2. ORIENTATION
• Orientation is the capacity of an individual to
accurately gauge time ,space and person in his
current setting.{Sims}
• The process by which an individual apprehends his
environment and locates himself in relation to it is
known as orientation.{Namboodiri}
• State of awareness of oneself and one’s surroundings
in terms of time, place and person.{synopsis}
3. Four areas of orientation
• Time
• Place
• Person
• Space
• If a person knows his position in reference to time,
appreciates his situation as to both space and
circumstances and understands his relationship to
other individuals ,he is said to be oriented.
{ A guide to clinical psychiatry :Namboodiri and john}
4. SERIES OF QUESTIONS FOR ASSESSMENT OF
ORIENTATON
• What is your name?
• Can you give me today’s date?
• Can you tell me what time is it?
• How long is it since you had breakfast?
• Can you tell me what place is this?
• Since how many days you are in hospital?
• Where is this hospital located?
• How far is this hospital from your home?
{A guide to clinical psychiatry :Namboodiri and john}
5. • Why have you come here?
• How long it is since Holi/Diwali/christmas?
• Can you tell me who am I?
• Who are these people who look after you?(nurse,
ward assistant)
• The above series of questions covers 4 areas of
orientation.
{A guide to clinical psychiatry :Namboodiri and john}
6. • Orientation to time ,place and person assess a type
of memory function(temporal or prospective
memory)
• When disorientation occurs it usually proceeds with
the sense of time lost first followed by place and
lastly person.
• Hospitalized patients commonly lose track of the
exact day of the month but should remain clear on
the month, season and year
• Should be close on the day of the week, whether
beginning , middle or end of the month.
{Paula T. Trzepacz and Robert W. Baker}
7. • Orientation to place: Tested by asking the name of
hospital and floor, also the city and the state can be
asked.
• Orientation in space is disturbed later in the disease
process than time.{sims}
• A patient may be unable to find his way especially in
an area that is new to him.{sims}
• Disorientation to time and place may be the earliest
signs of dementing process.
{Paula T. Trzepacz and Robert W. Baker}
8. • Orientation to person: means one’s self , to
one’s family and friends and to those in
contact with patient in the hospital
.impairment usually begins with those least
well known to the patient; the nurses, doctors
and the therapists
• Next , more familiar persons like neighbors or
family members may be misidentified.
• Finally the patient no longer know his identity
which is a grave sign of a delirious patient.
9. • Orientation to time is labile and quite readily
disturbed by strong emotion or organic brain
factors (alcohol intoxication)
• More advanced states are demonstrated with
incorrect day of the week, year or period of
the day or season.
10. DISORIENTATION
• Disorientation is most commonly observed in Confusional
states and severe Amnestic syndromes, extensive damage to
the prefrontal cortex may result in disorientation.
• Transient global amnesia involves temporary disorientation
and memory deficits related to temporal lobe.
• Moderately to severly demented persons can also sometimes
seem disoriented
• Sedation from medications too interfere with orientation
• Damage to frontal lobes from trauma or surgery too can alter
orientation.
• Electrolyte disturbances can also lead to disorientation.
{Paula T. Trzepacz and Robert W. Baker}
11. • If a patient is disoriented for time and place ,it is
customary to say they are ‘confused’
• This sign is seen is severe Anxiety and acute
schizophrenia {Fish}.
• Disorientation is significant symptomatology in organic
brain syndromes
• Can be seen in other psychiatric disorders too if the
patient has significant impairment of attention,
perception or memory. {Namboodiri}
• Orientation may fluctuate in some organic conditions, for
example a patient with an acute toxic state associated
with congestive cardiac failure was disoriented in time
every evening but quite clear in the morning. {sims}
• In severe intellectual defect and severe disturbances of
memory, orientation is impaired even when the
consciousness is clear.{SIMS}
12. DELUSIONS THAT MIMIC DISORIENTATION
• Disorientation is usually associated with other
organic features such as lowering of consciousness or
disturbance of memory.
• Delusions of misorientation will have the features of
delusion ; for example: a person on the ward may
believe himself to be in prison; and a visiting relative
may be considered to be an interrogator from the
Gestapo.
{Sims’ symptoms in the mind}
13. DISSOCIATION AND DISORIENTATION
• Definite and undisputed disorientation is indicative of
either an acute organic brain syndrome coupled with
lowering of consciousness or chronic organic
deterioration.
• Hysterical dissociation may mimic disorientation but
careful mental status examination reveals suggestive
discrepancies.
• Example: a patient lived in Birmingham , United kingdom
but who found himself after a hysterical fugue in
Montreal.
• Although apparently disoriented, he actually showed an
abnormality of memory as a part of dissociative state.
{sims’ symptoms in the mind}
