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.
"Homogenized" Criteria for a Manic Episode
A. Four (or more) of the following symptoms (five or more if mood is only irritable) have been present for at least one week (or any duration if hospitalization is necessary) and represent a change from previous functioning; at least one of the symptoms is elevated, expansive or irritable mood.
(1) abnormally and persistently elevated, expansive or irritable mood, asindicated by either subjective report or observation made by others
(2) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
(4) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
(5) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
(6) (more talkative than usual or pressure to keep talking)
(7) inflated self-esteem or grandiosity
(8) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
(9) (flight of ideas or subjective experience that thoughts are racing)
B. The symptoms do not meet criteria for a Mixed Episode.
C. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Dr. Suneja is medical director of the Andrew McFarland Mental Health Center in Springfield, Illinois.