What are mnemonic devices in psychology?

Abstract

Numerous mnemonic techniques have been used and advocated throughout history. In this chapter, some of the most popular and enduring formal mnemonic and organizational mnemonic techniques are discussed in terms of their underlying processes. Specifically, the method of loci, the peg-word method, and the keyword method are discussed as formal mnemonic techniques. The use of acronyms, linking by story, and categorical and schematic organizations are discussed as organizational mnemonic techniques. As is described in the discussion, each of the mnemonic devices represents simple applications of well-researched psychological processes. Furthermore, examination of mnemonic techniques in light of basic research suggests that a specific combination of processes is necessary for the effectiveness of any given mnemonic.

Use of Mnemonics and Disease Categories

Mnemonics are a commonly used learning aid to remember long lists of diseases associated with radiologic expression. For example, the differential considerations of a presenting cystic bone lesion are summarized by the mnemonic FEGNOMASHIC, or fibrous dysplasia, enchondroma, giant cell tumor, nonossifying fibroma, osteoblastoma, multiple myeloma/metastatic disease, aneurysmal bone cyst, simple bone cyst, hyperparathyroidism/hemophilic pseudotumor, infection, and chondroma, and listed with many others inside the back cover of this book. There are hundreds of mnemonics, limited only by the imagination of their creators.

Mnemonics are useful for deriving a differential list. They function as prompts to expand the interpreter's consideration of differential causes for a specific radiologic presentation. Typically, mnemonics are very specific; however, a few exceptions are worth noting. CAT BITES (defining congenital, arthritide, trauma, blood, infection, trauma, endocrine, and soft tissue) serves as a universal mnemonic, providing a comprehensive list of disease categories.100 Another universal mnemonic is described by VINDICATE (defining vascular, inflammatory, neoplastic, degenerative/drugs, idiopathic congenital, allergic/autoimmune, traumatic, and endocrine/metabolic). A short version is expressed by MINT (defining malformations, inflammation/intoxication, neoplasms, and trauma).

Regardless of the exact approach used to view and summarize radiologic data, the interpreter must view all findings in light of their clinical impact. Diagnostic imaging is a wonderfully valuable aid for assisting clinical diagnosis and patient management. One is cautioned not to manage patients from their imaging studies, or limit the investigation of the patient's problem to only that data obtained from diagnostic imaging. What appears as a puzzling presentation on an imaging study may be easily clarified by laboratory studies, use of more advanced imaging procedures, further physical examination, comparison with past imaging studies, or further elaborating the patient's history.

Mnemonics are memory aids that may appear to be unusual or artificial, but are based on the basic principles of learning and memory. Mnemonic techniques and systems have been used for at least 2,500 years, but have been studied experimentally for less than 40 years. Mnemonic techniques can be verbal (using words) or visual (using visual imagery). Verbal mnemonics include first-letter mnemonics (acronyms and acrostics), rhymes and songs, and stories. The keyword mnemonic involves two steps, one verbal (constructing a concrete word to substitute for an abstract term) and one visual (a visual image associating the substitute word with the meaning of the abstract term). Visual mnemonics include the use of visual imagery accompanying some verbal mnemonics, and the mnemonic systems described below. Interaction, vividness, and bizarreness can help make visual associations effective. Mnemonic systems are mental filing systems that are more general-purpose than mnemonic techniques. The loci system involves pre-memorizing visual images of familiar locations in a natural order, then associating images of the to-be-remembered items with the locations. The peg system uses pegwords that represent numbers, which are then used in the same manner as the locations in the loci system, except that direct retrieval as well as sequential retrieval is possible. The phonetic system represents the digits 0–9 by consonant sounds, which are used to construct keywords to represent numbers; these keywords are used in the same manner as the pegwords in the peg system, except that more keywords can be constructed and numerical information can also be remembered.

3 Circuit Leaks

Leaks in an air delivery circuit can cause hypoventilation and dilution of the inspired gases by entry of room air into the system. With an ascending bellows system, such as that found in newer models of anesthesia machines, the bellows do not rise completely during exhalation if there is a leak. This situation indicates that the circuit leak exceeds the inflow of fresh gas. Older machines with a descending bellows system do not provide such a visual clue and appear to function normally. The anesthesiologist should be vigilant at all times for signs of a circuit leak. The inspired oxygen concentration measured at the gas sampling port is reduced because of dilution with room air, and the partial pressure of end-tidal CO2 increases. Cyanosis, decreased oxygen saturation (Spo2), or hypertension and tachycardia associated with hypercapnia may be the presenting signs, although each of these is typically a late finding.

Mnemonics such as COVER ABCD–A SWIFT CHECK may help to diagnose and treat the conditions222:

C Circulation, capnograph, and color (saturation)

O Oxygen supply and oxygen analyzer

V Ventilation of intubated patient and vaporizers (include analyzers)

E Endotracheal tube (position, orientation, and patency) and eliminate machine problems

R Review monitors and equipment

A Airway (with face or laryngeal mask)

B Breathing (with spontaneous ventilation)

C Circulation (in detail)

D Drugs (consider all given or not given)

A Awareness of air and allergy

SWIFT CHECK of patient, surgeon, process, and responses

Conclusion

The mnemonic “five Bs,” which stands for balance of fluids, blood pressure, biomarkers, bioimpedance, and blood volume, provides a structured strategy for diagnosis in a patient with the potential to develop cardiorenal syndrome and presents an approach to management considerations for the cardiorenal patient with fluid overload. Consideration of the five Bs presents a pathway for assessing the appropriate degree of hydration and the determination of a neutral fluid balance. At the same time the five B approach represents an important mnemonic algorithm to guide fluid therapy and to make fluid removal safer and more effective. This combines clinical judgment, biomarkers, technology, and precise nursing to achieve the best outcome for patients in HF associated with fluid overload and varying degrees of renal dysfunction.

Episodic memory

Mnemonic functions and notably episodic memory mainly rely on PC. PC involves gray matter nodes of the limbic system including the hippocampus, thalamus, mammillary bodies, and cingulate cortex, interconnected by bundles of white matter fibers (Fig. 8.1). The anterior thalamus receives inputs from the mammillary bodies via the mammillothalamic tract and projects to the cingulate cortex via the internal capsule. Then, the cingulum bundle connects the cingulate cortex to the entorhinal cortex and hippocampus, which projects to the mammillary bodies through the fornix. Studies in AUD patients reported volume loss in mammillary bodies (Pitel et al., 2012; Sheedy et al., 1999; Sullivan et al., 1999), hippocampus (Sullivan et al., 1995), thalamus (Cardenas et al., 2007; Chanraud et al., 2007), and cingulate cortex (Pitel et al., 2012) but failed to show any correlation between gray matter macrostructural abnormalities and episodic memory impairments. Rather, episodic memory disorder may be associated with alteration of gray matter microstructure in the medial temporal lobes (Chanraud et al., 2009a) or damage of white matter bundles and tracts, in particular, the cingulum and the fornix (Pfefferbaum et al., 2009; Schulte et al., 2010; Trivedi et al., 2013), leading to a disruption of the PC. Segobin et al. (2015) found lower episodic memory performance in AUD patients with the most severe alterations of the microstructure within the cingulum and fornix.

Episodic memory is currently described as the memory system in charge of the encoding, storage, and retrieval of personally experienced events, associated with a precise spatial and temporal context of encoding. Episodic memory allows the conscious recollection of personal events from one's past and the mental projection of anticipated events into one's subjective future (Wheeler et al., 1997). Recollection of episodic events requires autonoetic awareness, which is the impression of reexperiencing or reliving the past and mentally traveling back in subjective time (Tulving, 2001). Episodic memory is not only hierarchically the most sophisticated memory system but also the most sensitive to pathology, trauma, and toxicity.

Most studies investigated episodic memory in AUD with classical learning tasks such as learning a list of words (Sherer, 1992), face–name associations (Beatty et al., 1995), or delayed recall of a complex figure (Sullivan et al., 1992). Learning abilities were impaired for both verbal and nonverbal information. Although AUD patients performed lower than healthy controls on the Free and Cued Selective Reminding Test (Pitel et al., 2007a), they seemed to improve their performance at the same rate. They can indeed show evidence of some learning over trials (Ryan and Butters, 1980). Pitel et al. (2007a) investigated episodic memory in accordance with the current and comprehensive definition of this skill: encoding, storage, and retrieval of factual information located in a precise space-time context associated with autonoetic recollection. AUD patients showed impairment on a recognition task test after a spontaneous encoding as well as on a free recall task after a deep encoding. These results suggest an impairment of both encoding and retrieval abilities in AUD. However, authors did not find any storage impairment in AUD patients, in accordance with a previous research (Sherer, 1992). Moreover, the spatiotemporal context of encoding was also altered, with a deficit in spatial and temporal contexts (Pitel et al., 2007a; Salmon et al., 1986). Patients tended not to recall complete episodes, i.e., correct factual information associated with the correct spatiotemporal context of encoding, suggesting incomplete episodic memories. AUD patients also present difficulties identifying the source of remembered information (Schwartz et al., 2002) and a deficit of autonoetic consciousness (Pitel et al., 2007a).

Noel et al. (2012) indicated that patients perform better on cued-recall and recognition testing conditions, which are less dependent on strategic retrieval operations. In AUD patients, impaired learning abilities could be related to executive dysfunctions and notably impoverished generation of spontaneous strategies. However, another study found very little relationship between episodic memory performance and executive results, and suggested rather a genuine episodic memory impairment that could not be interpreted solely as the consequence of executive dysfunctions (Pitel et al., 2007a).

Another component of episodic memory is prospective memory, which is the ability of remembering to carry out an intended action at some future point in time (Brandimonte et al., 1996). The Prospective Memory Questionnaire, based on self-report measures, revealed prospective memory complaints in AUD (Heffernan et al., 2002; Ling et al., 2003), suggesting that prospective memory may be impaired in AUD patients (Heffernan, 2008 for a review). The severity of the complaints was associated with the total amount of alcohol consumption (Ling et al., 2003). Moreover, patients who reported prospective memory difficulties also complained about impaired executive functioning (Heffernan et al., 2005). They did not appear to use sufficient internal or external memory strategies to compensate for prospective memory deficits (Heffernan et al., 2002).

Autobiographical memory (AM) refers to remote memory, comprising the specific personal events (episodic component) as well as general knowledge about one-self (semantic component) (Conway, 2001). Compared with healthy controls, AUD patients recalled specific memories less frequently and general memories more frequently, which is a phenomenon of overgenerality (D'Argembeau et al., 2006). However, when a specific past event was provided, AUD patients subjectively experienced as many sensory and contextual details as controls. AUD patients may encode and/or access fewer episodic memories than controls, but when they do, the richness of the memories seems qualitatively equivalent to that of controls. Nandrino et al. (2016) compared semantic and episodic dimensions of AM in AUD patients after a short-term (STA, nearly 5 weeks) and long-term (LTA, at least 6 months) abstinence and healthy controls. On the overall, the two groups of AUD patients were especially impaired for recall of both episodic and semantic recent events and knowledge, corresponding to the drinking period. However, no significant differences were observed between the AUD and control groups for childhood semantic events. Concerning episodic events from childhood, STA provided fewer memories than healthy controls and LTA. First, these results suggest encoding alteration during the drinking period. Second, the semantic component of AM may be less affected by heavy chronic drinking than the episodic component. Third, the preservation of episodic memories from childhood may be preserved in LTA because of cognitive and brain recovery with sobriety.

Although AUD patients are impaired on most of the episodic memory components, they seem to present a limited awareness of those deficits. AUD patients may thus exhibit a deficit of metamemory, which refers to personal knowledge about one's own memory abilities (Flavell, 1971). Metamemory is related to monitoring and control processes. Indeed, to improve performance during a memory task, it is necessary to adjust strategies according to this one. Monitoring concerns the capacity to assess future performance before a memory task and the skills to evaluate performance retrospectively (Nelson and Narens, 1990). The most frequently used measure of metamemory is the feeling-of-knowing (FOK) (Hart, 1965), characterized by the ability to accurately predict the future performance on tasks requiring recognition of newly learned information. The FOK judgment is recorded on a Likert-type scale (from 0% “definitely will not recall” to 100% “definitely will recall”). A FOK accuracy index is calculated to evaluate the agreement between predictions of the future recognition performance and real recognition performance (Goodman–Kruskal Gamma statistic; Nelson, 1984). Le Berre et al. (2010) found that AUD patients were impaired in this task as they obtained a FOK index significantly lower than that of the control group (not better than chance level). Patients had a tendency to overestimate their memory skills: they predicted that they would be capable of recognizing the correct word while they actually failed to do so. An explanation of this metamemory deficit is that AUD patients fail to update information about their level of memory and, as a consequence, assess their memory skills regarding earlier functioning in life (Le Berre and Sullivan, 2016). This metamemory impairment may be considered as a mild form of anosognosia, a lack of insight of the disease frequently observed in KS.

Examination

The mnemonic for a musculoskeletal examination is TART: T, tenderness or sensitivity; A, asymmetry (look); R, restriction of motion (move); and T, tissue texture abnormality (feel). The diagnosis of somatic dysfunction is based on a palpatory examination assessing TART. Terms to describe the “feel” might be ease and bind or freedom and resistance (eSlide 16.2). Segmental motion can also be tested using pressure applied through the hands, without relying on patient movement for diagnosis (eSlide 16.3).

Formal Mnemonics

Formal mnemonics are systems for remembering that must be learned through instruction, generally because they are complex systems built upon an acquired core of knowledge. Formal mnemonic systems are analogous to the scaffolding of a building upon which the remainder of the house depends; they provide a framework on which to ‘hang,’ or incorporate, information to be remembered. Prototypical examples include the method of loci (previously described) and the pegword system. For the pegword system, visual associations are created between individual items to be remembered and keywords (‘pegs’) that have already been learned in a sequence, one such sequence being ‘one is a bun, two is a shoe,’ and so on. To recall the items, one uses the familiar sequence to cue the visual associations, which then call forth the items.

Active memory researchers, who are presumably familiar enough with the theoretical and empirical underpinnings of memory research to be considered experts on memory, eschew formal mnemonics for themselves and do not recommend them to others. Formal memory techniques require much effort to learn and constant practice to maintain. They are most readily applied to simple situations, such as learning a list of words, in which, unfortunately, their use is often outmoded by present-day materials and technology. For example, using the pegword system to learn a list of items to buy at the grocery story is unduly cumbersome when a written list would serve the same purpose and be much more efficient. Thus, although formal memory strategies can significantly increase the amount of information a person can recall, they are impractical for meeting people's needs for remembering in many situations of everyday life.

153 What do “SLUDGE” and “DUMBELS” have in common?

Both are mnemonics used to remember the problems involved with organophosphate poisoning, lipid-soluble insecticides used in agriculture and terrorism (“nerve gas”). Organophosphates inhibit cholinesterase and cause all the signs and symptoms of acetylcholine excess.

Muscarinic effects: Increased oral and tracheal secretions, miosis, salivation, lacrimation, urination, vomiting, cramping, defecation, and bradycardia; may progress to frank pulmonary edema

CNS effects: Agitation, delirium, seizures, and/or coma

Nicotinic effects: Sweating, muscle fasciculation, and, ultimately, paralysis

The mnemonic SLUDGE is: Salivation, lacrimation, urination, defecation, GI cramps, emesis.

The mnemonic DUMBELS is: Defecation, urination, miosis, bronchorrhea/bradycardia, emesis, lacrimation, salivation.