Memorizing and Recalling DSM-IV Diagnostic Criteria

To the Editor: The Diagnostic and Statistical Manual of Mental Disorders constitutes the major diagnostic system used in psychiatric training, practice, and research in the United States and internationally. However, it is not easy to remember the large number of criteria for certain disorders.

Several authors have published mnemonics for memorizing diagnostic criteria (1,2,3,4). I present another approach. Remembering the criteria for a manic episode is easier when they are "homogenized" with the criteria for a major depressive episode. Then the criteria for a manic episode can be recalled through a process of association. I have used this approach for quite some time and would like to share it with other clinicians.

DMS-IV diagnostic criteria for a major depressive episode and for a manic episode are not homogeneous, which makes memorizing them rather difficult. This problem can be resolved by rearranging the criteria for a manic episode so that they follow the pattern of criteria for a major depressive episode. The rearrangement is shown in the accompanying box.

The initial statement of criterion A has been modified to correspond with the initial statement of criterion A for a major depressive episode without sacrificing the diagnostic requirements of the DSM-IV criteria for a manic episode. Note that the criteria for a manic episode do not include a symptom for weight change (symptom A3 of a major depressive episode). Thus symptom A3 is left blank.

The criteria for a manic episode do not include a symptom of increased energy (corresponding to symptom A6 of loss of energy for major depressive episode). Therefore, the manic symptom closest to it ("more talkative than usual or pressure to keep talking") is positioned as symptom A6. In addition, the criteria for a manic episode do not include a symptom corresponding to symptom A9 for a major depressive episode ("recurrent thoughts of death…"). Therefore, the manic symptom relating to thoughts ("flight of ideas or subjective experience that thoughts are racing") is positioned as symptom A9. To indicate the lack of exact correspondence in criteria A6 and A9, they are enclosed in parentheses. Finally, note that criteria B, C, and D correspond to criteria B, C, and D for a major depressive disorder.

The format of the criteria in the box is very similar to the format of the criteria for a major depressive episode. This similarity makes memorizing and recalling much easier.