Disorientation Health Dictionary

A condition of altered consciousness in which there is disorientation (as in a confusional state), incoherent talk and restlessness but with hallucination, illusions or delusions also present.

Delirium (confusion) In some old people, acute confusion is a common e?ect of physical illness. Elderly people are often referred to as being ‘confused’; unfortunately this term is often inappropriately applied to a wide range of eccentricities of speech and behaviour as if it were a diagnosis. It can be applied to a patient with the early memory loss of DEMENTIA – forgetful, disorientated and wandering; to the dejected old person with depression, often termed pseudo-dementia; to the patient whose consciousness is clouded in the delirium of acute illness; to the paranoid deluded sufferer of late-onset SCHIZOPHRENIA; or even to the patient presenting with the acute DYSPHASIA and incoherence of a stroke. Drug therapy may be a cause, especially in the elderly.

Delirium tremens is the form of delirium most commonly due to withdrawal from alcohol, if a person is dependent on it (see DEPENDENCE). There is restlessness, fear or even terror accompanied by vivid, usually visual, hallucinations or illusions. The level of consciousness is impaired and the patient may be disorientated as regards time, place and person.

Treatment is, as a rule, the treatment of causes. (See also ALCOHOL.) As the delirium in fevers is due partly to high temperature, this should be lowered by tepid sponging. Careful nursing is one of the keystones of successful treatment, which includes ensuring that ample ?uids are taken and nutrition is maintained.... delirium

A feeling of disorientation or tiredness which follows a long air journey. Jet lag is usually most pronounced when travelling from West to East over areas with time zone differences.... jet lag

A condition characterised by a deterioration in brain function. Dementia is almost always due to Alzheimer’s disease or to cerebrovascular disease, including strokes. Cerebrovascular dis-ease is often due to narrowed or blocked arteries in the brain. Recurrent loss of blood supply to the brain usually results in deterioration that occurs gradually but in stages. A small proportion of cases of dementia in people younger than 65 have a underlying treatable cause such as head injury, brain tumour, encephalitis, or alcohol dependence.

The main symptoms of dementia are progressive memory loss, disorientation, and confusion. Sudden outbursts or embarrassing behaviour may be the first signs of the condition. Unpleasant personality traits may be magnified; families may have to endure accusations, unreasonable demands, or even assault. Paranoia, depression, and delusions may occur as the disease worsens. Irritability or anxiety gives way to indifference towards all feelings. Personal habits deteriorate, and speech becomes incoherent. Affected people may eventually need total nursing care.

Management of the most common

Alzheimer-type illness is based on the treatment of symptoms. Sedative drugs may be given for restlessness or paranoia. Drugs for dementia, for example donepezil, can slow mental decline in some people with mild to moderate Alzheimer’s disease (see acetylcholinesterase inhibitors).... dementia

Alzheimer’s disease is a progressive degenerating process of neural tissue affecting mainly the frontal and temporal lobes of the BRAIN in middle and late life. There is probably a genetic component to Alzheimer’s disease, but early-onset Alzheimer’s is linked to certain mutations, or changes, in three particular GENES. Examination of affected brains shows ‘senile plaques’ containing an amyloid-like material distributed throughout an atrophied cortex (see AMYLOID PLAQUES). Many remaining neurons, or nerve cells, show changes in their NEUROFIBRILS which thicken and twist into ‘neuro?brillary tangles’. First symptoms are psychological with insidious impairment of recent memory and disorientation in time and space. This becomes increasingly associated with diffculties in judgement, comprehension and abstract reasoning. After very few years, progressive neurological deterioration produces poor gait, immobility and death. When assessment has found no other organic cause for an affected individual’s symptoms, treatment is primarily palliative. The essential part of treatment is the provision of appropriate nursing and social care, with strong support being given to the relatives or other carers for whom looking after sufferers is a prolonged and onerous burden. Proper diet and exercise are helpful, as is keeping the individual occupied. If possible, sufferers should stay in familiar surroundings with day-care and short-stay institutional facilities a useful way of maintaining them at home for as long as possible.

TRANQUILLISERS can help control di?cult behaviour and sleeplessness but should be used with care. Recently drugs such as DONEPEZIL and RIVASTIGMINE, which retard the breakdown of ACETYLCHOLINE, may check

– but not cure – this distressing condition. About 40 per cent of those with DEMENTIA improve.

Research is in progress to transplant healthy nerve cells (developed from stem cells) into the brain tissue of patients with Alzheimer’s disease with the aim of improving brain function.

The rising proportion of elderly people in the population is resulting in a rising incidence of Alzheimer’s, which is rare before the age of 60 but increases steadily thereafter so that 30 per cent of people over the age of 84 are affected.... alzheimer’s disease

Atropa belladonna (deadly nightshade) is a relatively rare plant and severe poisoning is not common. The berries, which are black, ripen from August to October and are the most commonly ingested part of the plant. However, all parts of the plant are toxic. The berries contain ATROPINE and other unidenti?ed ALKALOIDS, the leaves HYOSCINE and atropine, and the roots hyoscine. All these alkaloids have an ANTICHOLINERGIC e?ect which may cause a dry mouth, dilated pupils with blurred vision, TACHYCARDIA, HALLUCINATIONS and PYREXIA. There may also be ATAXIA, agitation, disorientation and confusion. In severe cases there may be CONVULSIONS, COMA, respiratory depression and ARRHYTHMIA. Clinical effects may be delayed in onset for up to 12 hours, and prolonged for several days. Treatment is supportive.... belladonna poisoning

A complication of severe HYPERTENSION, this serious but uncommon condition is characterised by neurological symptoms which include transient verbal and visual disturbances, PARAESTHESIA, disorientation, ?ts and sometimes loss of consciousness. It also affects the eyes, causing PAPILLOEDEMA. Haemorrhages may occur in the brain, usually in the area of the BASAL GANGLIA. Neurological symptoms can usually be treated e?ectively by controlling the patient’s hypertension.... hypertensive encephalopathy

an organic disorder affecting the brain that results in a memory defect in which new information fails to be learnt although events from the past are still recalled; *disorientation in time and place; and a tendency to unintentionally invent material to fill memory blanks (see confabulation). The commonest cause of the condition is untreated *Wernicke’s encephalopathy in the context of alcoholism. Large doses of thiamine are given as treatment. The condition often becomes chronic. [S. S. Korsakoff (1854–1900), Russian neurologist]... korsakoff’s syndrome

This is a colourless, odourless, tasteless, nonirritating gas formed on incomplete combustion of organic fuels. Exposure to CO is frequently due to defective gas, oil or solid-fuel heating appliances. CO is a component of car exhaust fumes and deliberate exposure to these is a common method of suicide. Victims of ?res often suffer from CO poisoning. CO combines reversibly with oxygen-carrying sites of HAEMOGLOBIN (Hb) molecules with an a?nity 200 to 300 times greater than oxygen itself. The carboxyhaemoglobin (COHb) formed becomes unavailable for oxygen transportation. In addition the partial saturation of the Hb molecule results in tighter oxygen binding, impairing delivery to the tissues. CO also binds to MYOGLOBIN and respiratory cytochrome enzymes. Exposure to CO at levels of 500 parts per million (ppm) would be expected to cause mild symptoms only and exposure to levels of 4,000 ppm would be rapidly fatal.

Each year around 50 people in the United Kingdom are reported as dying from carbon monoxide poisoning, and experts have suggested that as many as 25,000 people a year are exposed to its effects within the home, but most cases are unrecognised, unreported and untreated, even though victims may suffer from long-term effects. This is regrettable, given that Napoleon’s surgeon, Larrey, recognised in the 18th century that soldiers were being poisoned by carbon monoxide when billeted in huts heated by woodburning stoves. In the USA it is estimated that 40,000 people a year attend emergency departments suffering from carbon monoxide poisoning. So prevention is clearly an important element in dealing with what is sometimes termed the ‘silent killer’. Safer designs of houses and heating systems, as well as wider public education on the dangers of carbon monoxide and its sources, are important.

Clinical effects of acute exposure resemble those of atmospheric HYPOXIA. Tissues and organs with high oxygen consumption are affected to a great extent. Common effects include headaches, weakness, fatigue, ?ushing, nausea, vomiting, irritability, dizziness, drowsiness, disorientation, incoordination, visual disturbances, TACHYCARDIA and HYPERVENTILATION. In severe cases drowsiness may progress rapidly to COMA. There may also be metabolic ACIDOSIS, HYPOKALAEMIA, CONVULSIONS, HYPOTENSION, respiratory depression, ECG changes and cardiovascular collapse. Cerebral OEDEMA is common and will lead to severe brain damage and focal neurological signs. Signi?cant abnormalities on physical examination include impaired short-term memory, abnormal Rhomberg’s test (standing unsupported with eyes closed) and unsteadiness of gait including heel-toe walking. Any one of these signs would classify the episode as severe. Victims’ skin may be coloured pink, though this is very rarely seen even in severe incidents. The venous blood may look ‘arterial’. Patients recovering from acute CO poisoning may suffer neurological sequelae including TREMOR, personality changes, memory impairment, visual loss, inability to concentrate and PARKINSONISM. Chronic low-level exposures may result in nausea, fatigue, headache, confusion, VOMITING, DIARRHOEA, abdominal pain and general malaise. They are often misdiagnosed as in?uenza or food poisoning.

First-aid treatment is to remove the victim from the source of exposure, ensure an e?ective airway and give 100-per-cent oxygen by tight-?tting mask. In hospital, management is largely suppportive, with oxygen administration. A blood sample for COHb level determination should be taken as soon as practicable and, if possible, before oxygen is given. Ideally, oxygen therapy should continue until the COHb level falls below 5 per cent. Patients with any history of unconsciousness, a COHb level greater than 20 per cent on arrival, any neurological signs, any cardiac arrhythmias or anyone who is pregnant should be referred for an expert opinion about possible treatment with hyperbaric oxygen, though this remains a controversial therapy. Hyperbaric oxygen therapy shortens the half-life of COHb, increases plasma oxygen transport and reverses the clinical effects resulting from acute exposures. Carbon monoxide is also an environmental poison and a component of cigarette smoke. Normal body COHb levels due to ENDOGENOUS CO production are 0.4 to

0.7 per cent. Non-smokers in urban areas may have level of 1–2 per cent as a result of environmental exposure. Smokers may have a COHb level of 5 to 6 per cent.... carbon monoxide (co)

Deadly nightshade. Atropa belladonna L. German: Amaryllis. French: Belladonne d’Automne. Spanish: Belladonna. Italian: Amarilli a fiori rosei. Indian: Suchi.

Action. Antispasmodic, antasthmatic, anti-sweat, sedative, lactifuge.

For use by qualified practitioner only.

Uses: Spasmodic asthma; colic of intestines, gall bladder or kidney; spasm of bladder and ureters. Whooping cough, excessive perspiration (night sweats, etc), spermatorrhoea, bed-wetting (dose afternoon and at bedtime), dribbling of saliva in Parkinsonism. The common cold, hay fever, acidity – to inhibit secretion of stomach acid.

Contra-indications. Glaucoma, rapid heart, pregnancy, enlarged prostate. Side-effects – dry mouth, dilated pupils, mental disorientation. Used for a millennia in China as an anaesthetic (Kiangsu – 1719)

Widely used in homoeopathic medicine.

Preparations: Unless otherwise prescribed – up to thrice daily. Dried herb, 50mg in infusion. Tincture, BHC (vol 1). 1:10, 70 per cent ethanol, 0.5ml.

Initial dose recommended per week by British Herbal Compendium, Vol 1; dried leaf, 200mg (max 1g); tincture, 2ml (max 10ml).

A weaker solution may sometimes be used with good effect: 5 drops tincture to 100ml water – 1 teaspoon hourly. (Dr Finlay Ellingwood)

Pharmacy only sale ... belladonna

Progressive loss of brain cells, atrophy; caused by stress and a number of diseases: Huntingdon’s Chorea, Alzheimer’s Disease, Pick’s Disease, syphilis, trauma, and by certain sedative, anxiolytic, diuretic and hypotensive drugs.

Symptoms. Disorientation, failure of memory for recent events, failure to comprehend, unable to form elemental judgements, confusion, ataxia (lack of coordination of muscles), emotional instability with outbursts, forgetful.

Alternatives. Remedies known to sustain the brain. Nervines and alteratives believed to leach from the body deposits of toxic minerals: aluminium, sulphur, mercury, etc. Gotu Kola, Ginseng, Ginkgo, Vitamin E conserve oxygen. Pulsatilla – success reported for mental outbursts. Vasodilator of value. Ginkgo favourably reported.

Teas. Basil, Ginseng, Gotu Kola, German Chamomile, Horsetail, Yarrow.

Tea. Formula. Equal parts, Ginkgo, German Chamomile, Yarrow. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes; 1 cup thrice daily.

Tablets/capsules. Prickly Ash, Ginseng, Ginkgo, Kelp, Pulsatilla.

Powders, Liquid Extracts, Tinctures. Combine: Gotu Kola 3; Vervain 2; Rosemary 1. Doses.

Powders: 500mg; two 00 capsules or one-third teaspoon. Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water, honey or fruit juice thrice daily.

Incontinence. A frequent problem for which American Cranesbill is indicated.

Aromatherapy. Inhalation: Feverfew, Thyme.

Contra-indicated: Black Cohosh.

Diet. Low salt. Low fat. High fibre. Egg yolk. Lecithin.

Supplements. Folic acid, Vitamins B-complex, B12, C and E. Selenium, to conserve oxygen. Magnesium, Manganese, Zinc.

General. Home help. Meals on Wheels. Service from local Psychogeriatric unit. ... dementia, (senile)

An acute infection following bite of tick from deer, forest ponies or other animals. A spirochaete – Borrelia burdorfer is responsible.

Symptoms. Headache, disorientation, confused speech, sensitive to light, partial paralysis of face. Practitioners who see patients with Bell’s palsy should consider Lyme disease as a possible cause. Treatment: anti-infective therapy. Internal:–

Formula. Equal parts: Echinacea, Lobelia. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon), 3-4 times daily.

Topical. Disinfect bite sting with alcohol (methylated spirit, whiskey, etc). With tweezers or fingers (protected with rubber gloves or tissue) grasp the tick and pull upwards. Take care not to squeeze or puncture the body of the tick; dispose by flushing down the toilet. After removal, again wipe skin with alcohol; wash hands; apply antiseptic lotion or cream: Echinacea, Aloe Vera, Witch Hazel, Garlic, Eucalyptus, etc. ... lyme disease

A progressive condition in which nerve cells in the brain degenerate and the brain shrinks. Alzheimer’s disease is the most common cause of dementia. Onset is uncommon before the age of 60.

Early onset Alzheimer’s disease, in which symptoms develop before age 60, is inherited as a dominant disorder. Late onset Alzheimer’s disease is associated with a number of genes, including 3 that

are responsible for the production of the blood protein apolipoprotein E. These genes also result in the deposition of a protein called beta amyloid in the brain. Other chemical abnormalities may include deficiency of the neurotransmitter acetylcholine.

The features of Alzheimer’s disease vary, but there are 3 broad stages. At first, the person becomes increasingly forgetful, and problems with memory may cause anxiety and depression. In the 2nd stage, loss of memory, particularly for recent events, gradually becomes more severe, and there may be disorientation as to time or place. The person’s concentration and numerical ability decline, and there is noticeable dysphasia (inability to find the right word). Anxiety increases, mood changes are unpredictable, and personality changes may occur. Finally, confusion becomes profound. There may be symptoms of psychosis, such as hallucinations and delusions. Signs of nervous system disease, such as abnormal reflexes and faecal or urinary incontinence, begin to develop.

Alzheimer’s disease is usually diagnosed from the symptoms, but tests including blood tests and CT scanning or MRI of the brain may be needed to exclude treatable causes of dementia.

The most important aspect of treatment for Alzheimer’s disease is the provision of suitable nursing and social care for sufferers and support for their relatives. Tranquillizer drugs can often improve difficult behaviour and help with sleep. Treatment with drugs such as donepezil and rivastigmine may slow the progress of the disease for a time, but side effects such as nausea and dizziness may occur.... alzheimer’s disease

Disorder of consciousness, intellect, or mental functioning that is of organic (physical), as opposed to psychiatric, origin. Causes include degenerative diseases, such as Alzheimer’s disease; infections; certain drugs; or the effects of injury, stroke, or tumour. Symptoms range from mild confusion to stupor or coma. They may also include disorientation, memory loss, hallucinations, and delusions (see delirium). In the chronic form, there is a progressive decline in intellect, memory, and behaviour (see dementia). Treatment is more likely to be successful with the acute form. In chronic cases, irreversible brain damage may already have occurred. (See also psychosis.)... brain syndrome, organic

The term applied to the acute effects of ionizing radiation on the whole, or a major part, of the body when the dose is greater than 1 gray (1 Gy) of X-rays or gamma rays, or 1 sievert (1 Sv) of other types of radiation. The effect of radiation depends on the dose and the exposure time. Total-body doses of less than 2 Gy are unlikely to be fatal to a healthy adult. At doses of 1–10 Gy, transient nausea and occasional vomiting may occur, but usually disappear rapidly and are often followed by a 2–3 week period of relative well-being. By the end of this period, the effects of radiation damage to the bone marrow and immune system begin to appear, with repeated infections and petechiae (pinpoint spots of bleeding under the skin). Some people are successfully treated with a bone marrow transplant or by isolation in a sterile environment until the bone marrow recovers.

With a dose of 10–30 Gy there is also an early onset of nausea and vomiting, which tends to disappear a few hours later. However, damage to the gastrointestinal tract, which causes severe and frequently bloody diarrhoea (called the gastrointestinal syndrome), and overwhelming infection due to damage to the immune system is likely to result in death 4–14 days after exposure.

Acute exposures of more than 30–100 Gy cause the rapid onset of nausea, vomiting, anxiety, and disorientation.

Within hours, the victim usually dies due to nervous system damage and oedema of the brain; these effects are called the central nervous system syndrome.... radiation sickness

A rare disorder in which brain and liver damage follow a viral infection. Children over 15 are rarely affected. The cause is unknown, but aspirin seems to be a predisposing factor to developing the condition and is therefore not recommended for children.

The disorder starts as the child recovers from the infection. Symptoms include uncontrollable vomiting, lethargy, memory loss, and disorientation. Swelling of the brain may cause seizures, disturbances in heart rhythm, coma, and cessation of breathing.

Brain swelling may be controlled by corticosteroid drugs and by intravenous infusions of mannitol. Dialysis or blood transfusions may be needed. If breathing stops, a ventilator is used.

The death rate is around 10 per cent, and higher for those who have seizures, lapse into deep coma, and stop breathing.

Permanent brain damage may occur.... reye’s syndrome

An uncommon, severe illness caused by a toxin produced by the bacterium STAPHYLOCOCCUS AUREUS. Many cases occur in women using vaginal tampons. Other cases have been linked to use of a contraceptive cap, diaphragm, or sponge (see contraception), or to skin wounds or infections by the bacterium elsewhere in the body.A high fever, vomiting, diarrhoea, headache, muscle aches and pains, dizziness, and disorientation develop suddenly. A widespread skin rash that resembles sunburn and also affects the palms and soles, develops. Blood pressure may fall dangerously low, and shock may develop. Other complications include kidney failure and liver failure. Treatment in an intensive care unit may be needed. toxin A poisonous protein produced by pathogenic (disease-causing) bacteria, various animals, or some plants. Bacterial toxins are sometimes subdivided into 3 categories: endotoxins, which are released from dead bacteria; exotoxins, which are released from live bacteria; and enterotoxins, which inflame the intestine.

(See also poison; poisoning; toxaemia.)... toxic shock syndrome

An uncommon brain disorder almost always related to malnutrition occurring in chronic alcohol dependence, but occasionally due to that which occurs in other conditions, such as cancer. Wernicke–Korsakoff syndrome is caused by deficiency of thiamine (see vitamin B complex), which affects the brain and nervous system.The disease consists of 2 stages: Wernicke’s encephalopathy and Korsakoff’s psychosis. Wernicke’s encephalopathy usually develops suddenly and produces nystagmus (abnormal, jerky eye movements), ataxia (difficulty in coordinating body movements), slowness, and confusion. Sufferers usually have signs of neuropathy, such as loss of sensation, pins-and-needles, or impaired reflexes. The level of consciousness falls progressively and may lead to coma and death unless treated. The condition is a medical emergency. Treatment with high doses of intravenous thiamine often reverses most of the symptoms, sometimes within a few hours.

Korsakoff’s psychosis may follow Wernicke’s encephalopathy if treatment is not begun promptly enough. Symptoms consist of severe amnesia, apathy, and disorientation. Korsakoff’s psychosis is usually irreversible.... wernicke–korsakoff syndrome