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Imagine someone tells us the following story: "This morning I have been walking through the forest that surrounds this building. I go out every morning to walk. I like the fresh air in my face. By the way, this building is mine. As you can see it is very large. I would like to let it go. to my children, but they have their life and I don't think they want to take charge ". So far nothing strange. But if this story is told to us by an old woman tied to a wheelchair and locked in a wing of a nursing home ... What is happening? Welcome to the collusion!
Without a doubt, it is a striking and interesting phenomenon. Those who suffer from it live with maximum reality, that is, they believe that what they say is true. Throughout the article, the concept of collusion will be deepened, as well as the possible neuronal causes and cognitive models. Finally, it will investigate a little in the intervention and treatment. However, this last point, due to lack of research, is still to be developed.
- 1 Confabulation, a strange story
- 2 Cognitive models of collusion
- 3 Neuroanatomic correlation of confabulation
- 4 Intervention and treatment
Confabulation, a strange story
As defined by Ardeno, Bebibre and Triviño (2013), the "collusion is an alteration that mainly affects episodic memory - although it also compromises semantic memory - altering both the genesis of new memories and the recovery of older traces". What does this mean? Patients are able to create the most unlikely stories by mixing real memories with new fictional memories.. They can also relate something that happened to them years ago as if it had happened a few days ago.
In 1987, Kopelman proposed two types of confabulations, the provoked and the spontaneous. However, Dalla Barba and Boissé (2010), proposed a new classification of confabulations and affirm that the vast majority are related to "the general memory of habits and daily activities that are placed at the wrong time".
Types of collusions (Dalla Barba and Boissé, 2010)
- Inventions They are those in which the person invents an event that has nothing to do with his life.
- Confusion. The patient mixes many events with each other.
- Bizarre fantasies or confabulations. Patients with these types of confabulations can elaborate fully invented stories but believe in them firmly. For example, to say that a brother comes to visit us every day when he lives in another country.
Usually, who listens to these patients without knowing them, may think that nothing happens to them. The implausibility of history can be observed when someone in a wheelchair says that he runs through the forest every day or when we have knowledge of someone's biography.
For example, if a family member who is able to walk and who is more or less autonomous, tells us that he drives to the city every day, only we can know the truth. This is why it is so important to contrast information with family members. The story may seem very consistent and credible, but that person may not have a driver's license or know how to carry a vehicle.
Cognitive models of collusion
According to Dalla Barba and Boissé (2010), patients access memories through long-term memory. In this way, they remain trapped in the past. Thus, it is not strange that they fill mental gaps with past events.
Deficit of coding and monitoring of information
Mitchell and Johnson (2009), propose the hypothesis of reality monitoring to explain the most bizarre confabulations. According to the authors, exists "a deficit both in the monitoring of the timeline and in the monitoring of reality, that is, in the ability to differentiate real memories from imagined ones ".
Thus, the authors point out that "collusions do not arise only in relation to the temporal context of memories (that is, real memories shift in time and place), but they happen with all kinds of memory traces, such as thinking, associations and imaginations".
At this point the source monitoring hypothesis. What is it about? According to Schnider, (2003), he proposes that collusion takes place "when the individual confuses the source or origin from which a memory comes, misplacing an event happened in another or even with current reality".
Deficit in strategic recovery
The Gilboa team (2006) proposes that "collusions occur due to a failure in recovery processes and not so much in coding". That is, when there is a mental gap and the patient does not know how to fill it, he recalls memories, however, there is a failure in this recovery. As the authors claim, "collusions would arise from the deficit when using effective recall strategies, which include the use of keys, the use of memory search and filtering strategies and conscious monitoring of memories ".
The Schacter team (2007) proposes that it is a episodic memory error. This type of memory, beyond remembering and reproducing events that have taken place in the past, also imagines and simulates future events. Episodic memory carries out a constructive process, so it would be an error in this elaboration process.
Neuroanatomic correlation of confabulation
The team of Duarte (2010) states that cases of collusion after injuries to structures of the limbic system, such as the amygdala, the basal brain, the dorsomedial nucleus of the thalamus and the perirrinal or medial cortex of the hippocampus. Ardeno, Bebibre and Triviño (2013) highlight that collusion "It has been traditionally related to atrophy of the mammillary bodies and mammothalamic tract dysfunction".
On the other hand, the Gilboa team (2006), has collected cases in which collusion has appeared after damage to the frontal structures. Affirm that "The lesion in the ventromedial cortex is necessary but not sufficient, requiring the added damage of the orbital cortex". Alzheimer's disease is also related to the appearance of confabulations. Cases of collusion have been reported after suffering:
- Stroke in the middle and anterior cerebral arteries.
- Frontobasal craniocerebral trauma.
- Subdural Hematomas
- Herpetic encephalitis
Intervention and treatment
Some patients, after the injury, recover within a few weeks and stop confabular. However, others may be left to chronicle. Normally, the latter are those whose injury is greater. Despite being a problem that can incapacitate on a day-to-day basis, there is still enough to investigate, especially its intervention.
The treatment is usually pharmacological and therapeutic. Cognitive behavioral therapies are usually applied, but their efficacy is not yet fully demonstrated. As highlighted Ardeno, Bebibre and Triviño (2013), "contrasting reality and making the patient aware of their mistakes seems to be the key to the reduction of confabulations in these people".
- Arendo, M., Bembibre, J. and Triviño, M. (2013). Neuropsychology Through case studies. Madrid: Pan American Medical Editorial.
- Dalla Barba, G. and Boissé, M. (2010). Temporal consciousness and confabulation: is the medial temporal lobe "temporal"?Cognitive Neuropsychiatry, 15, 95-117.
- Duarte, A., Henson, R., Knight, R., Emery, T. and Graham, K. (2010). The orbitofrontal cortex is necessary for temporary context memory. Journal Cognitive Neuroscience, 22, 1819-1831.
- Gilboa, A., Alain, C., Stuss, D., Melo, B., Miller, S. and Moscovithc, M. (2006). Mechanisms of spontaneous confabulations: a strategic retrieval account. Brian, 129, 1399-1414.
- Mitchell, K. and Johnson, M. (2009). Source monitoring 15 years later: what have we learned from fMRI about the neural mechanism of source memory? Psychollogy Bull, 135, 638-677.
- Schacter, D., Addis, D. and Buckner, R. (2003). Remembering the past to imagine the future: the prospective brian. Nature Reviews Neuroscience, 8, 657-661.
- Schnider, A. (2003). Spontaneous confabulation and the adaptation of thought to ongoing reality. Nature Reviews Neuroscience, 4, 662-671.
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