ptsd What Is "spatial Disorientation" ?

[tssnave]

Hi - Newbie on board - been reading the posts for a while before joining and have learned a lot - thanks.

Question 1) What is "spatial disorientation" as it pertains to the rating of mental disorders such as ptsd?

I just had my C&P a couple of weeks ago and when I asked the doc what she meant when she asked me if I had any issues with spatial disorientation she asked me if I knew I was in bed when I was in bed. I told her yes, when I am in bed I know I am in bed. However, later I realized that I never had an opportunity to tell her how I get lost even on routes that I should be well familiar with and wondered if I should have said something about that when she asked me if I had problems with spatial disorientation. I looked spatial (dis)orientation up on the web and can find lots about it as it pertains to pilots flying a plane (I only jumped out of them in the Army, never flew them) but nothing about what it means from a general mental health standpoint much less what it means to the VA.

Question 2) What is the best way to get information that wasn't covered during the C&P exam into my file?

There were several areas from the mental health rating sheet that were not even covered during the C&P exam. How are they supposed to rate me on information they don't ask me? Equally maddening is when they asked closed ended questions such as "Did you graduate from high school." Yes. "Do you have any education beyond high school and if so, how much?" Yes, I have a BS in Business. Then she's on to the next question about something different. I get my rating and they say I don't have any impairment in school. It didn't cross my mind during the C&P to elaborate on the closed ended question about school and say, "When I got out of the Army I had a year of college credit but because of my sc disability it took me 7 years to get the last 3 years of college because I had attendance and concentration issues and dropped as many classes as I took." Then there's the fact that I wasn't doing well the day I took my C&P exam. The paradox of trying to mount a claim for a mental disorder is that you are the person who has to explain your mental illness but because of your mental illness you are unable to do so effecitvely. ARRRGGGG! The C&P exam lasted about 35 minutes and when I got the rating for 50% and read the specs for 70% I realized that I am squarely in the 70% but didn't communicate that fully to the examiner because she either didn't ask the questions in the 70% categories, I didn't understand or follow what she was asking, she asked a closed ended question I didn't elaborate one, or I couldn't concentrate enough to give her complete answers due to my sc mental illness. I want to go to a private shrink and talk it all out. I talked to one doc and he said that he could not give me an evalulation but he could listen and write up clinical notes of our conversation. Is this a good plan of action? Any advice would be appreciated.

Thanks,

tssnave

Edited March 13, 2007 by tssnave

[free_spirit_etc]

Off the bat I am thinking about spatial orientation - in the sense of inner ear mechanisms. Like if you closed your eyes and someone spins you around - your body gets disoriented in the terms of it's relations in space - and you can fall over, walk into walls, etc.

But for PTSD - it might mean being spacially oriented - knowing where you are all the time. Not so much do you get lost or not - but there being times when you don't have a clue where you are and have to look around for clues from your environment to get "back in touch" with where you are - especially during times of significant stress.

PTSD -- Stress = I need to be hypervigilant to what is happening around me to the extent that I am not paying attention to anything else.

So you could get stressed driving - and then pay attention to what the other cars are doing - and drive miles past where you were supposed to -- and if the stress was very bad - you might not know how to get back until you recover some.

So it would be different than the normal person just having a poor sense of direction or getting lost.

Two episodes in my life I can think of (and I DO have SOME PTSD -not military related) but I had something traumatic happen - so my mind kicked into its "pattern" of doing trauma -- And I was TOTALLY LOST!! I usually have a pretty poor sense of direction - but I was lost on a parking lot!!!! I kept driving around panicked trying to figure out HOW to get off this parking lot. (A normal person would probably slow down, stop, think, and look for the exit.) Not me - I just kept driving around like somehow if I could just get off this parking lot I would be safe.

I found my way off finally - and I was driving to school _ ACK! I had to teach that night. But all of a sudden - everything looked unfamiliar (I came out of trance and became aware) so i THOUGHT I was going the wrog way (but I wasn't really) - so I turned around -- then - after driving awhile - I realized I HAD been going the right way in the first place. But for some reason I kept driving the way I had been - But then I finally turned around -- and drove past where I was supposed to turn. Again, instead of immediately turing around - I kept driving - even knowing I was going the wrong way. It was like all those things that are in your brain to get you where you are going weren't working. I KNEW I was going the wrong way - and just kept driving. Then I turned around - and for some reason - I turned around again. And it was like the whole episode was etched in my mind. Like I was either in trance and not aware - or else watching myself driving - but not doing the things I should have been doing.

I am not sure - but I would say that could be an episode of being spatially disoriented. NOT all the time - but at times.

I also had a friend who had panic attacks. She went to her school one day and had a panic attack - and couldn't get home. She sat on the parking lot and creid because she couldn't figure out how to get home. She told me "I just couldn;t get a map in my head."

It was like when she paniced - her maps in her head disappeared -- and she couldn't get oriented to where she was or how to get out of there.

She had to get past her panic before she could do anything about getting out of there.

For quite some time she was afraid to go ANYWHERE because she was afraid she would have a panic attack and not be able to get back home.

I am not sure if these apply to your case - but would be what I would think of when I think of being spatially disoriented from PTSD.

And again, I think it is different than getting lost sometimes or having a poor sense of direction. You could have a great sense of direction that leaves you when you are under extreme stress.

http://dnl.ucsf.edu/users/dweber/dweber_do..._hippocamp.html

Hippocampal Functions in Post-traumatic Stress Disorder

Damage to the anterior portion of the hippocampus in PTSD can affect the ability to accurately develop supramodal, episodic representations and accurately evaluate and incorporate new information into episodic memory. This lack of accuracy in episodic memory will continually generate mismatch activity in the hippocampus that will initially hyperarouse the BIS and initiate excess stress reactions. These responses may attempt to habituate, but cannot do so due to impaired episodic memory evaluation and consolidation, which leads to cognitive, emotional, and endocrine exhaustion.

In this manner, PTSD patients are unable to incorporate new information after their trauma and the most recent episodic memories that were consolidated remain traumatic and continue to affect expectations of the world. This fundamentally alters their world view and psychic life.

Threshold of hippocampal activation for behavioural inhibition system is reached by threatening information and this information is incorporated into episodic memory and generates further traumatic associations that encourage intrusions, but neutral information doesn’t reach this threshold and so doesn’t get properly evaluated and integrated into episodic memory. The BIS shifts attention and executive functions away from neutral information toward threat.

Note similarity of this idea to that of Murburg (1997), "relative basal quiescence of [catecholamine] systems with enhanced responsivity to stimulation may provide for enhancement of ‘signal to noise ratios’ in neuronal and other systems. Such enhancement may facilitate selective attention and selective responding to the most strongly determined inputs …, potentially contributing to symptoms including hypervigilance, insomnia, flashbacks, intrusive memories, panic, physiological hyperactivity, and startle."

Murburg (1997) also points out interesting peripheral relationships to central processes. For instance, traumatic visualisations may induce increased peripheral epinephrine that increases memory consolidation by stimuluating the amygdala, which is important in emotional memories and was identified, along with increased activity in anterior cingulate and decreased activity in left inferior frontal cortex, in a rCBF study by Rauch and Shin (1997). Murburg (1997) also notes that, "responding to a stressor … may itself leave behind molecular ‘memory traces’ that so alter involved neural pathways as to predispose them to be more readily activated in the future."

Relationship of hippocampal volume to ERP stimulus evaluation amplitudes - hippocampal atrophy, episodic memory impairment, behavioural inhibition and executive function disruption, all impair integration of new non-threatening information into neutral information schemata. This impairs attentional strategies that are directed by knowledge of what to expect and when and where to expect it. It thereby impairs the ability to detect, evaluate, and consolidate knowledge about the regularities in various, especially complex, stimulus arrays.

http://userwww.service.emory.edu/~jdbremn/...tionalwords.pdf

Neural Correlates of Declarative Memory for

Emotionally Valenced Words in Women with

Posttraumatic Stress Disorder Related to Early

Childhood Sexual Abuse

Background: Animal studies have shown that early stressors

result in lasting changes in structure and function of

brain areas involved in memory, including hippocampus

and frontal cortex. Patients with childhood abuse–related

posttraumatic stress disorder (PTSD) have alterations in

both declarative and nondeclarative memory function, and

imaging studies in PTSD have demonstrated changes in

function during stimulation of trauma-specific memories

in hippocampus, medial prefrontal cortex, and cingulate.

The purpose of this study was to assess neural correlates

of emotionally valenced declarative memory in women

with early childhood sexual abuse and PTSD.

Other regions, including posterior cingulate, parietal

and motor cortex, and cerebellum are functionally related

to anterolateral prefrontal cortex (superior and middle

frontal gyri) (Selemon and Goldman-Rakic 1988), mediating

visuospatial processing that is critical to survival in

life-threatening situations (Devinsky et al 1995; Vogt et al

1992). Recent PET studies have established a role for the

cerebellum in attention and memory, probably mediated

by its projections through the thalamus to prefrontal cortex

(Ashkoomoff and Courchesne 1992; Leiner 1989). We

have hypothesized that the excessive vigilance seen in

PTSD is associated with increased demands on brain areas

involved in visuospatial aspects of memory function and

planning of response to potentially threatening stimuli

(Bremner et al 1999a, 1999b).

[Wings]

Wings,

Just curious the two psychiatrist that gave me the GAF of 40 put this in my C&P. What does it mean?

Oriented x 4

Thanks bunches!

Josephine

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x

x

Oriented x 4 : oriented to person, place, time, and event/situation.

I was a psyche tech in the USAF ;-)

I think I'm on my way to dementia, but I still can remember a mental staus exam. I must have given upwards of 10 per day!

[Wings]

x

x

x

Mental status examination

From Wikipedia, the free encyclopedia

http://en.wikipedia.org/wiki/Mental_status...Main_categories

[Josephine]

Wings,

Thanks, I find this so strange, being after the examination, I went to the nurse on duty, as I thought that I had a stroke, as I couldn't remember much of that visit.

I couldn't even remember the doctors names.

The nurse called me at home the next morning, to see If my memory had improved any.

No, it hadn't.

The male psychiarrist told my husband , that I would remember what he looked like in about 3 days.

It took me six months.

Thanks, strange things do happen.

Josephine

[tssnave]

Wings,

So what is your understanding, in layman terms, of what "spatial disorientation" means in the 70% mental disorders rating criters schedule?

Thanks,

TS