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Behaviorally spontaneous confabulation in limbic encephalitis: The roles of reality filtering and strategic monitoring

Published online by Cambridge University Press:  19 August 2010

LOUIS NAHUM ,
RADEK PTAK ,
BÉATRICE LEEMANN ,
PATRICE LALIVE  and
ARMIN SCHNIDER
LOUIS NAHUM
Affiliation:
Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Switzerland
RADEK PTAK
Affiliation:
Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Switzerland
BÉATRICE LEEMANN
Affiliation:
Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Switzerland
PATRICE LALIVE
Affiliation:
Division of Neurology, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Switzerland
ARMIN SCHNIDER*
Affiliation:
Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Switzerland
*
*Correspondence and reprint requests to: Armin Schnider, Service de Neurorééducation, Hôpitaux Universitaires de Genève, Av. de Beau-Séjour 26, CH-1211 Geneva 14 / Switzerland. E-mail: armin.schnider@hcuge.ch
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Abstract

Behaviorally spontaneous confabulation is characterized by a confusion of reality evident in currently inappropriate acts that patients justify with confabulations and in disorientation. Here, we describe a 38-year-old woman lawyer hospitalized because of non-herpetic, presumably autoimmune, limbic encephalitis. For months, she considered herself at work and desperately tried to respect her falsely believed professional obligations. In contrast to a completely erroneous concept of reality, she did not confabulate about her remote personal past. In tasks proposed to test strategic retrieval monitoring, she produced no confabulations. As expected, she failed in tasks of reality filtering, previously shown to have high sensitivity and specificity for behaviorally spontaneous confabulation and disorientation: she failed to suppress the interference of currently irrelevant memories and she had deficient extinction capacity. The observation underscores the special status of behaviorally spontaneous confabulation among confabulatory phenomena and of reality filtering as a thought control mechanism. We suggest that different processes may underlie the generation of false memories and their verbal expression. We also emphasize the need to present theories of confabulation together with experimental tasks that allow one to empirically verify the theories and to explore underlying physiological mechanisms. (JINS, 2010, 16, 995–1005.)

Keywords

Orbitofrontal cortexLimbic systemReality monitoringRehabilitationParamnesiaCaudate
Type
Symposia
Information
Journal of the International Neuropsychological Society , Volume 16 , Issue 6 , November 2010 , pp. 995 - 1005
Copyright
Copyright © The International Neuropsychological Society 2010

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