Just do the best you can in answering them. Tell me, what day is it today?” Client: “They told me I was riding my bike and that I didn’t have my helmet on.” Interviewer: “That’s right. I’m still curious, though. What day is it today?” Client: “Could I get a glass of water?” After several minutes of this client’s interview, it became apparent that he was evading the question about orientation to time. Note also that the examiner began with a simple orientation to time question . When clients are resistant to answering orientation questions, you may tentatively conclude they are disoriented, especially if additional evidence suggests disorientation.
Orientation levels can be pursued in greater or lesser depth. For example, clients can be asked what county they are in, who the governor of the state is, and the name of the mayor or local newspaper. They also can be asked if they recognize hospital personnel, visitors, and family. However, these additional questions may be confounded by factors such as the client’s level of intelligence, social awareness, or cultural background, and, therefore, they are not always accurate indicators of orientation.
Clients can become disoriented for a number of reasons. Common causes include drug intoxication, recent brain trauma, and dementia . It is not the mental status examiner’s task to determine the cause of a client’s disorientation, but to accurately and brie?y document presence or absence of disorientation.
In cases of delirium, acutely disoriented clients may experience a gradual clearing of The Mental Status Examination 229consciousness. When clients become disoriented, they usually lose their sense of time ?rst, then of place, and ?nally of person. Orientation is recovered in reverse order .