[0:06]Hi, and welcome. In this video, we're going to take a whirlwind tour of mnemonics that you can use to remember diagnostic criteria for every major psychiatric diagnosis. I'm hoping that this will be a one-stop shop for anyone who needs to get the basics of these disorders down quickly. With over 100 different entries in the DSM, there's no way we can possibly cover all the different disorders, but so we'll be talking about the most prototypical and highest yield disorders in each category. Before we begin, please keep in mind that the diagnostic criteria we're about to review are not the diseases themselves. They are at best a starting point for arriving at a true understanding of the conditions that we treat. These lists and algorithms should never take the place of a thorough clinical evaluation and will not bring you any closer to truly understanding a patient's experience. These criteria are like maps. They're helpful for understanding a territory, but they should never be confused for the territory itself. Trying to understand these disorders by memorizing the criteria is like traveling to Yosemite and then staring at your map the whole time. However, there are times when you need to learn these and learn them fast, like the week before a test or the day before starting a clinical rotation. In those cases, it makes sense to study the map rather than hike all the trails. If you're going to cram like this, that's okay. Just promise to build upon your knowledge base when actually seeing patients, as it takes much more than just the narrow definitions provided here to actually figure out what's going on with your patients and get them the help that they need. And with that disclaimer out of the way, let's get started. Our first disorder is the single most common diagnosis in all of psychiatry, major depressive disorder or just depression. A commonly used mnemonic to remember the signs and symptoms of depression is SIGECAPS. Legend has it that SIGECAPS refers to an old practice where a doctor making a prescription would write SIG for directions, and then E CAPS for energy capsules, an old term for antidepressants. SIGECAPS can help you remember the core signs and symptoms of major depressive disorder, including disturbed sleep, reduced interest in or enjoyment from activities, guilt or hopelessness, decreased energy, impaired concentration, appetite changes, psychomotor slowing, and suicidal thoughts and behaviors. All of these occur in the context of depressed mood, but that one should be easy to remember since depression is right there in the name. You need just over half or five out of nine of these criteria, for at least two weeks to be diagnosed with major depressive disorder. You can remember the time frame for depression by thinking of two blue weeks. To diagnose a manic episode in a patient with bipolar disorder, the mnemonic here is DIG FAST, which stands for high levels of distractibility and impulsivity, as well as grandiosity, flight of ideas, increased goal-directed activity, decreased need for sleep, and excessive talkativeness. All of these would occur in the context of a euphoric or irritable mood. Like major depressive disorder, you need around half of these criteria to qualify, and they must be there for at least one week. Just as you can use two blue weeks to remember depression, you can use one fun week to remember mania. For schizophrenia, the mnemonic here is to think of this disorder as like being connected to a High-Def BS Network. Recall that auditory hallucinations are commonly associated with schizophrenia. These voices are incredibly clear and sound like real voices to the patient, so they're very high definition. However, they're also not real, so it's as if there are radio waves spreading fake BS via a network. High-Def BS Network will help you remember the hallucinations, delusions, disorganized behavior, disorganized speech, and negative symptoms that are the five core signs and symptoms of schizophrenia. Like with two blue weeks or one fun week, we need a way to remember how many symptoms are required and for how long. Think of this disorder as 2-4-6-ophrenia to help you remember that by DSM standards, you need at least two of these symptoms for a period of at least six months to qualify. For substance use disorders and other forms of addiction, the DSM lists 11 distinct criteria, which you can remember using the phrase Time to Cut Down Pal. First off, the two will help you remember that two of these 11 criteria are required for diagnosis. The rest of the mnemonic should remind you that people with substance use disorders often spend lots of time using or obtaining the substance, experience cravings or urges to continue using, are unable to cut down on their own, experience tolerance to the effects of the substance, can have dangerous results of use, affect other people through their use resulting interpersonal or social problems, experience withdrawal when they stop using the substance, end up neglecting major roles and responsibilities such as work or family, have physical or psychological problems that have been created and or made worse by substance use, have given up activities like socializing or hobbies due to excessive use, and finally, have used larger amounts of the substance or for longer than wanted. These 11 criteria are a lot to remember. And frankly, you can recognize the overall pattern of addiction using just three things, which we will refer to as the three reapers. Addiction is when a patient engages in repeated use, so not just once but ongoing, of specific reinforcers, and in particular positive reinforcers are things that generally feel good and make someone want to keep using them, all in spite of clear repercussions from their use, such as worsening health, alienating family and friends, and losing one's job. So you can use the 11 criteria listed in the DSM to be more thorough, but in actual clinical practice, you can diagnose cases of addiction just by using the three reapers. For anxiety disorders, there are a few that we will skip such as social anxiety disorder and specific phobias, as the concepts are easy enough to understand even without a mnemonic. Instead, we'll talk about two disorders where a little more detail is needed. The first is Generalized Anxiety Disorder or GAD. While the core concept of GAD is all captured in the name itself, there are some additional criteria that are added, which we can account for using the mnemonic EGADS, I'm miserable! The first part stands for the core pattern of generalized anxiety disorder, which is excessive and generalized anxiety that occurs on most days for at least six months. An additional criterion that the DSM adds is that there must be at least three of the six physical symptoms that are captured in the second part of the mnemonic, miserable, which stands for muscle tension, irritability, sleep disturbance, low energy, restlessness, and problems maintaining attention. The second anxiety disorder we will talk about is Panic Disorder. Panic attacks are brief periods of intense mental and physical discomfort that result from sudden activation of the fear response. It's important to note that people can have panic attacks without necessarily having panic disorder. To know when someone has panic disorder, use the mnemonic SURP-rise to remember that it's not just the panic attacks, it's specifically when someone has sudden, unexpected, recurrent panic that then gives rise to chronic anxiety about the possibility of future attacks. Our next disorder, Obsessive-Compulsive Disorder or OCD, is characterized by the presence of obsessive thoughts as well as the compulsive behaviors that result from them. Obsessions can take various forms, from repeatedly worrying that you forgot to lock the door, to being haunted by recurrent thoughts of murdering others and other violent imagery. Use this latter image to think of a person who has started to have obsessive thoughts of murdering others. Horrified, he thinks to himself, I murder, with shock and bewilderment. This will remind you that obsessive thoughts are specifically intrusive, meaning that they appear suddenly and without warning. They're mind-based in that the patient recognizes they're coming from their own mind and not from outside, like in a hallucination. They are unwanted, they are resistant to attempts to make them go away, they are distressing, they are ego-dystonic, meaning that the patient recognizes that these thoughts don't reflect their genuine desires or wishes, and finally, they are recurrent. When using the mnemonic I murder, please keep in mind that people with OCD, even those with violent thoughts, are generally not violent, and if anything, are less likely to act on these thoughts than your average person. The second part of the disorder is the compulsions. Some people with obsessive thoughts develop specific behaviors that help to calm their distress, such as someone with an obsession about germ contamination, spending hours a day washing their hands, or someone with violent intrusive thoughts, locking all potential weapons away where they can't reach them. You can remember the function of compulsions by thinking of them as calm-pulsions. They are used to calm obsessions, at least temporarily. One disorder related to OCD is Body Dysmorphic Disorder, which involves a patient who has an obsessive fixation that some part of their body is deformed. The patient then goes to great lengths to check, groom, hide, or otherwise try to cover up the perceived flaw. However, the key is that these flaws are entirely imagined and no objective outside observer would think they are deformed. Compared to the ego-dystonic thoughts in OCD, in BDD, the fixations are ego-syntonic. Patients with BDD will often seek plastic surgery to fix their appearance, but because it's a problem of perception, no amount of surgery will actually do the trick, leading to an endless cycle of futile and harmful treatments. The phrase, fix me doc, should be easily linked to the concept of Body Dysmorphic Disorder. It will help you remember the fixation on a perceived flaw, the pattern of seeking medical care, the ego-syntonic thought pattern, the disabling nature of the disorder, the similarities to the obsessive thought patterns in OCD, and finally, the compulsive grooming and checking behaviors that result. Our next disorder, Post-Traumatic Stress Disorder or PTSD, is a condition characterized by exposure to a life-threatening or violent event that results in specific psychiatric symptoms. You can use the mnemonic TRAUMA to remember the criteria for PTSD. Specifically, that a life-threatening traumatic event needs to have occurred, and that this event seems to have triggered symptoms such as re-experiencing the trauma through flashbacks and nightmares, heightened levels of arousal manifesting through restlessness and hypervigilance, the patient being unable to function for a period of one month or more, and finally, the patient engaging in avoidance of people, places, and things that might trigger symptoms. Dissociation is also common following a traumatic event, and there are a variety of specific disorders in the DSM that feature dissociation in some way. Dissociation as a state is often difficult to understand, so let's use the mnemonic Deeper Dreams to remember the key signs and symptoms of this phenomena. These include feelings of depersonalization or feeling of being separated from one's body, as well as derealization or feeling that one's experience is unreal or dreamlike. Specific memory abnormalities are seen as well, including both retrograde amnesia, which is a loss of previously acquired memories, as well as memory errors of commission, which is a tendency to remember things that have not necessarily happened. The final three signs and symptoms of dissociation overlap with things that are seen during a state of hypnosis. These signs and symptoms are absorption, which is a state of being highly engaged in or entranced by stimuli. Motor automaticity, which are behaviors that the patient does automatically without conscious awareness or effort, and finally suggestibility, which is the psychological trait of being inclined to accept and act upon the ideas and suggestions of others. For personality disorders, the DSM groups them into three clusters based on superficial similarities between the disorders. You can remember the specific disorders that fall into each category by thinking of what would happen if you were to invite people from each cluster to a party. Cluster A will pass on the invitation, as people with these disorders tend to shy away from social interaction, either due to paranoia about other people's intentions, having no desire for interpersonal contact, or feeling discomfort when interacting socially due to odd mannerisms and beliefs. We'll talk a bit more about Cluster A in a few slides. Cluster B will come to the party, but they run the risk of being banned from future parties for engaging in overly emotional, narcissistic, histrionic, or downright antisocial behavior. Borderline personality disorder is the most complex disorder in Cluster B, so we'll talk more about that in a few slides as well. Finally, Cluster C will join, but the party will be DOA, dead on arrival, given their tendency to be dependent, obsessive-compulsively perfectionistic, and socially avoidant, which will drag down the spirit of the party. In general, the meaning of each of the personality disorders is fairly obvious from the name, so no mnemonics are needed. However, there are a few that are worth providing some additional detail about. In Cluster A, two of the personality disorders can often be confused, especially as they first begin with schiz. Let's clarify this using a couple of mnemonics. Schizoid personality disorder involves a tendency to avoid social relationships, not due to fear of rejection as an avoidant personality disorder, but because they simply don't desire the presence of others. You can remember this by thinking that schizoid avoids. In contrast, schizotypal personality disorder involves the presence of odd beliefs and difficult relating to other people that strongly resembles, though is not quite as impairing as, schizophrenia. Schizotypal personality disorder is genetically linked to schizophrenia, and around a third of patients go on to develop schizophrenia, so it's best to think that schizotypal is a type of schizo. As mentioned before, Borderline Personality Disorder is worth spending some time on, as it is the single most complicated personality disorder to understand. It's not just an extreme of a single trait, but rather is a constellation of different signs, symptoms, and patterns. However, it's crucial to understand this well, given how common it is in clinical settings. So let's use a mnemonic to help us. You can remember the specific signs and symptoms using the mnemonic I Despair, which stands for identity disturbance, such as an inconsistent sense of self, dysphoria, including chronic depressive symptoms, anxiety, and feelings of emptiness, emotional instability, involving rapid swings from one extreme of emotion to another, suicidal acts or self-harm, such as cutting or recurrent overdoses, psychotic and or dissociative symptoms like paranoia, anger, antagonism and hostility towards others, impulsive or risky behavior, especially when someone's trying to escape from negative feelings, and finally, unstable relationships due to a high sensitivity to rejection, a deep fear of abandonment, and a tendency to see other people as either all good or all bad, with little nuance in between, a phenomenon known as splitting. Somatoform disorders are those in which the patient either experiences or feigns symptoms of a medical illness, like chest pain, in a way that is excessive or beyond what would be expected from medical findings. There are a few different types of disorders to be aware of here. First is somatic symptom disorder, which involves the presence of somatic symptoms, along with excessive thoughts, feelings, or behaviors related to it. To remember the key features of somatic symptom disorder, use the mnemonic some attic. This should remind you of the somatic symptoms that are at the heart of the disorder. Most people with this disorder have multiple symptoms, but ultimately, only one is required. The symptoms are often either medically unexplained or so clearly in excess of what would be expected from the disease itself, that it suggests a large psychological component. The excessive concern about the symptoms manifests as feelings of anxiety about what the symptom could mean, frequently thinking about the symptom, a lot of time and energy consumed by activities related to the symptom, such as researching things online for hours each day, and being clearly impaired or distressed by the disorder. Finally, somatic symptom disorder is chronic, lasting months or even years at a time. Conversion Disorder, also known as functional neurologic disorder, is when a patient presents with specific neurologic signs or symptoms, such as paralysis, numbness, blindness, or seizure-like fits, with no evidence of an observable organic cause. Historically, it was required for there to be a recent stressor, the stress being the thing that was converted into the neurologic abnormality, but that's not the case in the DSM-5. Regardless, the name remained the same. You can remember the features of conversion disorder by thinking of it as CAN'T-version disorder, which should help you remember that it involves a clinically unexplained abnormality, specifically in the nervous system, that is sometimes, but not always, brought on by a stressful trigger. The CAN'T should help you remember as well that these patients aren't faking it. They genuinely can't do the things they say they can't, even in the absence of observable causes. While both somatic symptom disorder and conversion disorder are out of the patient's control, some patients will intentionally feign having a medical condition. This takes two main forms. In factitious disorder, the patient feigns having an illness in order to gain sympathy or attention, while in malingering, the patient feigns having an illness in order to get some external reward, like disability or money. You can remember the clinical pattern associated with each by focusing on the first three letters, and thinking that someone who is malingering always leaves once their need has been met, or someone with factitious disorder always comes back for more because it's the attention itself they're seeking, not some external reward. Eating disorders take two main forms. Anorexia nervosa is defined by a distorted perception of weight in which someone perceives themselves as fat even when they are dangerously underweight, leading to food avoidance and other activities, like excessive exercise to lose weight. You can remember the core patterns of anorexia by thinking of it as under-rexia, which stands for the patient being underweight, which is a required part of the diagnosis. Being abnormally nervous or fearful about gaining weight, having distorted perceptions about their own weight and health, engaging in exercise, purging, or other behaviors to interfere with weight gain, and finally, restricting caloric intake through food avoidance or other means. In contrast, bulimia nervosa is less about the distorted perceptions and food restriction, than it is about a recurrent pattern of bingeing and purging. You can remember the pattern here by picturing a bowl of ice cream and thinking of the name as BOUL-emia, which should remind you of the impulsive and out-of-control binges where the patient eats lots of food at once, and then engages in offsetting behaviors where they try to purge the food and its associated calories through vomiting, laxatives, or other means. Per DSM criteria, these episodes must have happened at least weekly for a period of three months. Unlike anorexia, which is linked to distorted perceptions of weight, in bulimia, the core psychological pattern is that the patient has linked their self-esteem to their weight and worries that being overweight will lead to them being rejected or alone. In the next few slides, we'll talk about a few disorders that begin during childhood development and are known as neurodevelopmental disorders. We'll first go over autism, known sometimes as Autism Spectrum Disorder or ASD. Autism is characterized by three things. First are deficits in interpersonal interaction and communication, such as trouble producing language or understanding the emotions of others. These communication deficits lead to what was termed an autistic aloneness when the disorder was first described. Second is a pattern of restricted interests or behavior, such as doing the same thing over and over again or being very rigid in one's routines. This was termed an insistence on sameness. Both of these patterns must be present during early childhood development, typically within the first three years of life. These things can all be packed into the acronym ASD, an autistic aloneness, an insistence upon sameness, that are both present during early childhood development. ADHD is another neurodevelopmental disorder that, on the face of it, doesn't seem to really need a mnemonic, as the core patterns are right there in the name. An attention deficit and hyperactivity. However, there are some additional details to pay attention to. Use the mnemonic FIDGETY to remind you of the criteria for ADHD. The first half encompasses the core symptoms of ADHD, which are functionally impairing patterns of inattention and or disinhibition. Note that you don't need both. While some people have both, most people with the disorder have either the hyperactive or the inattentive subtype. The second half of the word includes a few additional caveats to remember, and those are that these symptoms must be greater than expected and not just the usual running around that is a completely normal part of growing up. That you need to exclude other possible causes such as mood or anxiety disorders or intentional oppositional behavior, which is important, as patients with ADHD specifically do not intend to upset others with their behavior. That these patterns must be observed in two or more settings such as school and at home, otherwise you run the risk of diagnosing a child with a disorder when the problem is actually in the environment. And finally, that the patient must have been young at the first onset of the disorder, with signs and symptoms first appearing before the age of 12, if not even earlier. The last neurodevelopmental disorder we will talk about is a tic disorder, which involves short bursts of muscle contractions in specific muscle groups that occurs suddenly in repetitive bouts. In contrast to something like a sneeze, a tic can be delayed, but not resisted completely. Most kids outgrow these by the time they reach adulthood, but while they exist, they can be impairing or socially difficult for the patient. You can remember the definition of a tic by making an acronym out of it. A TIC is a transient, irreversible, contraction. A specific condition known as Tourette Syndrome is characterized by multiple motor tics and at least one vocal tic where the patient may yell out suddenly without meaning to, sometimes involving obscenities. You can remember the difference between Tic Disorder and Tourette Syndrome by thinking of the latter as Tou-rette Syndrome, as it involves two forms of tics, both motor and vocal. Okay, we're almost done. We'll jump now from childhood disorders to those seen primarily in older adults. First, we'll talk about dementia, known more formally as a major neurocognitive disorder in the DSM-5. The diagnostic criteria are really quite simple. You can remember them using the word DIRE, which should remind you of a clear decline in one or more cognitive domains, leading to impairment and decreasing independence. Importantly, you need to make sure to both rule out delirium, which we'll talk about next, as well as exclude other psychiatric conditions such as depression as possible causes. Finally, delirium is an acute state of changes in awareness, attention and cognition, in someone who is medically unwell. Most often occurring in intensive care units of hospitals. You can remember the key features of delirium using the phrase, Where the F am I? The Where should remind you of the disorientation that occurs in delirium. The T should remind you of the transient nature of delirium, often lasting a few days or weeks. The F is for the fluctuating or waxing and waning course that delirium tends to have. The A should remind you of the acute onset that occurs, often over hours or days. And finally, the M and I are to remind you to look for either a medical cause and or an intoxicant like a medication or substance that causes the abnormality in mental status. Ooh, and we're done. What a whirlwind. We've covered a lot in this video, but I'm hoping that you now have a starting point for each of these diagnoses. The universe of mental disorders can at first seem overwhelmingly vast and complex, so it's helpful to have a mnemonic to help orient you, especially when working with patients when you want to be thorough and consider all possible explanations.
[24:54]This mnemonic can remind you of addiction and substance use disorders, mood disorders, including depression and bipolar disorder, anxiety disorders like generalized anxiety and panic, psychotic disorders like schizophrenia, trauma-related and dissociative disorders, OCD and related disorders, medical disorders, some of which can mimic psychiatric conditions, specific intoxicants like alcohol or other substances that can also mimic psychiatric conditions, normalcy, which should always be on the differential, delirium, somatoform disorders, personality disorders, with a particular focus on borderline and anti-social personality disorders, since those are the two that come up most often in clinical practice, ADHD, autism and other neurodevelopmental disorders, cognitive disorders such as Alzheimer's disease and other forms of dementia, and finally, eating disorders such as anorexia and bulimia. Just as you would use a map to know the key features of an area, this mnemonic can serve as a map to the space of the mind and the various ways in which things can go awry. And that's it. Please, please, please remember that lists of diagnostic criteria are no substitute for actually understanding these disorders. If you want to explore each of these conditions in more depth, and learn not only how to recognize them, but how to effectively treat them as well, consider getting my books, Memorable Psychiatry and Memorable Psychopharmacology, which are available on Amazon. See the link down in the description below. Until next time, happy studying.
