Feeling disorientated (Acute Confusional Syndrome)

In this blog post, we will talk about the reasons why someone may be feeling disorientated and confused.

Mainly, we talk about the Acute Confusional Syndrome, also known as Delirium. 

What does it mean to be disorientated?

Disorientation represents the absence of temporal and/or spatial orientation.

It can occur temporarily in organically based disorders of consciousness (delirium) or permanently (brain injuries).

It can also appear in dissociative states or in schizophrenic psychoses (apathetic disorientation).

Delirium – Delirium is a symptom of rupture with the reality of psychosis, it is not considered a mental disorder in itself but can appear in the course of various disorders or diseases.

Delirium comes from the Latin de-lirare which means to get out of the furrow when tilling the soil.

A delusion is defined as a belief or set of beliefs that are lived with absolute conviction despite the evidence to the contrary.

It affects the reasoning, the memory, the thought and the way of acting of the person. These ideas are persistent and cannot be reduced to logical reasoning.

Brain Injuries – Iteration of neurological function due to trauma produced on the cranial, brain or meningeal components, causing deficits of different severity depending on the location and extent of the wound.

Mild trauma: In these cases, the person usually remains under observation for a few hours to detect possible changes in the level of consciousness or neurological signs that may indicate a complication of the clinical picture.

After this period, he is discharged and sent home under family supervision.

Moderate trauma: These are cases involving some type of alteration of consciousness, memory loss, a history of multiple trauma, vagal signs, severe headache, etc. 

Severe trauma: There is usually a skull fracture and implies a significant level of consciousness alteration associated with clear neurological signs (pupillary alteration, vomiting, etc.).

Diagnostic tests will mark the location and extent of the wound and the presence of associated neurological deficits should be detected and taken into account in view of the clinical course and treatment of the injured person.

Dissociative states – Dissociative identity disorder is characterized by the presence of two or more distinct or divided identities or personality states, which have continuous power over the person’s behaviour. 

In the case of this disorder, the person has the inability to remember key personal information, and this cannot be explained as simple forgetfulness.

In this case, the diagnosed person experiences extremely distinct memory variations, which fluctuate with the person’s dual personality.

Schizophrenic psychoses – Schizophreniform disorder is characterized by the presence of at least 2 of the following symptoms: hallucinations, delusional ideas, disorganized or catatonic behaviour, disorganized language, and negative symptoms (symptoms of the active phase of the disease); their duration is at least one month or less if the patient has been successfully treated.

This period with more intense manifestations of the disease is framed in a longer time interval, in which the symptoms are of lesser intensity, but in which there is a major change in the patient’s behaviour: he isolates himself, loses interest in activities on who carries them out, responds less emotionally to the events around him, has some strange beliefs or unusual sensory experiences, without these being delusional ideas or hallucinations.

However, in this article, we want to pay more attention to another cause of why someone may feel disorientated, namely the Acute Confusional Syndrome. 

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Delirium and disorientation: what can cause Acute Confusional Syndrome?

It is common for older people or those who suffer from certain conditions – such as alcoholism, for example – to have episodes of confusion.

Periods of time in which they suffer disorientation or certain alterations of consciousness, which are not necessarily attributable to a basic pathology.

In the medical literature, there is a name for this condition and it is an acute confusional syndrome, also known as delirium or delirium tremens.

It is a transitory syndrome, which is highly frequent in certain population groups such as those mentioned.

The main characteristic of this condition is a clear alteration in consciousness and cognitive abilities, which can alert us and lead to confusion with the onset of dementia or any other neurological pathology.

How does Acute Confusional Syndrome appear?

There are some symptoms or manifestations that clearly indicate the presence of such disorders.

Knowing them can be useful at the time of the medical consultation, on the part of the patient, and in the detection of the condition, on the part of the specialist.

Impaired consciousness: the person suffering from this syndrome is not aware of what is happening, that their symptoms are abnormal.

That is why it manifests an evident difficulty to pay attention to its environment and those tasks that it tries to perform.

Memory problems: it is common for difficulties to remember recent events or to recognize people from the closest environment.

Temporal and/or spatial disorientation: these difficulties appear very frequently in patients with acute confusional syndrome. Problems recognizing where they are, how they got there, or what day of the week they are on are common in this group of people.

Hallucinations: erroneous perceptions that are interpreted as real by the person, such as seeing someone who is not really there, erroneous recognition of certain objects, seeing animals or unreal objects, hearing sounds that are not really taking place, etc.

Delusional ideas: in some cases distorted beliefs appear that are totally real to the person who suffers them.

For example, believing that an event has occurred that has not really taken place, or thinking that other people want to cheat or steal it, mistrust others, even their close environment, for fear of this deception.

It is important to keep in mind that these alterations can remain for a considerable time – one day, for example – and can manifest themselves with greater intensity at certain times in particular.

It is worth mentioning that there are also sleep disturbances that can arise from an acute confusional syndrome, as well as distortions at a psychomotor or emotional level.

Sleep disturbances: problems of the sleep-wake cycle, such as difficulty sleeping at night, great drowsiness during the day, waking up early, among others.

Psychomotor disturbances: psychomotor agitation, erratic wandering, disorderly behaviour, are some of the most frequent distortions that appear in this area.

Emotional disturbances: it is common for patients to find it difficult to express their emotions or to have a higher sensitivity.

Another central characteristic of this syndrome is that it has an acute character, which means that it occurs in a short period of time (in hours or days).

That is, it does not have an insidious, progressive onset, but occurs suddenly.

What can cause Acute Confusion Syndrome?

The main causes of this disorder can be an illness, substance intoxication or withdrawal (for example, alcohol) or exposure to toxins (for example, side effects of a drug or drug over-intake).

That is why it is a transitory syndrome, precisely because its causes are usually so. 

When the alterations extend over time and last longer than expected, the patient probably suffers from another type of condition, more severe and permanent or progressive.

It is important to keep in mind that in older people from time to time, the common causes of the acute confusional syndrome are some pathologies (for example, urinary or respiratory infections), prolonged hospitalization, or the intake of certain drugs.

How to differentiate it from the onset of dementia?

The aforementioned symptoms may suggest the similarity of this syndrome with the onset of dementia or with other pathologies at the cognitive level.

However, there are some defining points that can help differentiate one condition from the other.

Start – Confusional syndrome is characterized by a sharp, sudden onset. This means that in a matter of hours or days the patient manifests all or some of the mentioned symptoms.

However, in the case of dementias, its onset is usually progressive, that is, it progresses little by little and all of the manifestations can take years to appear.

Duration – Taking into account the possible causes of the confusional syndrome, its duration will tend to be short, as long as the problems that originate it last.

Therefore, it is configured as a reversible condition: once the cause is resolved, the person returns to his usual general and cognitive state.

However, dementia is a progressive neurodegenerative disorder, which worsens over time, and may last for years.

Causes – Confusional syndrome finds its origin in some of the causes mentioned above.

In the case of dementia, its cause is found at the brain level, in neurotransmitters and, ultimately, at the genetic level.

Attention – The attentional capacity of the person with the confusional syndrome is altered from the first moment.

She is distracted, with great difficulties in maintaining attention and concentrating on what she is doing, as well as interacting appropriately with her surroundings. 

In the case of dementia, on the contrary, the person is initially well connected with her environment, while distraction and lack of interaction usually appear later.

Psychomotor restlessness – Restlessness and nervousness are characteristic symptoms of the confusional syndrome, accompanied even by tremor and erratic behaviours (such as walking for no apparent reason, performing actions without an objective, etc.).

In the case of dementia, this type of behaviour does not usually occur in the initial stages.

Hallucinations – In the initial stages of dementia, hallucinations are not common, but rather are characteristic of advanced stages of the disease. In the case of the confusional syndrome, they are quite common, especially visual ones.

All the mentioned elements can be useful when distinguishing acute confusional syndrome from a more severe disease.

However, it is important to highlight the need to consult with a health professional in case any of the mentioned symptoms appear, both in oneself and in other people.

In this way, the specialist will be able to evaluate the patient and know the origin of her condition, which will help her to face the most appropriate treatment.

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FAQ about feeling disorientated

What does it mean to be disoriented?

Disorientation represents the absence of temporal and/or spatial orientation. It can occur temporarily in organically based disorders of consciousness (delirium) or permanently (brain injuries).

It can also appear in dissociative states or in schizophrenic psychoses (apathetic disorientation).

What is the difference between confused and disoriented?

The difference between confused and disoriented is that confusion is when you feel you cannot think clearly, while disorientation is more of an extreme state, also known as delirium. 

Can anxiety make you confused?

Yes, anxiety can make you feel confused, forgetful. It can also create difficulties concentrating or speaking your mind.

Can anxiety make you disoriented?

Although it is extreme, yes, anxiety can make you feel disoriented. That is, when you feel intense fear or stress, you can feel completely lost in space and time. 

Why do I feel confused all the time?

One of the reasons you are feeling confused all the time may be an infection, a mini-stroke or other mental and physical health issues. It is best to consult a doctor and get properly assessed. 

Conclusions

In this blog post, we talked about the reasons why someone may be feeling disorientated and confused. Mainly, we talked about the Acute Confusional Syndrome, also known as Delirium. It is a transitory syndrome, which is highly frequent in certain population groups such as those mentioned.

The main characteristic of this condition is a clear alteration in consciousness and cognitive abilities, which can alert us and lead to confusion with the onset of dementia or any other neurological pathology.

If you have any questions or comments, please let us know!

References

Gustafson, Y., Olsson, T., Eriksson, S., Asplund, K., & Bucht, G. (1991). Acute Confusional States (Delirium) in Stroke Patients. Cerebrovascular Diseases, 1(5), 257–264.

Lorenzl, S., Füsgen, I., & Noachtar, S. (2012). Acute confusional States in the elderly–diagnosis and treatment. Deutsches Ärzteblatt international, 109(21), 391–400. 

Rai, D., Garg, R. K., Malhotra, H. S., Verma, R., Jain, A., Tiwari, S. C., & Singh, M. K. (2014). Acute confusional state/delirium: An etiological and prognostic evaluation. Annals of Indian Academy of Neurology, 17(1), 30–34.

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