ORIENTATION: in time, place and person; loss occurs in this sequence, recovery in reverse order Disorientation in delirium: Orientation is the normal state of (oneself and one's surrounding in terms of time, place and person. Stupor Twilight state Oneiroid state / Onirism An imprecise term for 1. State of decreased reactivity to stimuli. 2.Unresponsiveness with immobility 3. Mutism but retention of consciousness & often with open eyes that follows external objects. * It is disturbed consciousness with hallucinations. * It appears as waking dreams that portray desires, wishes or fears in a direct or symbolic way as being already fulfilled. * A transitory disturbance of consciousness during which many acts, sometimes very complicated may be performed without the subjects conscious volition and without retaining any remembrance of them. *Responsiveness as a rule only to some given complex, the rest of the personality being subordinated to, or as a rule, more or less completely submerged during the period of twilight state for example an epileptic patient, entirely unmindful of his natural surroundings, believed that he was walking around in Heaven; during the phase he was utterly unable to recall any part of his life. It is dream state, while one is awake, a waking dream. Delirium Acute reversible cognitive disorder with relatively global impairment, consisting of deficits of attention, arousal, consciousness, memory, orientation, perception, and speech or language. Akinetic mutism It may be of two types- - The patient lay inertly in bed mute and almost totally unresponsive, although he followed the movements of people around him with his eyes. H. Cairn described this state due to tumor of 3rdventricle, hence known as Cairn stupor. The syndrome is probably a result of interference with RAS, so that response to environment stimuli is defective. The term has also been used to describe subjects with bilateral frontal lobe lesions who lack all drive and impulse to action, despite intact motor and sensory tracts. - Coma vigil. Psedocoma / locked in syndrome / Deafferented state. It is a state in which patient appears to be asleep but can be aroused. The subject is conscious and aware but is unable to respond. The lesion is in ventral pons with preservation of dorsal tegmental area, the activating system is intact but interruption of corticobulbar and spinal pathways make it impossible for the subject to move or speak.