Confabulation


Article Author:
Amanda Wiggins


Article Editor:
Jessica Bunin


Editors In Chief:
Kranthi Sitammagari
Mayank Singhal


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Frank Smeeks
Kristina Soman-Faulkner
Trevor Nezwek
Radia Jamil
Patrick Le
Sobhan Daneshfar
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Pritesh Sheth
Hassam Zulfiqar
Navid Mahabadi
Steve Bhimji
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Mark Pellegrini
James Hughes
Beata Beatty
Nazia Sadiq
Hajira Basit
Phillip Hynes
Tehmina Warsi


Updated:
1/26/2019 9:18:47 PM

Definition/Introduction

Confabulation is a neuropsychiatric disorder wherein a patient generates a false memory without the intention of deceit.[1] The patient believes the statement to be true, hence the descriptive term “honest lying.”[2] The hypothesis is that the patient generates information as a compensatory mechanism to fill holes in one’s memories.[3] It functions for self-coherence, integration of memories, and self-relevance.[4][1] Confabulations can include small details such as birthdays or they may be fantastical and more broadly based.[5] They can be believable or bizarre. Presenting patients with contradictory information may further perpetuate confabulation in an attempt to explain their account.

Issues of Concern

Associated Conditions:

The most common reports of confabulation are in patients with Korsakoff syndrome from Wernicke encephalopathy, wherein patients have anterograde amnesia in addition to confabulations.[6] It has been seen in several other disease processes to include Alzheimer dementia, traumatic brain injury, schizophrenia, bipolar disorder, anterior communicating artery aneurysms, and cortical blindness with Anton syndrome. It can, however, also present in otherwise healthy patients.[7][8][9][3]

Mechanism:

Multiple reported lesions have correlations with the phenomenon. While most disorders associated with confabulation are related to lesions in the orbitofrontal or ventromedial prefrontal cortex of the frontal lobe, errors in processing may also occur within the hypothalamus, mammillary bodies, and the dorsomedial nucleus of the thalamus.[10][8][6][3][9] Due to the complex physiology, it is difficult to determine the exact mechanism of false memories. There are multiple theories regarding the evolution of and motivation behind confabulation, but there is no conclusive data.[5] Memory tests may identify errors in executive function, temporal context confusion, or reduced memory capacity.[9]

Spontaneous vs. provoked confabulation:

Two types of confabulation can be distinguished. Provoked confabulations can be discovered by directly questioning and prompting a false memory.[5] This type commonly correlates with an impairment in autobiographical and semantic memory such as dates, places, and common history. For example, one asks the patient “Who was the forty-fourth president of the United States?” the patient would then reply incorrectly instead of responding with “I don’t know.”[3][8] Spontaneous confabulations are memories elicited without an external trigger, and generally, do not occur within an interview. Their trigger is from an individual confusing chronology or attempting to explain situations to themselves.[5] Spontaneous confabulations may reveal themselves in standard day to day conversation, such as a patient divulging false information randomly at the dinner table.

Delusions vs. confabulation:

While confabulations appear to be false memories, delusions are more akin to false beliefs.[11][12] Confabulations are more commonly associated with Korsakoff syndrome while delusions more commonly correlate with schizophrenia. That said, both errors in information processing may exist in both disorders. Research into the motivations behind confabulations and delusions has attempted to differentiate these disorders, but this has not been conclusive.[11][12][13] As such, confabulations and delusions may prove to be different manifestations along the same spectrum.

Clinical Significance

Treatment most commonly revolves around treating the underlying disorder, such as using thiamine to treat Korsakoff syndrome or antipsychotic medications to treat schizophrenia. Interdisciplinary cognitive rehabilitation, however, may also be helpful. Specific interventions such as maintaining a diary and specific therapies such as self-monitoring training may also be efficacious.[4][11][1][14]


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Confabulation - Questions

Take a quiz of the questions on this article.

Take Quiz
Confabulation is not associate which of the following conditions?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
An occupational therapist is interviewing a patient with Alzheimer disease and recognizes the patient is confabulating. What is the next best step?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 60-year-old homeless man with a history of alcohol use disorder presents to the emergency department after the police found him wandering around downtown, confused, and agitated. He is afebrile with normal vitals. The physical exam is significant for cachexia, disorientation, agitation, and ataxic gait. He had a normal TSH, complete blood count, complete metabolic panel, negative alcohol level, and negative urine drug screen. Head imaging with a CT and MRI were significant for mamillary body atrophy. At that time he was admitted to the hospital with a diagnosis of Wernicke encephalopathy and treated with thiamine. Over the next several days his agitation and gait improve, but he is persistently disoriented. Staff notes that he is confabulating, concerning for Korsakoff syndrome. What are the two types of confabulation that are seen with Korsakoff syndrome?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
An elderly gentleman is brought to the emergency department by his daughter. He has a known history of alcohol use disorder and his daughter reports increasing confusion and a worsening ataxic gait. During the interview with the patient, he seems confident about the details surrounding his illness, but his daughter reports that his details are not accurate. What area of the brain is most likely responsible for the error in his thought processes?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Confabulation - References

References

Arts NJ,Walvoort SJ,Kessels RP, Korsakoff's syndrome: a critical review. Neuropsychiatric disease and treatment. 2017;     [PubMed]
Dalla Barba G,La Corte V, A neurophenomenological model for the role of the hippocampus in temporal consciousness. Evidence from confabulation. Frontiers in behavioral neuroscience. 2015;     [PubMed]
El Haj M,Larøi F, Provoked and spontaneous confabulations in Alzheimer's disease: An examination of their prevalence and relation with general cognitive and executive functioning. Psychiatry and clinical neurosciences. 2017 Jan;     [PubMed]
Martín Juan A,Madrigal R,Porta Etessam J,Sáenz-Francés San Baldomero F,Santos Bueso E, Anton-Babinski syndrome, case report. Archivos de la Sociedad Espanola de Oftalmologia. 2018 Nov;     [PubMed]
Fujikawa M,Nishio Y,Kakisaka Y,Ogawa N,Iwasaki M,Nakasato N, Fantastic confabulation in right frontal lobe epilepsy. Epilepsy     [PubMed]
Shakeel MK,Docherty NM, Confabulations in schizophrenia. Cognitive neuropsychiatry. 2015;     [PubMed]
Fotopoulou A, False selves in neuropsychological rehabilitation: the challenge of confabulation. Neuropsychological rehabilitation. 2008 Oct-Dec     [PubMed]
Berrios GE, Confabulations: a conceptual history. Journal of the history of the neurosciences. 1998 Dec     [PubMed]
Mendez MF,Fras IA, The false memory syndrome: experimental studies and comparison to confabulations. Medical hypotheses. 2011 Apr     [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of PA-Hospital Medicine. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for PA-Hospital Medicine, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in PA-Hospital Medicine, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of PA-Hospital Medicine. When it is time for the PA-Hospital Medicine board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study PA-Hospital Medicine.