Where are you? What are you doing here? What date are we on? Who are you? A large majority of people were able to answer these questions.
However, if these same questions are asked of someone with brain damage or who is intoxicated by certain medications or medications, we may not know how to answer them, there may be serious doubts, or the answers are completely wrong (because For example, a person may say that it is 1970 or that they are in a shopping mall when they are in fact in the hospital). These are people who manifest the existence of orientation disorders.
Before defining the various orientation disorders, it is necessary to specify what this concept refers to. It is considered an orientation towards cognitive ability that allows us to be able to determine our position in space and time from environmental references, as well as who we are and what we do in this spatiotemporal position.
Most people identify with the concept of orientation only with the ability to determine our relationship with the environment and to place oneself in a given space and time. This type of orientation is called allopsychic.
However, there is another type of orientation, the autopsychic orientation. This is the orientation related to his being: we know that we are us, or that our hand or other parts of our body are part of us and do not belong to another person.
Orientation is very related to other processes such as consciousness, attention and memory, And can be influenced by failures in any of these skills or processes. For example, thanks to memory, we are able to establish and order our experiences in time or to remember the meaning or concept of the place where it is located.
The main orientation disorders
Understanding and what the term orientation means, we can identify different pathological orientation processes: orientation disorders. In this way we can find the following pathologies or problems.
Disorientation is understood as the loss of the ability to place oneself correctly in space and / or time. Subject does not identify their situation and cannot respond if asked where they are or the date. This disorientation can be only temporal or spatial, or appear jointly both.
It is also possible that this disorientation is not complete.: For example, the patient may know that it is 2017, but not the month or the day.
Disorientation can also occur (alone or alongside the previous ones) at the autopsychic level, not knowing who it is, what she is doing there or not recognizing.
2. Double orientation
Dual orientation occurs when the subject is able to orient himself at certain times or he mixes the real situation with unreal or abnormal elements. For example, you can say that you are in a hospital in a colony on Mars, being true that you are in a hospital.
3. Conspiracy or false orientation
The subject is considered oriented and provides data on his location in time space or on who he is, however the answers he gives are unreal and worked out by the subject himself ignoring the real answers.
Certain parts of the brain affected
Orientation changes can come from affecting different brains. For example, the management of orientation in space has been linked to the functioning of the hippocampus, which allows make a mind map of space. Time and its measurement are often related to the striatum, the suprachiasmatic nucleus, and the management of the biorhythm.
Dysfunction of nerve connections from the thalamus to the cortex and vice versa can lead to alterations such as conspiracy. Parietal lobe damage may also explain the presence of disorientation.
In what contexts do they appear?
Orientation disorders can arise in a wide variety of situations. It is common for them to appear in any situation in which there are alterations in consciousness. too much they are linked to cortical and subcortical degeneration and problems with memory and attention.
One of the disorders in which they usually appear is schizophrenia along with other psychotic disorders, being possible in many cases to observe conspiratorial orientation or double orientation. In some manic episodes, they can also be observed. It is also very common for some of the above disorders to appear in neurodegenerative diseases such as Alzheimer’s disease or other dementias.
Organic poisoning due to the use of toxic substances, drugs or certain drugs can also lead to orientation disorders. It is not uncommon for it to appear in Wernicke-Korsakoff syndrome or withdrawal syndromes.
Finally, disorientation it can be mentally generated in disorders such as dissociative (For example unrealization or depersonalization), agnosis or in some cases mood disorders or anxiety.
The treatment to be used for orientation disorders will depend largely on the causes of these disorders, limiting each treatment to the corresponding situations.
I usually try that the subject is oriented indicating the data he does not know, By allowing them to observe contextual clues and / or by trying to get the person to relate the missing data to something known. It is also useful to explain the situation to the person concerned and to his immediate entourage in order to reassure him.
- Belloch, Sandín and Ramos (2008). Manual of psychopathology. Madrid. McGraw Hill. (Vol 1). Revised edition.
- Sants, JL (2012). Psychopathology. CEDE PIR preparation manual, 01. CEDE: Madrid.