnosing a specific mental disorder requires often necessary to learn clusters of symptoms memorising specific symptom criteria, and their improper corresponding to a particular diagnosis.1 Reli- ►► Additional material is recall may result in misdiagnosis. Clinicians may use published online only. To view able diagnoses are essential for treatment, mnemonics, considering them as narratives or anecdotes please visit the journal online research, documentation and epidemiolog- of the diagnostic criteria. A scoping review of previously (http://dx. doi.org/ 10.1136/ ical purposes. The current and Fifth Edition gpsych-2019- 100109). described mnemonics for DSM diagnostic criteria was carried out. An electronic search was done in PubMed, of the Diagnostic and Statistical Manual of Google Scholar, Google Books and Google Search engine Mental Disorders (DSM V) serves clinicians as Received 27 June 2019 using a prespecified search strategy. Reference lists a guide to identifying the criteria for the diag- Revised 12 December 2019 4 of relevant articles and chapters were hand searched nosis of mental disorders. The current paper Accepted 10 January 2020 to identify original and additional articles. Mnemonics presents a scoping review of mnemonics retrieved from websites were manually searched in available in recalling the DSM diagnostic Google to identify published journal articles or chapters criteria for mental disorders. Alongside, some for the same mnemonics. Additionally, some mnemonics mnemonics developed or modified by the were developed, modified or added based on the author’s author are also presented. knowledge. The comprehensive search identified 93 records (44 journal articles, 45 books and 4 websites) http://gpsych.bmj.com/ eligible for the review. Most of the mnemonics retrieved Method were related in some way to the disorder itself. They were This review aims to provide an overview or listed under the heading of their respective disorders and indexed in the same order as in DSM V. The mnemonics map the available mnemonics rather than that reflect a facet of their respective disorders were to critically appraise or provide concrete elaborated in detail. guidance for their use in clinical practice. A method of scoping review was selected to summarise and disseminate the available mnemonics for DSM diagnostic criteria.5 6 on September 25, 2021 by guest. Protected copyright. Introduction The methodology for this scoping review was Mnemonics are specific devices for improving based on the framework outlined by Arksey memory and have been used since clas- and O’Malley and ensuing recommendations sical times. It is unlikely that any of us come made by Levac et al.7 8 The review included through life without relying on a mnemonic 1 the following four key phases: (1) defining at some time or another. Mnemonics use the research question and selection criteria; © Author(s) (or their cognitive cuing processes of organisation, (2) comprehensive search of the litera- employer(s)) 2020. Re-use elaboration and mental imagery during both 2 ture; (3) data extraction, and (4) collating, permitted under CC BY-NC. No learning and recall. Most mnemonics are summarising and reporting the results. commercial re-use. See rights categorised into acrostic sentences, acronyms, and permissions. Published by BMJ. peg word, keyword, method of loci, rhymes or Research question and selection criteria Department of Psychiatry, Alluri word play. Acrostic mnemonics are sentences This review was guided by the question, Sitarama Raju Academy of in which the first letter of each word is the ‘What are all the mnemonics available for Medical Sciences, Eluru, Andhra first letter of one of the things that need to be remembering the DSM diagnostic criteria for Pradesh, India remembered. An acronym is a word created mental disorders?’ Mnemonics published in Correspondence to by using the first letter of each word of the any way, whether journal articles or chapters Dr Pavan Kumar Kadiyala; information to be recalled. Mnemonics made in books or websites or presentations and drkadiy ala2@gmail.com by oneself are often the most useful. Often those developed or modified by the author,

Kadiyala PK. General Psychiatry 2020;33:e100109. doi:10.1136/gpsych-2019-100109 1 General Psychiatry Gen Psych: first published as 10.1136/gpsych-2019-100109 on 14 May 2020. Downloaded from Table 1 STARLITE principles applied to the literature the relevant mnemonics. A search was also done by the search Google Search engine to identify grey literature. A deci- sion was made to screen only the first 100 hits in Google Criteria Result Books and Google Search engine because it was believed S Sampling strategy Comprehensive that further screening was unlikely to yield many more T Type of study Any kind of qualitative study relevant articles.10 Articles from Google Scholar were 11 A Approaches Electronic and citation retrieved by using Publish or Perish software. The snowballing keywords used in various combinations were: [‘DSM R Range of years No restrictions to the beginning— OR psychiatry OR psychiatric] AND [mnemonic OR to the end of September 2019 mnemonics]’. Searches were completed in September L Limits Language (English) 2019. The results of searches were entered into a bibliographic software program (Zotero) for the auto- I Inclusion and Included all the articles published matic removal of duplicates.12 The STARLITE (Stan- exclusions in any way, whether in journals or chapters in books or websites or dards for Reporting Literature searches) principles 13 presentations were used to report the literature search (table 1). T Terms DSM, psychiatry, psychiatric, The selection process was also presented in a flowchart mnemonic, mnemonics (figure 1). E Electronic sources PubMed, Google Scholar, Google The titles and abstracts of all the articles, the content Books, Google Search engine of chapters and websites retrieved by the initial searches were screened. Full-text articles of those deemed relevant DSM, Diagnostic and Statistical Manual of Mental Disorders; were retrieved for subsequent review. Reference lists and STARLITE, Standards for Reporting Literature searches. secondary citations in relevant articles and chapters were hand searched to identify original and additional articles in were included. Search for mnemonics was limited to the 14 15 English language, with no date restrictions applied. No a ‘snowball’ technique. The articles with no secondary exclusion criteria were defined based on the publication references were taken as original sources of the mnemonics type, as long as the article described original research. and cited the same. There was no appraisal of the quality of the records. Mnemonics taken from the journal articles Comprehensive search of the literature and chapters in books were given higher preference as they Literature was searched systematically in an expansive may be peer reviewed or edited systematically. Mnemonics manner. It allows search strategies to emerge as the retrieved from websites were manually searched in Google research investigation takes shape and ensures that to identify published literature (in the form of journal data collection efforts yield more than narrowly redun- articles or chapters) for the same mnemonics. If multiple http://gpsych.bmj.com/ dant data.9 Electronic searches were carried out using records with the same mnemonic were available, then the PubMed, Google Scholar and Google Books to locate oldest published article was given preference. on September 25, 2021 by guest. Protected copyright.

Figure 1 Flowchart of the study. DSM, Diagnostic and Statistical Manual of Mental Disorders.

2 Kadiyala PK. General Psychiatry 2020;33:e100109. doi:10.1136/gpsych-2019-100109 General Psychiatry Gen Psych: first published as 10.1136/gpsych-2019-100109 on 14 May 2020. Downloaded from Data extraction –– Reduced word knowledge (vocabulary). The data of mnemonics for diagnostic criteria were –– Limited sentence structure. extracted by retrieving full-text articles or chapters of the –– Impairments in discourse. books. The mnemonics from websites without published 2. Below expected for age. literature were retained by citing the website itself. Few 3. Onset in the early developmental period. articles and chapters were included based on the author’s knowledge if mnemonics for any psychiatric disorder were Speech sound disorder not found by the search strategies applied. The authorship, ‘Sound limits communication during development.’ year of publication, type and source of the articles were 1. Persistent difficulty with speech sound. extracted and tabulated. The reasons that led to the devel- 2. Limits effective communication. opment or collation of mnemonics were discussed. 3. Onset in the early developmental period.

Collating, summarising and reporting the results Childhood-onset fluency disorder (stuttering) The mnemonics were collated and summarised under ‘Repeat or prolong or substitute the pauses or block the heading of each disorder. The disorders were indexed repetitive tensions during development.’ in the same order as in DSM V. Some mnemonics were 1. Persistent disturbances in normal fluency and time modified or developed by the author. Those mnemonics patterning of speech, inappropriate for the individu- that have no citation are the works of the author. Those al’s age and language skills. Frequent and marked oc- mnemonics that reflect a facet of their respective disor- currences of one (or more) of the following: ders were elaborated in detail. –– Sound and syllable repetitions. –– Sound prolongations. –– Substituting problematic words (circumlocutions). Results –– Pauses within a word (broken words). The comprehensive search identified 4288 records –– Audible or silent blocking. (PubMed 692, Google Scholar 2996, Google Books 300, –– Monosyllabic whole-word repetitions. Google Search engine 300). After the automatic removal –– Words produced with an excess of physical ten- of duplicates by software (Zotero), 2741 records were sion. identified. Screening the titles and abstracts of these 2. Onset in the early developmental period. records, followed by the full text of relevant articles and chapters in books, retrieved 60 eligible records. Of these, Social (pragmatic) communication disorder 31 were journal articles and 25 were book chapters. The ‘Understand social and contextual rules of conversation remaining four were websites without published liter- during development.’ ature. Eleven records were added when searched for A. Persistent difficulties in the social use of verbal and http://gpsych.bmj.com/ published literature (of journal articles and chapters) for non-verbal communication as manifested by: the mnemonics in websites. Ten records were retrieved 1. Difficulty understanding what is not explicitly stat- from the reference lists of relevant articles. Twelve were ed or non-literal language. added based on the author’s knowledge. A total of 93 (44 2. Deficits in using communication for social purpos- journal articles, 45 books and 4 websites) were eligible for es. this review. The authorship, year of publication and type 3. Disability to change communication to match context or the needs of the listener.

and source of the articles were tabulated and available in on September 25, 2021 by guest. Protected copyright. the online supplementary file 1. 4. Difficulties following rules for conversation and storytelling. Mnemonics for diagnostic criteria of DSM mental disorders B. Onset in the early developmental period. Neurodevelopmental disorders Intellectual disability Autism spectrum disorder ‘During development Intellects adapt by conceptual, ‘Reciprocate, relate and communicate in social inter- social and practical support.’ actions; Restrict repetitive, rigid and unusual reactive 1. Onset during developmental period. behavior during developmental period.’ 2. Deficits in intellectual functions. A. Persistent deficits in social communication and social 3. Deficits in adaptive functioning. interaction, manifested by: Severity defined on the basis of adaptive functioning in 1. Deficits in socioemotional reciprocity. conceptual, social and practical domains that determine 2. Deficits in developing, maintaining and understand- the level of supports required. ing relationships. 3. Deficits in non-verbal communicative behaviours used Language disorder for social interaction. ‘Express or Comprehend words, sentences, discourses B. Behaviour or interests manifested by at least two of expected for age during development.’ the following: 1. Persistent deficits in expression and comprehension of 1. Highly restricted, fixated interests that are abnormal language that include: in intensity.

Kadiyala PK. General Psychiatry 2020;33:e100109. doi:10.1136/gpsych-2019-100109 3 General Psychiatry Gen Psych: first published as 10.1136/gpsych-2019-100109 on 14 May 2020. Downloaded from 2. Repetitive or stereotyped motor movements, use of ob- Other mnemonics for ADHD jects, or speech. 1. Inattentive symptoms: when the child is inattentive, 3. Rigid adherence to routines, or ritualised patterns of CALL FOR FrEd (six of nine). Hyperactive-impulsive verbal or non-verbal behaviour, insistence on same- symptoms: with these symptoms, the child RUNS ness. FASTT (six of nine).19 4. Hyper- or hypo-reactivity to sensory input or unusual 2. Inattention: (mnemonic: SOLID); hyperactivity and 20 interest in sensory aspects of the environment. impulsivity: (mnemonic: WORST FAIL). C. Onset in the early development period. 3. You’ll need a MOAT around the classroom for the Other mnemonics for autism spectrum disorder (ASD; hyperactive child. Movement excess, Organisational 21 modified by the author) are: problems, Attention problems, Talking impulsively. 1. AUTISTICS:16 4. RAPID GIRL for symptoms of hyperactivity and impul- 22 Again and again (repetitive behaviour/speech) sivity; DETAILS OFF for symptoms of inattention. Unusual (hyper or hypo) reactivity to sensory aspects 5. CAN’T FOCUS? For inattentive subtype, DO I Toddlers (during early development) FIDGET? For hyperactive/impulsive subtype. The sev- 23 Insistence on sameness, inflexible adherence to en I’s of ADHD combined type. routines; Interests restricted and abnormal in intensity or Schizophrenia spectrum and other psychotic disorders focus Delusional disorder: ‘DeluSIONAL’ Socioemotional reciprocity deficits Delusion/s To relate with others is a difficulty Schizophrenia A criteria not met Impairment in social, occupational or other functioning Impairment of functioning is absent Communication (non-verbal) poor for social Odd or bizarre behaviour absent interaction Not due to substance or another medical condition Social communication below that expected for Absence of mood episodes and if occurred are brief general development; that is, not due to intellectual relative to the duration of delusional periods disability Lasts 1 month or more 17 2. SCARE: Another mnemonic for the delusional disorder is ‘NO Social relationships and reciprocity deficits FAME’.24 Communication for social interaction poor Activities restricted, rigid and repetitive Brief psychotic disorder Reactivity to sensory aspects hyper or hypo ‘HalDol disorganizes speech and behavior in cat for at Early onset least 1 day but less than 1 month’ (≥1; at least one in first 3. AUTISTIC PEOPLE18 three). http://gpsych.bmj.com/ A. Presence of one (or more) of the following, with at Attention-deficit/hyperactivity disorder (ADHD) least one must be 1, 2 or 3: Symptoms of inattention include (mnemonic: ATTEN- 1. Hallucinations. TION): six or more 2. Delusions. Attention difficulty 3. Disorganised speech. Trouble listening to others even when spoken directly 4. Disorganised behaviour including catatonia.

Tasks that require sustained mental effort are difficult B. Duration for at least 1 day but less than 1 month. on September 25, 2021 by guest. Protected copyright. Easily distracted Necessary things for tasks are lost Schizophreniform disorder To finish what he/she starts is difficult HalDol disorganises speech and behaviour in cat nega- Is forgetful in daily activities tively for at least 1 month but less than 6 months (two of Organisational skills lacking five; at least one from first three). A. Two (or more) of the following, with at least one must Not concerned about details or makes careless mistakes be 1, 2 or 3: Symptoms of hyperactivity and impulsivity include 1. Hallucinations. (mnemonic: RUN FIDGET) (developed by the author 2. Delusions. based on other mnemonic: RUNS FASTT)19: six or more 3. Disorganised speech. Runs, climbs or restless 4. Disorganised behaviour including catatonia. Uninhibited in conversation 5. Negative symptoms. Not able to play quietly B. Duration for at least 1 month but less than 6 months. Fidgets or squirms in seat Interrupts or intrudes on others Schizophrenia Difficulty waiting his or her turn ‘HalDol disorganizes speech & behavior in cat negatively Get going or acting as if driven by a motor impairing function for 6 months’ (two of five; at least one Evacuates seat unexpectedly from first three): Talks excessively A. Same as that of schizophreniform disorder.

4 Kadiyala PK. General Psychiatry 2020;33:e100109. doi:10.1136/gpsych-2019-100109 General Psychiatry Gen Psych: first published as 10.1136/gpsych-2019-100109 on 14 May 2020. Downloaded from B. Impairment of functioning. anhedonia for at least 2 weeks continuously, along with C. Duration for at least 6 months. four of the other seven depressive neurovegetative symp- Criteria A of schizophreniform disorder or schizo- toms (without having depressed mood as such).30 The phrenia can be remembered by the mnemonic: Delu- eight neurovegetative symptoms of depression can be sions Herald Schizophrenic’s Bad News.19 remembered with the mnemonic ‘SIGECAPS’ developed Other mnemonics for schizophrenia that may be by Dr Carey Gross at Massachusetts General Hospital. useful are Haldol-D, 25 A HARD CRASH26 and HALDOL The mnemonic refers to a prescription one might write BENDER.24 for a patient who is depressed and anergic—SIG: Energy CAPSules (‘sig’ is written before the directions on a Catatonia prescription).34 44 Catatonia associated with another mental disorder (cata- Suicidal thoughts tonia specifier): Interests decreased ‘G-MAN SWEEPS MineCraft’ (≥3 of 12) Guilt Grimacing, Mannerism, Agitation, Negativism, Stupor, Energy decreased Waxy flexibility, Echolalia, Echopraxia, Posturing, Stereo- Concentration decreased typy, Mutism, Catalepsy Appetite disturbance (increased or decreased) Other mnemonics that may be helpful are Wired & 27 26 28 Psychomotor changes (agitation or retardation) Mired, LIMP MEN and A SLIME-posture. Sleep disturbance (increased or decreased) Bipolar and related disorders Other mnemonics are C GASP DIE—it overcomes the problem of the two S’s (and trying to recall what Manic episode An abnormal and persistent elevated, expansive or irri- they stand for) in the mnemonic SIGECAPS. Here, D represents thoughts or acts of death,45 46 DEPRESSION,25 47 table mood and increased goal-directed activity or energy 23 48 26 plus DIGFAST (three or four of seven) for 7 days. Dr DISGUSTED, DEPRESSING, SAMPLEIDS, Depres- sion Is Worth Seriously Memorizing Extremely Weighty William Falk at Massachusetts General Hospital devel- 32 33 29–31 Criteria Sorry, Depression Is Worth Studiously Memo- oped the mnemonic DIGFAST. The term may refer 49 to the speed with which a patient who is manic would dig rizing Extremely Grueling Criteria. Sorry (DIWSMEGCS), DIGSPACES,50 DEAD SWAMP,51 SAD IMAGES, MASS FEE a hole if put to the task, as they may appear as if ‘driven 24 52 53 by a motor’.19 GAP FITS, Two weeks of A SAD FACE, SAD FACES, IN SAD CAGES,54 ESCAPISMS (as many patients want to escape Distractibility 55 56 Indiscretion, pleasurable activities with painful their condition), ESCAPERS. consequences Specifiers for bipolar and related disorders http://gpsych.bmj.com/ Grandiosity With anxious distress: ‘CARLoT’ (two of five) Flight of ideas/subjective racing thoughts Concentration difficulty Activity increased or psychomotor agitation Awful or apprehension Sleep need decreased Restless Talkativeness Lose control Other mnemonics for the manic episode are: Tense or keyed up DAFTSIG,32 33 FASTPED,34 GIDDY HIGH,26 GRAN- 25 With mixed features: manic or hypomanic episode with DIOSE, IE RATE DIS (emphasises bipolar disorder an IE mixed features: SIG E DR (three of six) on September 25, 2021 by guest. Protected copyright. (ie—that is) RATE DIS (order) or a disorder with variable 35 36 Suicidal thoughts rates of activity and thinking), GIDDINESS, DeTeR the Interests decreased HIGH (Dr Carey Gross developed it),37 GREAT SAD,38 Guilt DR MANIA,23 GST PAID,39 Grand Sex Through Impulse Energy decreased Distracts (from) Appropriate Pleasure.40 Depressed Hypomanic episode Retarded FLIGHTY (The dictionary defines ‘flighty’ as frivolous, Depressive episode, with mixed features: MIGFAST (three irresponsible, capricious, mercurial and volatile, words of seven): the acronym is the same as the ‘DIGFAST’ that also could describe hypomanic individuals),41 TAD mnemonic of the manic episode with ‘D’ replaced by ‘M’. HIGH,37 HIGH-4.42 M stands for Mood elevated and expansive. With melancholic features: PRe MED GAP Major depressive episode/major depressive disorder Pleasure loss; Reactivity loss (one of two) SIG: EM CAPS (five out of nine symptoms for over 2 weeks Three or more of six: to fulfil the definition of major depression, including Morning worsening either depressed mood or loss of interest).43 That is, an Early morning awakening individual must have a depressed mood for at least 2 Distinct quality of mood weeks continuously along with four of eight depressive Guilt neurovegetative symptoms. Or an individual may have Anorexia

Kadiyala PK. General Psychiatry 2020;33:e100109. doi:10.1136/gpsych-2019-100109 5 General Psychiatry Gen Psych: first published as 10.1136/gpsych-2019-100109 on 14 May 2020. Downloaded from Psychomotor changes (agitation or retardation) Interest decreased Other mnemonics that help remember the specifier Anergia (energy loss) for melancholic features are: ‘MELANcholic’: Morning Symptoms not an Exacerbation of another disorder or worsening of symptoms/psychoMotor agitation, retarda- Attributable to effects of substance or another medical tion/early Morning awakening/Mood distinct, Excessive condition guilt, Loss of emotional reactivity/pLeasure (one of two), 5—at least five symptoms present Anorexia (or weight loss)/aNhedonia (bestmedicalm- Times—final week before the onset of menses, improve 57 24 nemonics.blogspot.com, 2011), PAGER MAD, MAD within few days of onset, minimal in the week after menses 20 GRADS. In—interference with work or causing distress 20 With atypical features: ‘RAILS’ 2 months—confirmed during at least two symptomatic menstrual cycles Another mnemonic for premenstrual dysphoric 23 Depressive disorders disorder is TOUGH MENSES. Disruptive mood dysregulation disorder ‘SITs 3 times per week, irritate others for 1 year, started Anxiety disorders before 10 years; Not diagnosed first before 6 or after 18 Separation anxiety disorder years, neither BIO nor MDD, exclude mania & others.’ ‘HUG PANDaS’ (three of eight for 4 weeks in children Severe and adolescents or 6 months in adults) (A child will HUG Inconsistent Temper outbursts PANDaS when he or she fears or anticipates separation of 3 or more times per week major attachment figure). Irritable mood in between observed by others Harm or loss of an attachment figure Others (parents, teachers, peers; in at least two of three Untoward event that causes separation from attach- settings, severe in one) ment figure worry for 1 year (never without above symptoms for 3 or more Going out of home consecutive months) Physical symptoms with anticipated separation started before 10 years by history or observation Alone is a big fear Not diagnosed first before 6 years or after 18 years Nightmares involving the theme of separation Neither coexist with Bipolar, Intermittent explosive, Distress of separation Oppositional defiant disorder nor occur exclusively Sleeping without an attachment figure during MDD Another mnemonic is ‘PUSH or NAGS’.19 Exclude full symptom criteria of hypomania or mania lasting more than 1 day, or any other mental disorders Specific phobia: ‘PHOBIA’ http://gpsych.bmj.com/ (substance or medical condition induced also) Persistent (>6 months) Handicapping (restricted lifestyle) Persistent depressive disorder (dysthymia) Out of proportion HE’S 2 SAD,58 Depressed mood plus CHASE E,59 or Beginning immediately and almost always ACHEWS,21 ‘the rule of twos: 2 years of depressed mood, Intense fear or anxiety about a specific object or situa- 2 of 6 neurovegetative symptoms, no more than 2 months tion leading to without symptoms.’60 Six neurovegetative symptoms Avoidance on September 25, 2021 by guest. Protected copyright. can be remembered by mnemonic ‘SIGECA’ (the same 62 24 mnemonic for depression, except that the last two criteria Other mnemonics are PHOBIA and FEARED. (psychomotor agitation/retardation and suicidality) and Social anxiety disorder (social phobia) interest decreased, guilt criteria replaced by low self- 61 23 1. FEARED esteem and hopelessness, respectively), DESPOND, Fear of social situations where exposed to possible scru- HE TAILS,24 CHASES.32 33 tiny by others; Fears of being negatively evaluated Premenstrual dysphoric disorder Exposure to the social situation almost always provokes ‘SAIL Over CASPIAn SEA 5 Times In 2 months’ (five, fear or anxiety with one from SAIL, one from Over CASPIAn) Avoids the social situation or endured with intense fear Sad or anxiety Anxiety Recognises that the fear is out of proportion Irritability Exclusion of fear induced by a substance or another Lability mental or medical disorder; Excessive/unrelated to fear Overwhelmed or out of control of another coexisting medical condition Concentration Distress or impairment; Duration lasting for 6 months Appetite changes 2. ANTI-FEAR Sleep changes Almost always provoke anxiety or fear of a social Physical symptoms situation

6 Kadiyala PK. General Psychiatry 2020;33:e100109. doi:10.1136/gpsych-2019-100109 General Psychiatry Gen Psych: first published as 10.1136/gpsych-2019-100109 on 14 May 2020. Downloaded from Negative evaluation of patient’s act or anxiety symp- Public transport toms feared Enclosed spaces Timing: duration lasting 6 months or more B. Other criteria remembered by mnemonic ‘PHOBIA’ Impairment or distress in social, occupational or other Persistent (>6 months) important areas of functioning Handicapping (restricted lifestyle) Fear or anxiety about social situations where possible Out-of-proportion fear or anxiety scrutiny by others Because of thoughts that escape or help might not be Excessive/unrelated to fear of another coexisting available in the event of developing panic-like symptoms medical condition; Exclusion of fear induced by a or other incapacitating or embarrassing symptoms substance or another mental or medical disorder Intense fear or anxiety provoked almost always with the Avoidance of social situations or endured with intense agoraphobic situations fear or anxiety Avoidance Recognises out of proportion Other mnemonics are FAINT63 and FEARS.23 Generalised anxiety disorder The criteria of generalised anxiety disorder (GAD) can be Panic disorder remembered by the mnemonic ‘WATCHER’ (modified by 68 1. A panic attack is an abrupt surge of intense fear or the author from the original mnemonic ‘WATCHERS’). intense discomfort that reaches a peak within minutes Worry and Anxiety and during which four or more of the following symp- Time for at least 6 months toms, remembered by the mnemonic ‘STUDENTS FEAR Controlling the worry difficult 3 C’s’.64 Handicapping Sweating Exclude another mental disorder Trembling or shaking Rule out worry, not due to physiological effects of a Unsteadiness, dizziness, light headed or faint substance or another medical condition Depersonalisation or derealisation The symptoms associated with worry and anxiety (three Excessive heart rate, palpitations or more of six) can be remembered by the mnemonics: 32 33 59 Nausea or abdominal distress FIRST C, MERCI-S, Macbeth Frets Constantly Tingling (numbness or paraesthesias) Regarding Illicit Sins (based on the idea that Macbeth had 21 69 Shortness of breath or smothering GAD before and after killing King Duncan), TICKES, 65 Fear of dying, losing control or going crazy BE SKIM, ‘Does Mr Fisc worry excessively about minor 70 71 3 C’s: chest pain, chills, choking matters?, MR FISC’, I C REST (‘I see rest’). Other mnemonics for GAD that are useful are

The other criteria can be remembered by using http://gpsych.bmj.com/ 38 72 73 68 mnemonic ‘ABCD’. STOMACH, Worry WARTS, WATCHERS, AND 71 23 26 2. At least one attack followed by 1 month of one or I C REST, I’M TENSED, DEFICITS, I’M A FICKLE ≥ 24 both of: CASE. ►► Behaviour to avoid having panic attacks, such as avoidance of unfamiliar situations or exercise. Obsessive-compulsive and related disord ►► Concern or worry about the additional panic attack or Obsessive-compulsive disorder (OCD): ‘Thoughts RIDE TIME, their consequences. Acts Reduce TIME’ 3. Disturbance not attributable to effects of a substance A. Presence of obsessions, compulsions, or both on September 25, 2021 by guest. Protected copyright. or another medical or mental disorder. Obsessions: ‘Thoughts RIDE’ Another mnemonic for the panic attack: 1. Thoughts, urges or images that are: ABC2D2F3P2S2.32 Recurrent and persistent. The other mnemonics that help remember panic Intrusive and unwanted. 38 23 Distress (anxiety) provoking disorder are CATASTROOF3IES, SUDDENLY SCARY, STUDENTS,65 by visualising a patient with panic disorder 2. Effaced by ignoring or suppressing or neutralis- clutching his chest (heart cluster), hyperventilating (breathing with other thought or compulsion. lessness cluster), and shaking with fear (fear cluster) and Compulsions: ‘Acts Reduce’ screaming out ‘355! 355!’,21 PANICS.66 1. Acts, mental or behavioral, repetitively performed Panic attack specifier: same as criterion 1 of panic disorder. in response to an obsession oraccordingto rigid rules. Agoraphobia 2. Reduce or prevent anxiety or distress, prevent a A. Marked fear or anxiety about two or more of the five dreaded event. situations that can be remembered by the mnemonic B. Time-consuming or IMpair socio-occupational func- ‘COOPE’.67 tioning. Crowded area C. Exclude being induced by a substance or another Open spaces medical condition. Outside the home D. Exclude another mental disorder.

Kadiyala PK. General Psychiatry 2020;33:e100109. doi:10.1136/gpsych-2019-100109 7 General Psychiatry Gen Psych: first published as 10.1136/gpsych-2019-100109 on 14 May 2020. Downloaded from Another mnemonic for OCD: ‘REORIENT PATIENT’. Keen to decrease or stop skin picking by repeated Obsessions: attempts Recurrent and persistent thoughts, urges, images Impairment in socio-occupational functioning or cause Experienced as intrusive and unwanted significant distress Often cause marked anxiety or distress Not attributable to substance-induced, another medical Resist by ignoring or suppressing the thoughts or or mental disorder. neutralise with some other thought or compulsion Impairing social, occupational and other areas of Trauma and stressor-related disorder functioning Reactive attachment disorder: ‘LACK In EMPATHY’ Exclude due to substance or another medical condition Limited or Absent or Changing Not related to other mental disorder (K) Caregivers for forming stable and selective Time consuming attachments Compulsions: Induce Performing in response to an obsession or according Emotionally withdrawn or inhibited behaviour by not to rigid rules seeking or responding to comfort when distressed and Acts, behavioural or mental, performed repetitively Minimal social and emotional responsiveness To prevent or reduce anxiety or distress or Positive affect limited Impair social, occupational and other areas of Appearance of episodes of unexplained irritability functioning or sadness or fearfulness even evident during non- Exclude due to substance or another medical condition threatening situations Not related to other mental disorder To exclude ASD Time consuming Has a developmental age of at least 9 months before 5 Other mnemonics that may help remember criteria for Years OCD: 1. RITUALS (obsessions require first four—RITU, Disinhibited social engagement disorder: LACK In WARING compulsions next two—AL, both require last one—S), Limited or Absent or Changing REPEATER MRS PETER (obsessions require REPEATER; (K) Caregivers for forming stable and selective compulsions require MRS; both require PETER),23 A BIT attachments FORCED,24 RESIDENT PRISONER,72 RITUAL.25 Induce Willingness to go off with unfamiliar adults Body dysmorphic disorder: ‘PAIN’ Absent or diminished checking back with an adult care- Preoccupation with perceived defects or flaws in physical

giver after venturing away, even in unfamiliar situations http://gpsych.bmj.com/ appearance Reduced or absent reticence in approaching or inter- Acts, mental or behavioural, repetitive, in response to acting with unfamiliar adults appearance concerns Inappropriate overly familiar verbal or physical Impairment in socio-occupational functioning behaviour Not due to an eating disorder Not limited to impulsivity (as in ADHD) Got developmental age of at least 9 months Hoarding disorder: ‘PILED’ Post-traumatic stress disorder (PTSD): ‘TRAAUMA’

Perceived need to save items and distress associated with on September 25, 2021 by guest. Protected copyright. (modified by the author from the original mnemonic discarding them results in TRAUMA)37 74 75 Inability to discard or parting possessions regardless of Traumatic event: witnessed or experienced or occurred their actual value to dearest or exposure repeatedly to its aversive details Litter up possessions Re-experience one of following intrusion symptoms: Exclude another medical condition or another mental memories, nightmares, flashbacks, psychological distress disorder or physiological reaction to cues symbolising the trau- Distress or dysfunction in socio-occupational matic event functioning Avoidance of memories, thoughts, feelings of the trau- Trichotillomania (hair-pulling disorder): ‘HAIR’ matic event or its reminders Hair loss, due to recurrent pulling out of one’s hair Alterations in cognitions and mood negatively: forget- Attempts repeatedly to decrease or stop hair pulling ting, mislabelling, blaming, no positive emotions, always Impairment in socio-occupational functioning or cause negative emotions, anhedonia, detachment (two of seven) significant distress Unable to function or cause distress/Unattributed to a Rule out another mental or medical disorder that substance or another medical condition causes hair loss Month or more of symptoms Arousal and reactivity increased with two of the Excoriation (skin-picking) disorder: ‘SKIN’ following: irritability, recklessness, hypervigilance, star- Skin picking resulting in skin lesions tling, concentration and sleep disturbances

8 Kadiyala PK. General Psychiatry 2020;33:e100109. doi:10.1136/gpsych-2019-100109 General Psychiatry Gen Psych: first published as 10.1136/gpsych-2019-100109 on 14 May 2020. Downloaded from The subcriteria to symptom clusters of PTSD can be Termination of symptoms within 6 months oftermina- remembered by75: tion of stressor or its consequences (1) Intrusion symptoms: ‘R3D2’ (think Star Wars and Exclusion of another mental disorder or exacerbation add an ‘R’) which stands for of pre-existing mental disorder ruled out Recollections, Recurring and Reactivity (physiolog- Symptoms do not represent bereavement ical) in response to cues of the traumatic event; Dreams Another mnemonic for adjustment disorder: IT’S (distressing) and Distress (psychological). BAD.24 (2) Avoidance, negative cognitions/mood and dissociative symptoms: ‘AFRAID’ (modified by author) Dissociative disorders Avoid internal or external stimuli associated with the Dissociative identity disorder: ‘DID’ trauma Disruption of identity with two or more distinct person- False cognitions (mislabelling and blaming) ality states including Recall difficulty Inability to recall properly traumatic events and/or Affect (no positive, always negative emotions) everyday events or personal information Interest (diminished) Distress or impairment in socio-occupational Detachment functioning (3) Arousal symptoms: ‘SCARE’ (modified by the Depersonalisation/derealisation disorder: ‘DREAM’ (modi- author) fied by the author)25 Sleep disturbance Detachment experiences Concentration (difficulty) Reality testing intact Anger (outbursts or irritability) Exclude other primary mental disorders Really vigilant/Reckless or self-destructive behaviour Attributable not to a substance or another medical Exaggerated startle response condition Other mnemonics for PTSD that may help are: FIGHT,76 Marked distress caused by symptoms DREAMS,38 CRASH,23 PRIDE AFRAID CHAINS,24 ERAA.32 Somatic symptom and related disorders Acute stress disorder: the subcriteria to symptom clusters Somatic symptom disorder: the B criterion can be remem- of acute stress disorder can be remembered by: ‘R3D2 bered by the mnemonic ‘TEA’. AFRAID SCARE’ (similar to PTSD) (presence of nine or Thoughts: disproportionate and persistent about the more of the following 14 symptoms): seriousness of somatic symptoms Intrusion symptoms: Emotion: persistently high anxiety about health or

Recollect (memories) (1), Dreams (distressing) (2), symptoms http://gpsych.bmj.com/ Recurring (flashbacks) (3), Reactivity (physiological) Actions: excess time and energy devoted to these and Distress (psychological) in response to cues of the symptoms traumatic event (combined as 4). Illness anxiety disorder: ‘Persistent search for any big Negative mood, dissociative and avoidance symptoms disease’ (cognitive symptoms removed): Preoccupation of having or acquiring an illness Avoid internal (5) or external (6) stimuli associated Somatic symptoms absent or of mild intensity/Signifi- with the trauma cant preoccupation about the risk of developing or for an (False cognitions (mislabelling and blaming) removed) existing disease on September 25, 2021 by guest. Protected copyright. Recall difficulty (7) For at least 6 months Affect (no positive emotions) (8) Anxiety about health (‘Interest diminished’ removed) Behaviour—excessive health-related behaviours (care- Detachment (9). seeking type) or maladaptive avoidance (care-avoidant Arousal symptoms: type) Sleep disturbance (10) Disturbance not better explained by another mental Concentration (difficulty) (11) disorder Anger (outbursts or irritability) (12) Conversion disorder (functional neurological symptom Really vigilant (13) disorder): ‘CONVERSION’77 Exaggerated startle response (14) Adjustment disorder: ‘EMOTES’ (modified by the Feeding and eating disorders author)23 Anorexia nervosa: ‘Weight Fear Bothers Anorexics’ (modi- Emotional or behavioural symptoms within 3 months of fied by the author)19 onset of stressor(s) with Significantly low body Weight in the context of age, sex, Marked distress in excess of what would be expected developmental trajectory and physical health from exposure to the stressor (or) Fear of gaining weight or becoming fat or persistent Occupational, academic or social functioning is signifi- behaviour that interferes with weight gain cantly impaired Body weight and shape are perceived in a distorted way

Kadiyala PK. General Psychiatry 2020;33:e100109. doi:10.1136/gpsych-2019-100109 9 General Psychiatry Gen Psych: first published as 10.1136/gpsych-2019-100109 on 14 May 2020. Downloaded from Seen in Anorexics Breathing-related sleep disorders Other mnemonics for anorexia nervosa: RAID,32 33 Obstructive sleep apnoea-hypopnoea FLAB,25 I FEAR LARD.24 A mnemonic validated for screening obstructive sleep Bulimia nervosa: ‘Bulimics Over-Consume Pastries’19 21 apnoea-hypopnoea is STOP-BANG. It is a simple, easy- Recurrent episodes of Binge eating (at least once a to-remember and self-reportable screening tool, which week for 3 months) with a sense of includes four subjective (STOP: Snoring, Tiredness, Out of control overeating Observed apnoea and high blood Pressure) and four Excessive Concern with body shape and weight demographic items (BANG: BMI, Age, Neck circum- Purging behaviours, such as self-induced vomiting, ference, Gender).81 The DSM V criteria and associated misuse of laxatives, diuretics, enemas, or other medica- features can be remembered by this mnemonic. tions; fasting; excessive exercise Parasomnias Other mnemonics that may help remember criteria Non-rapid eye movement sleep arousal disorders for bulimia nervosa: A BINGE,24 BASTE,78 BORCEN,72 ‘Forgets or recalls little of incomplete awakening BINS,32 33 FRIDGES.25 happened while walking or shouting during the first third of sleep’. Sleep-wake disorders Forgets (amnesia of) the episodes Insomnia disorder: ‘SLEEP’ (modified by the author)23 Recalls little of dream imagery during episodes of Sleep quantity or quality dissatisfaction associated Incomplete awakening from sleep presenting as with one or more of difficulty initiating, maintaining, Sleepwalking or returning back to sleep Shouting (sleep terrors) Lasting for at least 3 months, occurring at least three During the first third of sleep times a week despite adequate opportunity for sleep, Restless legs syndrome: ‘URGE’82 causing significant distress or impairment Urge to move Exclude this diagnosis if a disturbance occurs exclu- Rest induced sively during the course of another sleep-wake disorder Gets better with activity and Exclude the complaint of insomnia not being due to Evening and night accentuation coexisting mental and medical disorders Physiological effects of a substance do not attribute to Disruptive, impulse control and conduct disorders insomnia Oppositional defiant disorder Hypersomnolence disorder: ‘SLEEP LOT’ (modified by the When children and adolescents are oppositional and 23 author) defiant, they act like ‘REAL BADS’19 (four of eight symp-

Sleep excess despite the main sleep period lasting at toms within the last 6 months). http://gpsych.bmj.com/ least 7 hours Resentful Lasting for at least 3 months, occurring at least three Easily annoyed times a week, causing significant distress or impairment Argues with adults Excludes this disorder if disturbance occurs exclusively Loses temper during the course of another sleep disorder Blames others for his or her misbehaviour Exclude the excess sleep not being due to coexisting Annoys people deliberately mental and medical disorders Defies rules or requests on September 25, 2021 by guest. Protected copyright. Physiological effects of a substance do not directly attri- Spiteful bute to hypersomnolence The three subcriteria of criterion A can be remem- Conduct disorder bered by: The behaviours of conduct disorder are ‘BAD FOR A Lapses into sleep recurrently within the same day or BUSINESS’19 (three of the following 15 criteria in the Overcoming sleepiness and being awake is difficult past 12 months, with at least one present in the past 6 after abrupt awakening or months) Time spent on the main sleep episode is more than 9 Bullying hours though unrefreshing. Animal cruelty Narcolepsy: ‘CHES’ Destroying others’ property Cataplexy or Fighting Hypocretin deficiency or Out late at night Evidence in sleep studies (polysomnography or multiple Running away from home sleep latency test) in the presence of Actively forcing sex Sleep attacks (recurrent daytime naps or lapses into Being cruel to people sleep) Using a weapon Mnemonics that may help in remembering the criteria Setting fires and associated symptoms of narcolepsy: CHESS79 and Into someone’s house, building or car CRASH80 Not going to school

10 Kadiyala PK. General Psychiatry 2020;33:e100109. doi:10.1136/gpsych-2019-100109 General Psychiatry Gen Psych: first published as 10.1136/gpsych-2019-100109 on 14 May 2020. Downloaded from Everyday lying or conning others Tempted With Cognac,21 ROLAID PUPILS,24 PEWTERR,89 Stealing while confronting a victim TWO 6 PACK,90 Won’t Resist Imbibing and Seeks Tipple Stealing without confronting a victim Every Night,91 I DRANK MORE.23 The behavioural The four categories of criteria for conduct disorder can patterns of compulsive substance use that is characteristic be remembered by the mnemonic ‘TRAP’.83 of dependence in DSM IV-TR can be remembered by the Theft—breaking and entering, deceiving, non- mnemonic ‘TEACH’.92 The criteria for substance abuse confrontational stealing in DSM IV-TR can be remembered by the mnemonics: Rule breaking—running away, skipping school, out late CLOD,92 WILD,89 FOLD,87 ‘When alcohol takes HOLD Aggression—people, animals, weapons, forced sex of you’,88 DRiNK,90 FAILS.23 The DSM V criteria for Property destruction substance use disorder are a combination of DSM IV-TR 24 Another mnemonic that may be helpful is DDAVP. dependence and abuse criteria, with the ‘craving’ criterion added and ‘legal consequences’ criterion removed.93 Substance-related and addictive disorders The mnemonics ‘WILD PEWTERR’89 and ‘DRiNK TWO Substance use disorders 6 PACK’90 represent this combination. ‘Haphazard knowledge of or failure to control problems in activities urges excess tolerance with time’ Alcohol intoxication Hazardous use The six features from criterion C can be remembered by Use despite knowledge of having a persistent or recur- the mnemonic: SAM’S GIN.94 rent physical or psychological problem caused or exacerbated by the substance Alcohol withdrawal The eight features of criterion B can be recalled using the Failure to fulfil major role obligations at work, school 94 or home mnemonic: PAST NITE. Persistent desire to cut down or control substance use Cannabis intoxication and report multiple unsuccessful efforts to decrease or The four features in criterion C can be recalled by the discontinue use mnemonic: MEAT.94 Use despite social or interpersonal problems caused or exacerbated by the substance Phencyclidine intoxication Important social, occupational or recreational activities At least two of eight features from criterion C develop given up or reduced within an hour of phencyclidine use. These eight features Intense urge or desire for the drug (craving) can be recalled by the mnemonic: MAP STAND.94 Taking in excess amounts or over a longer period than

was originally intended Other hallucinogen intoxication http://gpsych.bmj.com/ Tolerance Criterion D can be recalled using the mnemonic: Withdrawal DISTORT.94 A great deal of time is spent for obtaining or using the substance or recovering from its effects Inhalant intoxication Another mnemonic is: ‘WITHDRAW THE substance’. The 13 criterion C features can be recalled using the 94 Work, school or home obligation failures mnemonic: DISRUPTS GLOBE. Interpersonal or social consequences

Opioid intoxication on September 25, 2021 by guest. Protected copyright. Time spent too much for obtaining, using or recovering from effects of substance Pupillary constriction (or dilation following an overdose) Hazardous use is present along with one of three features from criterion C. These three features of criterion C can be recalled by Desire for the drug 94 Reinstatement the mnemonic SAD. Activities (important or recreational) given up Opioid withdrawal Withdrawal These nine features from criterion B can be recalled by Tolerance the mnemonic: ARMY FINDS (as in a possible headline: Harmful use Army finds Opioid Withdrawal In Troops).94 Exceed the intended amount or time Other mnemonics available for remembering DSM V Sedative, hypnotic or anxiolytic intoxication criteria are: The six features from criterion C can be remembered by 1. The Wise Know: Decline Tender Loving Care And mnemonic: SAM’S GIN.94 Respect Silver Hair.84 2. ‘CHEW THAT COP’.85 Sedative, hypnotic or anxiolytic withdrawal Other mnemonics that may aid in remembering the The eight features of criterion B can be recalled using the criteria of substance dependence in the Text Revision of mnemonic: PAST NITE (as in an individual who is expe- Fourth Edition of DSM (DSM IV-TR) are ADDICTD,86 riencing symptoms of withdrawal from decreased intake WHATCAT,87 WE are unable TO CUT our drinking,88 over the past several nights).94

Kadiyala PK. General Psychiatry 2020;33:e100109. doi:10.1136/gpsych-2019-100109 11 General Psychiatry Gen Psych: first published as 10.1136/gpsych-2019-100109 on 14 May 2020. Downloaded from Stimulant intoxication Distress or impairment in social, occupational or other The nine features from criterion C can be recalled using important areas of functioning the mnemonic: A CODE BLUE.94 Cluster A personality disorders Stimulant withdrawal Paranoid personality disorder: SUSPECT,37 98 GET FACT.24 69 The five features from criterion B can be recalled by the Schizoid personality disorder: DISTANT,37 98 SIR SAFE,24 mnemonic ‘PANTS’ (as in an individual who pants when DISORDER,23 CLOSED IN.25 out of breath).94 Schizotypal personality disorder: ME PECU- LIAR,37 98 PERSONALITY,23 UFO IDEA,20 UFO AIDER,24 25 Neurocognitive disorders PERCEPTS. Delirium: ‘4A and 3C’ Cluster B personality disorders Disturbance in Attention and Antisocial personality disorder: CORRUPT,37 98 CALL ASPD,14 Awareness CALLOUS MAN,24 CAR FIRM WAGER.72 Abrupt or Acute onset with Borderline personality disorder: AM SUICIDE,98 Altering in severity during the course of a day DESPAIRER,37 DISTURBED,23 BIAS IRA,72 I RAISED A Cognitive disturbance PAIN24 I DESPAIR99 I DESPAIRR,44 PRAISE,100 IMPUL- Consequence of another medical condition or SIVE,101 ARISES MAD,32 33 LABILITY25 I’M A SAP (criti- substance related cised as being stigmatic),102 103 DARE.104 Can’t explained by another neuroCognitive disorder or Histrionic personality disorder: PRAISE ME,37 98 Coma ACTRESSS,29 I CRAVE SIN,24 SEDUCTIVE,23 Five S’s.25 Another mnemonic that may help in remembering the Narcissistic personality disorder: SPE CIAL,98 GRAN- diagnostic criteria is ‘Medical FRAT’.21 3 DIOSE,37 105 SELF-IMPORT,23 A FAME GAME,24 Five E’s.25 Mnemonics that may aid in remembering the criteria and supporting features of delirium are: Cluster C personality disorders 95 96 97 DELIRIUM, PHYSICAL, ‘C, DIPPS’, FEELS Avoidant personality disorder: CRINGES,37 98 RESERVED,23 38 72 32 33 SPACED, CCCC. RIDICULE.24 Dependent personality disorder: RELIANCE,37 98 DEPEN- Major and mild neurocognitive disorder DENT,23 DARN HUT,24 FEARS.20 The neurocognitive domains can be remembered using Obsessive- compulsive personality disorder: LAW FIRMS, the mnemonic SAMPLE. SCRIMPER,37 COMPULSIVE,23 PERFECTION,20 LOW Social cognition 24 MIRTH. Attention The mnemonics of individual personality disorders are http://gpsych.bmj.com/ Memory and learning only enumerated without description, as most of them Perceptual motor are described together in the provided references. Language Executive function Medication-induced movement disorders and other adverse effects of medication Major neurocognitive disorder: ‘DIRE’ Neuroleptic-induced parkinsonism; other medication-induced Decline from a previous level of performance in one or parkinsonism: the mnemonic ‘TRAP (tremor at rest, more cognitive domains on September 25, 2021 by guest. Protected copyright. rigidity, akinesia and bradykinesia, and postural insta- Interfere with independence in everyday activities bility)’ used for describing cardinal features of parkin- Rule out delirium sonism can also be used for remembering the criteria of Exclude another mental disorder 106 95 this disorder. Another mnemonic that may be helpful: DEMENTIA. Neuroleptic malignant syndrome (NMS): the mnemonic FEVER (Fever, Encephalopathy, Vital sign unstable, Personality disorders Enzyme elevation, Rigidity) can help identify clinical General personality disorder: ‘AIM COIN As Per Distance’ and laboratory NMS markers in patients.107 Another An enduring pattern of inner experience and behaviour mnemonic that aids in remembering the criteria of NMS that deviates markedly from the expectations of the is: RECTAL.108 individual’s culture. Manifested in two (or more) of the Antidepressant discontinuation syndrome: FINISH.109 following areas: Affectivity Impulse control Discussion Cognition The objective of this review is to scope the field and Interpersonal functioning to summarise the mnemonics as presented across Adolescence or early adulthood onset articles rather than to synthesise or distil the articles Pervasive and inflexible across a broad range of to make a qualitative meta-synthesis. Any memory- personal and social situations improving strategy can be termed a mnemonic strategy.

12 Kadiyala PK. General Psychiatry 2020;33:e100109. doi:10.1136/gpsych-2019-100109 General Psychiatry Gen Psych: first published as 10.1136/gpsych-2019-100109 on 14 May 2020. Downloaded from It becomes the most useful memory aid when one needs Future recommendations to remember items in a sequence or where there are There is a need to validate the usefulness of mnemonics no meaningful connections to be made between the for remembering the criteria of psychiatric disorders. items.110 A survey can be conducted on clinicians, academicians and students about their previous or current mnemonic Main findings usage in clinical practice or in preparation for exams. A Mnemonics usage in psychiatry started as it moved single or group of mnemonics can be provided to them towards the medical model with more emphasis placed on and assess their perceived helpfulness. Reliability and making diagnostic criteria. The use of diagnostic criteria validity indices of the usefulness of a specific mnemonic started with DSM III and its revision classifications, as the or preference of a particular mnemonic over others for diagnosis of mental disorders moved towards an atheo- a specific disorder can be found. Additionally, a study retical, descriptive approach. This approach led to the that compares the clinical or learning outcomes between practical problem of recalling a large number of complex those who were exposed to mnemonics and those who criteria by clinicians, especially by the primary care physi- were not can be carried out. Further, the mnemonics that cians. To overcome this problem and in search of tools aid in the treatment of psychiatric disorders need to be that assist in recalling these criteria, clinicians started reviewed and validated as well. developing and publishing mnemonics in journals and chapters in the textbooks. The use of mnemonics helps Implications in screening or recognising various disorders and may Despite several studies showing the effectiveness of avoid misdiagnosis or delay in accurate diagnosis.34 38 42 mnemonic strategies, these remain the least frequently They were also reported as being developed or modified used formal memory aid in medical practice. The present by some authors, largely as an outcome of several years of compilation helps the clinicians or the students memo- experience in teaching psychiatry and medical students. rise a mnemonic for a particular DSM mental disorder Most of the mnemonics are related in some way to the that is fascinating for them. They can further create their disorder itself, facilitating easy recall. The students may mnemonics as one’s own mnemonics are often the best use them for their training and completion of certifica- and, therefore, more memorable. They can also experi- tion examinations.32 110 111 Some mnemonics were devel- ment with other types of mnemonics such as picmonics, oped or modified to overcome the limitations of certain rhymes and peg words that are not described in the previous mnemonics that are phonologically, heuristically present review. and aesthetically less than ideal for meaningful assimila- 45 Funding The authors have not declared a specific grant for this research from any tion and practical application. One of the mnemonics funding agency in the public, commercial or not-for-profit sectors.

102 103 http://gpsych.bmj.com/ published was criticised for being stigmatic. Simi- Competing interests None declared. larly, disagreement had arisen over the possession of Patient consent for publication Not required. mnemonics and resolved.75 Provenance and peer review Not commissioned; externally peer reviewed. Strengths and limitations Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which There are many sources of mnemonics for the diagnostic permits others to distribute, remix, adapt, build upon this work non-commercially , criteria and can be time consuming to go through many and license their derivative works on different terms, provided the original work is phrases from different sources for the same condition. properly cited, appropriate credit is given, any changes made indicated, and the use on September 25, 2021 by guest. Protected copyright. is non-commercial. See: http://creativecommons.org/ licenses/by- nc/4. 0/. Little work was done until now in the systematic compilation of these mnemonics. This was further restricted to ORCID iD selected topics like DSM IV personality or substance use Pavan Kumar Kadiyala http://orcid. org/0000- 0001-9268- 0549 disorders or description of a single mnemonic for each major psychiatric disorder.25 26 32 33 37 94 98 The recently published fifth edition of the American Psychiatric Asso- ciation’s DSM V largely continues the previous edition’s References 1 Parkin AJ. Improving memory. In: Memory and amnesia an criterion-based descriptive approach. To date, this is the introduction. 2nd edn. Oxford, UK: Blackwell publishers, first review that gathered almost all the available acrostic 1997: 57–9. 2 Worthen JB, Hunt RR. Mnemonic Techniques: Underlying sentences and acronyms that aid in remembering diag- Processes and Practical applications. In: Byrne JH, Menzel R, nostic criteria of most of the psychiatric disorders in DSM eds. Learning and memory: a comprehensive reference. 2nd edn. Oxford, UK: Elsevier Ltd, 2017: 1. 515–28. V. Electronic search for the mnemonics may miss some of 3 Evan RL. Introduction Mnemonics. In: Every good boy deserves the mnemonics that were described in the older books or Fudge: the book of mnemonic devices. New York, USA: Penguin journals not available online. Some original mnemonics Group Inc, 2007: 1–5. 4 American Psychiatric Association. Diagnostic and statistical manual are modified by the author to cater to the changed criteria of mental disorders. 5th edn. Arlington, VA: American Psychiatric of some of the disorders in DSM V. These are intended to Publishing, 2013. 5 Grant MJ, Booth A. A typology of reviews: an analysis of 14 be used in conjunction with DSM V classification and not review types and associated methodologies. Health Info Libr J a substitute for it. 2009;26:91–108.

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Dr Pavan Kumar kadiyala obtained an MBBS degree from Government Medical College, Guntur, Andhra Pradesh in India in 2009, and completed the post-graduation program in psychiatry from Father Muller Medical College, Mangalore, Karnataka in India in 2014. He is now working as an associate professor at the Department of Psychiatry in ASR Academy of Medical Sciences, Eluru in India. His research interests include teaching methods for post-graduates in psychiatry and geriatric psychiatry.

Kadiyala PK. General Psychiatry 2020;33:e100109. doi:10.1136/gpsych-2019-100109 15 Open access Correction

Correction: Mnemonics for diagnostic criteria of DSM V mental disorders: a scoping review

Kadiyala PK. Mnemonics for diagnostic criteria of DSM V mental disorders: a scoping review. General Psychiatry 2020;33:e100109. doi: 10.1136/gpsych-2019-100109.

In this paper, all instances of ‘DSM V’ should be written as ‘DSM 5’.

Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

General Psychiatry 2020;33:e100109corr1. doi:10.1136/gpsych-2019-100109corr1

General Psychiatry 2020;33:e100109corr1. doi:10.1136/gpsych-2019-100109corr1 1