Orientation refers to an individual's awareness of time, place, and person. The document discusses orientation and how it is assessed through a series of questions covering four areas: time, place, person, and space. Disorientation, or the lack of proper orientation, is commonly seen in conditions like confusion states, amnestic syndromes, and dementias. Disorientation to time typically occurs before place and then person. The document provides details on assessing and interpreting orientation and disorientation in clinical psychiatric evaluations.

1. ORIENTATION
BY:
DR.SAKSHI SHAH
1ST YEAR RESIDENT
DEPARTMENT OF PSYCHIATRY
DR. M.K. SHAH MEDICAL COLLEGE AND RESEARCH CENTRE

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}

14. Thank you