Confabulation: a spontaneous and fantastic review

Interventions for confabulation: A systematic literature review

OBJECTIVE

Confabulations are false memories which are expressedwithout the intention to deceive and arise following brain damage or psychological dysfunction. Confabulations can become a barrier to effective neuropsychological rehabilitation and consequently, intervention is required.The current review aimed to provide a detailed evaluative account of existing interventions for confabulation and their relative effectiveness.

METHOD

The search process found 11 studies conducive with the inclusion and exclusion criteria. A methodological quality assessment was then carried out and the majority of included studies demonstrated poor methodological quality.

RESULTS

Ten types of interventions were identified and the majority of theseled to a reduction or elimination of confabulations.

CONCLUSION

Since methodological quality of many included studies was deemed unsatisfactory, further large-scale experimental research and standardised measures are necessary to adequately compare the relative effectiveness of these interventions. Further research and clinical implications are also highlighted.

Fetal alcohol spectrum disorder and confabulation in psycholegal settings: A beginner's guide for criminal justice, forensic mental health, and legal interviewers

Fetal alcohol spectrum disorders (FASD) are neurodevelopmental/neurobehavioral conditions caused by prenatal alcohol exposure (PAE). Impairments caused by PAE contribute to the over-representation of individuals with FASD in the United States juvenile and adult criminal justice systems. These same impairments can equally impact on individuals with FASD who are witnesses to or victims of crime who also have to navigate the complexities of the criminal justice system. Difficulties include increased susceptibility to confabulation throughout the legal process that, in turn, can contribute to increased rates of poor outcomes including false confessions and wrongful convictions. Individuals with FASD are particularity at risk of confabulation when they are subjected to tactics, such as stressful and anxiety-provoking situations, threats, and leading, suggestive, or coercive questioning. Many professionals in the forensic context are unfamiliar with FASD or related confabulation risk and may unintentionally utilize tactics that intensify impacts of pre-existing impairment. This article serves as a beginner's guide for professionals working in criminal justice settings by (a) providing research-based overviews of FASD and confabulation, (b) describing how FASD may lead to confabulation, and (c) suggesting ways that professionals can modify protocols when interacting with individuals with FASD. Suggestions in this article hold the potential to decrease the risk of confabulation in the criminal justice system and decrease problematic outcomes, such as false confessions and wrongful convictions among individuals with FASD.

The contribution of mamillary body damage to Wernicke's encephalopathy and Korsakoff's syndrome

Histopathological alterations of the mamillary bodies are the most conspicuous and the most consistent neuropathological features of several disorders that occur after severe thiamine deficiency, such as Wernicke's encephalopathy and Korsakoff's syndrome. Moreover, they are among the few abnormalities that are visible to the naked eye in these disorders. With a lifetime prevalence of approximately 1.3%, Wernicke's encephalopathy is by far the most frequent cause of damage to the mamillary bodies in humans. Still, there is a persisting uncertainty with regard to the development and the clinical consequences of this damage, because it is virtually impossible to study in isolation. As a rule, it always occurs alongside neuropathology in other subcortical gray matter structures, notably the medial thalamus. Converging evidence from other pathologies and animal experiments is needed to assess the clinical impact of mamillary body damage and to determine which functions can be attributed to these structures in healthy subjects. In this chapter, we describe the history and the current state of knowledge with regard to thiamine deficiency disorders and the contribution of mamillary body damage to their clinical presentations.

Frontolimbic affective bias and false narratives from brain disease

Since the nineteenth century, clinicians and investigators have systematically evaluated the origin of delusions and psychotic thinking. One major clue to understanding the neurobiological underpinnings of delusions is the emergence of false narratives from brain disease. In addition to delusions themselves, there are a range of other false narratives not due to deliberate lying and resulting from neurological disorders, including provoked confabulations, fantastic confabulations, false memories, magical thinking, dream delusions, and "fantastic thinking". A comparison of their characteristics, similarities, and differences suggest a hypothesis: despite different sources for their false narrative experiences, such as unusual thoughts or perceptions, all false narratives from brain disease involve erroneous or mismatched "affective biases" applied to the experiences. Affective labels usually signal the sense of rightness, sense of familiarity, and the external vs. internal origin of an experience, and they can be altered by limbic neuropathology. The location and involvement of neuropathology that facilitates false narratives involves frontolimbic regions and their connections, particularly on the right. Future investigations can focus on frontolimbic mechanisms involved in the provision of the intrinsically-linked affective biases, which indicate the nature and external/internal origin of experiences.

The imaginative mind

The astounding capacity for the human imagination to be engaged across a wide range of contexts is limitless and fundamental to our day-to-day experiences. Although processes of imagination are central to human psychological function, they rarely occupy center stage in academic discourse or empirical study within psychological and neuroscientific realms. The aim of this paper is to tackle this imbalance by drawing together the multitudinous facets of imagination within a common framework. The processes fall into one of five categories depending on whether they are characterized as involving perceptual/motor related mental imagery, intentionality or recollective processing, novel combinatorial or generative processing, exceptional phenomenology in the aesthetic response, or altered psychological states which range from commonplace to dysfunctional. These proposed categories are defined on the basis of theoretical ideas from philosophy as well as empirical evidence from neuroscience. By synthesizing the findings across these domains of imagination, this novel five-part or quinquepartite classification of the human imagination aids in systematizing, and thereby abets, our understanding of the workings and neural foundations of the human imagination. It would serve as a blueprint to direct further advances in the field of imagination while also promoting crosstalk with reference to stimulus-oriented facets of information processing. A biologically and ecologically valid psychology is one that seeks to explain fundamental aspects of human nature. Given the ubiquitous nature of the imaginative operations in our daily lives, there can be little doubt that these quintessential aspects of the mind should be central to the discussion. Hum Brain Mapp 37:4197-4211, 2016. © 2016 Wiley Periodicals, Inc.

Korsakoff's syndrome: a critical review

In this review, we present a survey on Korsakoff's syndrome (KS), a residual syndrome in patients who suffered from a Wernicke encephalopathy (WE) that is predominantly characterized by global amnesia, and in more severe cases also by cognitive and behavioral dysfunction. We describe the history of KS and its definition, its epidemiology, and the lack of consensus criteria for its diagnosis. The cognitive and behavioral symptoms of KS, which include anterograde and retrograde amnesia, executive dysfunction, confabulation, apathy, as well as affective and social-cognitive impairments, are discussed. Moreover, recent insights into the underlying neurocognitive mechanisms of these symptoms are presented. In addition, the evidence so far on the etiology of KS is examined, highlighting the role of thiamine and alcohol and discussing the continuity hypothesis. Furthermore, the neuropathology of KS is reviewed, focusing on abnormalities in the diencephalon, including the mammillary bodies and thalamic nuclei. Pharmacological treatment options and nonpharmacological interventions, such as those based on cognitive rehabilitation, are discussed. Our review shows that thiamine deficiency (TD) is a crucial factor in the etiology of KS. Although alcohol abuse is by far the most important context in which TD occurs, there is no convincing evidence for an essential contribution of ethanol neurotoxicity (EN) to the development of WE or to the progression of WE to KS. Future research on the postmortem histopathological analysis of brain tissues of KS patients is crucial for the advancement of our knowledge of KS, especially for associating its symptoms with lesions in various thalamic nuclei. A necessary requirement for the advancement of studies on KS is the broad acceptance of a comprehensive definition and definite diagnostic criteria. Therefore, in this review, we propose such a definition of KS and draft outlines for prospective diagnostic criteria.

The false memory syndrome: experimental studies and comparison to confabulations

False memories, or recollections that are factually incorrect but strongly believed, remain a source of confusion for both psychiatrists and neurologists. We propose model for false memories based on recent experimental investigations, particularly when analyzed in comparison to confabulations, which are the equivalent of false memories from neurological disease. Studies using the Deese/Roedinger-McDermott experimental paradigm indicate that false memories are associated with the need for complete and integrated memories, self-relevancy, imagination and wish fulfillment, familiarity, emotional facilitation, suggestibility, and sexual content. In comparison, confabulations are associated with the same factors except for emotional facilitation, suggestibility, and sexual content. Both false memories and confabulations have an abnormal sense of certainty for their recollections, and neuroanatomical findings implicate decreased activity in the ventromedial frontal lobe in this certainty. In summary, recent studies of false memories in comparison to confabulations support a model of false memories as internally-generated but suggestible and emotionally-facilitated fantasies or impulses, rather than repressed memories of real events. Furthermore, like confabulations, in order for false memories to occur there must be an attenuation of the normal, nonconscious, right frontal "doubt tag" regarding their certainty.

Confabulation in schizophrenia: a neuropsychological study

Confabulation has been documented in schizophrenia, but its neuropsychological correlates appear to be different from those of confabulation in neurological disease states. Forty-five schizophrenic patients and 37 controls were administered a task requiring them to recall fables. They also underwent testing with a range of memory and executive tasks. The patients with schizophrenia produced significantly more confabulations than the controls. After correcting for multiple comparisons, confabulation was not significantly associated with memory impairment, and was associated with impairment on only one of eight executive measures, the Brixton Test. Confabulation scores were also associated with impairment on two semantic memory tests. Confabulation was correlated with intrusion errors in recall, but not false positive errors in a recognition task. The findings suggest that confabulation in schizophrenia is unrelated to the episodic memory impairment seen in the disorder. However, the association with a circumscribed deficit in executive function could be consistent with a defective strategic retrieval account of confabulation similar to that of Moscovitch and co-workers, interacting with defective semantic memory.

"Fantastic thinking" in pathologically proven Pick disease

BACKGROUND

Reports of false beliefs may be a unique feature of behavioral variant frontotemporal dementia (bvFTD) but the nature of these experiences is unclear.

OBJECTIVE

To report a case of pathologically verified Pick disease in a patient presenting with prominent and recurrent fantasies.

METHODS

We describe the clinical, neuroradiologic, and neuropathologic findings of a 53-year-old woman presenting with fantasies and meeting Clinical Consensus Criteria for bvFTD.

RESULTS

Early in her course, she reported interactions with different actors, having torrid affairs with them, and other related fantasies. When confronted with her false beliefs, she admitted that these relationships were imaginary. Autopsy revealed Pick disease with tau-immunoreactive Pick bodies in the frontal and temporal cortices, and in the hippocampi.

CONCLUSIONS

Fantastic thinking, or vividly experienced imagination, may be a manifestation of bvFTD that is distinct from delusions and confabulations and could be the source of previously reported delusions and confabulations in bvFTD.