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Living with Dementia

Presbyophrenia and confabulation

  • - Dementia: general aspects
  • Jun 20, 2011
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Tags: | amnesia | confabulation | confabulatory euphoria | delirium tremens |

Reported in relation to clinical conditions other than memory deficit, ‘confabulation-like’ behaviours can already be found in the clinical literature of the second half of the nineteenth century. Sully (1885) suggested that such behaviours might be related to a psychological function whose role was filling gaps in the flow of our lives and explained why ‘our image of the past is essentially one of an unbroken series of conscious experiences’. Sully believed that this function also intervened when memory failed: ‘just as the eye sees no gap in its field of vision corresponding to the ‘blind’ spot of the retina, but carries the impression over this area, so memory sees no lacuna in the past, but carries its image of conscious life over each of the forgotten spaces’ (p. 282).

Kraepelin (1886-1887) reported typical cases of confabulation associated with, among other things, general paralysis of the insane, melancholia and dementia; and later on suggested that ‘pseudomemories’ could be a symptom of paraphrenia (without cognitive impairment), and described a clinical variety called paraphrenia confabulans (Kraepelin, 1919). Under schizophrenic akzessorischen Gedachtnisstorungen,  Bleuler (1911)  discussed three related phenomena:  Gedachnisillusionen (illusions or distortions of memory), identifizierenden Erinnerungstauschungen (memory falsifications based on identification), and Erinnerungshalluzinationen (memory hallucinations).  Of the former he wrote:  ‘memory illusions often constitute the main material for the construction of delusions in paranoids. The entire previous life of the patient may be changed in his memory in terms of this complex’ (p. 115). On this definition, it is difficult, on the basis of their intrinsic features, to distinguish illusion of memory from confabulation. Indeed, symptom-naming is determined by whether schizophrenia or ‘organic disorder’ is the associated disease.

Unsuccessfully, Bleuler (1911) tried to establish a differentiation on the basis of mechanism: ‘until now, and in contrast to the views of some authors, I have not observed confabulation as it appears in organic cases; e.g. memory hallucinations which fill in memory gaps which at first appear at a (usually external) given moment and mostly adapt themselves to such an occasion’ (p. 117). Kleist (1960)  described patients with ‘progressive confabulosis’ as ‘cheerful, expansive, and with little in the way of thought or speech disorder’ (p. 211); and Leonhard (1957) redescribed the condition as ‘confabulatory euphoria’.

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Edited by

Alistair Burns MPhil, MD, FRCP, FRCPsych
Professor of Old Age Psychiatry,
Wythenshawe Hospital,
Manchester, UK

John O’Brien MA, DM, FRCPsych
Professor of Old Age Psychiatry,
Institute for Ageing and Health,
University of Newcastle upon Tyne,
Newcastle upon Tyne, UK

David Ames BA, MD, FRCPsych, FRANZCP
Professor of Psychiatry of Old Age,
University of Melbourne, St George’s Hospital, Melbourne,
Victoria, Australia

###


Author:

GERMAN BERRIOS
German Berrios BA (OXFORD), MD, DM H.C. HEIDELBERG, FRCPsych, FBPSS
Professor,
University of Cambridge Department of Psychiatry,
Cambridge, UK


References

  1.   Alzheimer A. (1907) Uber eine eigenartige Erkrankung der Hirnrinde.
  2.   Allgemeine Zeitschrift fur Psychiatrie und Psychisch-Gerichtlich Medizine 64: 146-148
  3.   Alzheimer A. (1911) Uber eigenartige Krankheitsfalle des spateren Alters. Zeitschrift fur die gesamte Neurologie und Psychiatrie 4: 356-385
  4.   Anderson EW, Threthowan WH, Kenna JC. (1959) An experimental investigation of simulation and pseudodementia. Acta Psychiatrica et Neurologica Scandinavica 34 (Suppl. 132)
  5.   Anonymous (1832) An exposure of the unphilosophical and unchristian expedients adopted by antiphrenologists, for the purpose of obstructing the moral tendencies of phrenology. A review of John Wayte’s book. The Phrenological Journal and Miscellany 7: 615-622
  6.   Baillarger J. (1883) Sur la theorie de la paralysie generale. Annales Medico-Psychologiques 35: 18-52; 191-218
  7.   Baillarger J. (1889) Doit-on dans la classification des maladies mentales assigner une place a part aux pseudo-paralysies generales? Annales Medico-Psychologiques 41: 521-525
  8.   Ball B and Chambard E. (1881) Demence. In: A. Dechambre and L. Lereboullet (eds), Dictionnaire Encyclopedique des Sciences Medicales. Paris, Masson, pp. 559-605
  9.   Barrett AM. (1913) Presenile, arteriosclerotic and senile disorders of the brain and cord. In: WA White and SA Jelliffe (eds), The Modern Treatment of Nervous and Mental Diseases. London, Kimpton, pp. 675-709

Full References  »

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