Orientation disorders: symptoms, types and treatment

Where are you? What are you doing there? What date are we on? Who are you? A vast majority of people will be able to answer these questions.

However, if these same questions are made to someone with brain injuries or who is intoxicated with some drugs or medicines it is possible to find ourselves in which they do not know how to answer them, that there are serious doubts or that the answers are completely wrong (for example, a person can say that we are in 1970 or that he is in a shopping center when he is actually in a hospital). These are people who manifest the existence of orientation disorders.

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The orientation

Before defining the different orientation disorders, it is necessary to specify what this concept refers to. Orientation is considered the 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 said spatiotemporal position.

Most people identify with the concept of orientation only with the ability to determine our relationship with the environment and situate ourselves in a specific space and time. This type of orientation is called allopsychic..

However, there is another type of orientation, the autopsychic orientation. This refers to the orientation linked to one's own 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.

The orientation is very linked to other processes such as consciousness, attention and memory, and can be influenced by failures in any of these skills or processes. For example, through memory we are able to establish and order our experiences in time or remember the meaning or concept of the place where it is.

• Related article: "Types of memory: how does the human brain store memories?"

The main orientation disorders

Once we understand what the term orientation means, we can identify different pathological orientation processes: orientation disorders. In this sense we can find the following pathologies or problems.

1. Disorientation

Disorientation is understood as the loss of the ability to locate oneself in space and/or time correctly. The subject does not identify her situation and does not know how to answer if they ask him where he is or the date. Said disorientation can be only temporary or spatial, or both appear together.

It is also possible that such disorientation is not complete.: for example, the patient may know that we are in 2017, but not the month or the day.

Disorientation can also occur (either alone or together with the above) at the autopsychic level, not knowing who you are, what you are doing in that place or not recognizing yourself.

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2. double orientation

Double orientation occurs when the subject is able to orient himself at certain times or makes a mix between the real situation and unreal or abnormal elements. For example, he can say that he is in a hospital in a colony on Mars, while it is true that he is in a hospital.

3. Conspiring Guidance or False Guidance

The subject is considered oriented and provides data regarding his spatio-temporal location or who he is, but the answers you provide are unreal and elaborated by the subject himself ignoring the real answers.

Some brain elements affected

Alterations in orientation may come from the affectation of different brains. For example, the management of orientation in space has been linked to the functioning of the hippocampus, which allows create a mind map of space. Time and its measurement are often linked to the striatum, suprachiasmatic nucleus, and biorhythm management.

A malfunction of the nerve connections that go from the thalamus to the cortex and vice versa can lead to alterations such as confabulation. injuries of the parietal lobe they can also explain the presence of disorientation.

In what contexts do they appear?

Orientation disorders can appear in a wide variety of situations. It is common for them to appear in any situation in which there are alterations of consciousness. Also are linked to cortical and subcortical degeneration and memory and attention problems.

One of the disorders in which they usually appear is schizophrenia together with other psychotic disorders, being possible to observe in many cases the conspiratorial orientation or the double orientation. In some manic episodes they can also be observed. It is also very common for any of the above disorders to appear in neurodegenerative diseases such as Alzheimer's or other dementias.

Organic poisoning from the consumption of toxic substances, drugs or some medications can also cause orientation disorders. It is not uncommon for it to appear in the Wernicke-Korsakoff syndrome, or in withdrawal syndromes.

Finally, the disorientation can be mentally generated in disorders such as dissociative (for example derealization or depersonalization), agnosias or in some cases mood or anxiety disorders.

possible treatments

The treatment to be used in cases of orientation disorders will depend to a large extent on the causes of said disorders, circumscribing each treatment to the corresponding situations.

In general, an attempt is made that the subject is oriented by indicating the data that he does not know, encouraging him to look at contextual clues and/or trying to get the person to link the failing data to something known. It is also useful to explain the situation to the affected person and those close to him in order to reassure them.

Bibliographic references:

• Belloch, Sandin and Ramos (2008). Manual of Psychopathology. Madrid. McGraw Hill. (vol 1). Revised edition.

• Santos, J. L. (2012). Psychopathology. CEDE PIR Preparation Manual, 01. CEDE: Madrid.