Evidence-Based Reviews

Mnemonics in a mnutshell: 32 aids to psychiatric diagnosis

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

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References

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BOX 3.

MNEMONICS FOR DIAGNOSING MEDICATION ADVERSE EFFECTS

Antidepressant discontinuation syndrome FINISH⁷ Flu-like symptoms Insomnia Nausea Imbalance Sensory disturbances Hyperarousal (anxiety/agitation)	Neuroleptic malignant syndrome FEVER⁸ Fever Encephalopathy Vital sign instability Elevated WBC/CPK Rigidity WBC: white blood cell count CPK: creatine phosphokinase	Serotonin syndrome HARMED Hyperthermia Autonomic instability Rigidity Myoclonus Encephalopathy Diaphoresis

Mnemonics may use rhyme, music, or visual cues to enhance memory. Most mnemonics used in medical practice and education are word-based, including:

Acronyms—words, each letter of which stands for a particular piece of information to be recalled (such as RICE for treatment of a sprained joint: rest, ice, compression, elevation).
Acrostics—sentences with the first letter of each word prompting the desired recollection (such as “To Zanzibar by motor car” for the branches of the facial nerve: temporal, zygomatic, buccal, mandibular, cervical).
Alphabetical sequences (such as ABCDE of trauma assessment: airway, breathing, circulation, disability, exposure).²⁹

An appropriate teaching tool?

Dozens of mnemonics addressing psychiatric diagnosis and treatment have been published, but relatively few are widely used. Psychiatric educators may resist teaching with mnemonics, believing they might erode a humanistic approach to patients by reducing psychopathology to “a laundry list” of symptoms and the art of psychiatric diagnosis to a “check-box” endeavor. Mnemonics that use humor may be rejected as irreverent or unprofessional.³⁰ Publishing a novel mnemonic may be viewed with disdain by some as an “easy” way of padding a curriculum vitae.

BOX 4.

MNEMONICS FOR DIAGNOSING PERSONALITY DISORDERS

Paranoid personality disorder SUSPECT⁹ Spousal infidelity suspected Unforgiving (bears grudges) Suspicious Perceives attacks (and reacts quickly) Enemy or friend? (suspects associates and friends) Confiding in others is feared Threats perceived in benign events	Schizotypal personality disorder ME PECULIAR⁹ Magical thinking Experiences unusual perceptions Paranoid ideation Eccentric behavior or appearance Constricted or inappropriate affect Unusual thinking or speech Lacks close friends Ideas of reference Anxiety in social situations Rule out psychotic or pervasive developmental disorders	Borderline personality disorder IMPULSIVE¹⁰ Impulsive Moodiness Paranoia or dissociation under stress Unstable self-image Labile intense relationships Suicidal gestures Inappropriate anger Vulnerability to abandonment Emptiness (feelings of)	Histrionic personality disorder PRAISE ME⁹ Provocative or seductive behavior Relationships considered more intimate than they are Attention (need to be the center of) Influenced easily Style of speech (impressionistic, lacking detail) Emotions (rapidly shifting, shallow) Make up (physical appearance used to draw attention to self) Emotions exaggerated	Narcissistic personality disorder GRANDIOSE¹¹ Grandiose Requires attention Arrogant Need to be special Dreams of success and power Interpersonally exploitative Others (unable to recognize feelings/needs of) Sense of entitlement Envious	Dependent personality disorder RELIANCE⁹ Reassurance required Expressing disagreement difficult Life responsibilities assumed by others Initiating projects difficult Alone (feels helpless and uncomfortable when alone) Nurturance (goes to excessive lengths to obtain) Companionship sought urgently when a relationship ends Exaggerated fears of being left to care for self
Schizoid personality disorder DISTANT⁹ Detached or flattened affect Indifferent to criticism or praise Sexual experiences of little interest Tasks done solitarily Absence of close friends Neither desires nor enjoys close relationships Takes pleasure in few activities	Antisocial personality disorder CORRUPT⁹ Cannot conform to law Obligations ignored Reckless disregard for safety Remorseless Underhanded (deceitful) Planning insufficient (impulsive) Temper (irritable and aggressive)	Borderline personality disorder DESPAIRER* Disturbance of identity Emotionally labile Suicidal behavior Paranoia or dissociation Abandonment (fear of) Impulsive Relationships unstable Emptiness (feelings of) Rage (inappropriate) * Created by Jason P. Caplan, MD	Histrionic personality disorder ACTRESSS* Appearance focused Center of attention Theatrical Relationships (believed to be more intimate than they are) Easily influenced Seductive behavior Shallow emotions Speech (impressionistic and vague) * Created by Jason P. Caplan, MD	Avoidant personality disorder CRINGES⁹ Criticism or rejection preoccupies thoughts in social situations Restraint in relationships due to fear of shame Inhibited in new relationships Needs to be sure of being liked before engaging socially Gets around occupational activities with need for interpersonal contact Embarrassment prevents new activity or taking risks Self viewed as unappealing or inferior	Obsessive-compulsive personality disorder SCRIMPER* Stubborn Cannot discard worthless objects Rule obsessed Inflexible Miserly Perfectionistic Excludes leisure due to devotion to work Reluctant to delegate to others * Created by Jason P. Caplan, MD

Entire Web sites exist to share mnemonics for medical education (see Related Resources). Thus it is likely that trainees are using them with or without their teachers’ supervision. Psychiatric educators need to be aware of the mnemonics their 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 the prejudice of a potentially pejorative label.

Our methodology

In preparing this article, we gathered numerous mnemonics (some published and some novel) designed to capture the learner’s attention and impart information pertinent to psychiatric diagnosis and treatment. Whenever possible, we credited each mnemonic to its creator, but—given the difficulty in confirming authorship of (what in many cases has become) oral history—we’ve listed some mnemonics without citation.