Confabulation: a clinical mental disorder

Confabulation: Clinical Mental Disorder
Kathleen Benjamin Rickard, DNP, APRN, FNP-C
Sept. 6, 2014
Upon recently completing a six-day conference on the mind and the benefits of
meditation, one of many terms popped out as a most fascinating concept for exploration. An
understanding of the word confabulation offers an opportunity to appreciate the complexity of
the mind.

In my personal world, I have been enmeshed in a significant amount of frustration
attempting to clarify, justify, understand, correct, and/or appreciate a person who clearing
restates sequences of events with strange and usually hurtful renditions that seem really odd to
everyone except the person stating them. When these topics are questioned, the rebuttal response
provided by this person is directed with more passion and anger than is appropriate for the
incident. It has been a befuddling incident until now.

The definition of this type of memory disorder is called confabulation. According to
Myers (2006), confabulation results from damage to the basal forebrain and frontal lobes. It is
described as a spontaneous production of false thoughts and memories. These memories can be
quite elaborate or very simple but can often lead to strong argumentative behavior to justify these
thoughts as truth. These memories are not actually lies because the person is not aware that they
are fabricated and inaccurate memories. Confabulation is a clinical syndrome. According to the
Memory Disorders Project newsletter, these distorted memories may resolve with time but often
require therapy to address the incidents and behaviors (Myers, 2006). Learning more about the
brain is important for understanding this condition.

The frontal lobe is divided into different functional domains. According to results from
research using magnetic resonance imaging (MRI), positron emission tomography (PET), and
single photon emission computed tomography (SPECT) scans, it has been determined that
symptoms such as impulsiveness, confabulatory verbosity, grandiosity, increased sexuality, and
mania are associated with right frontal as well as bilateral neurological disturbances (Joseph,
1999). These symptoms improve at times and are exacerbated by depression (Joseph, 1999).

Kapur and Coughlan (1980) described a case report of a patient with frontal lobe damage
who provided fictitious recounts post repair of a brain aneurism. When this patient was
confronted with these stories, he became puzzled but did not have a sense of having lied about
the incidents. In this case, improvement was noted with time.

Through human neuroimaging and animal studies, the ventromedial prefrontal cortex
(vmPFC) has been identified as a location for the development of different forms of memory,
particularly in facilitating new encoding of information by existing memory. Confabulation
appears following vmPFC damage. (Ghosh, Moscovitch, Colella, & Gilboa, 2014).

Appreciating the complexity of the brain, coping strategies under stress, detecting
possible underling pathology, and the marvels of modern technology all provide the opportunity
for dealing with this very difficult form of mental disease. Although definitely not an easy
disorder to repair partly due to the person being unaware that there is a problem, having
compassion and finding the appropriate diagnosis and treatment, offer enormous potential for
healing the afflicted person and all those they encounter.

Berlyne, N. (1972). Confabulation. The British Journal of Psychiatry 120, 31-39. doi:
Ghosh, V.E., Moscovith, M., Collela, B.M., & Gilboa. (2014). Schema representation in patients
with ventromedial PFC lesions. The Journal of Neuroscience. 34(36),12057-12070. doi:
Joseph, R. Frontal lobe psychopathology: mania, depression, confabulation, catatonia,
perseveration, obsessive compulsion, and schizophrenia. Psychiatry, 62(2). 138-172.
PMID: 10420428
Kapur, N., & Coughlan, A.K. (1980). Confabulation and frontal lobe dysfunction. Journal of
Neurology, Neurosurgery, and Psychiatry. 43, 461-463. doi: 10.1136/jnnp.43.5.461
Myers, C. E. (2006). Confabulation. Memory Loss and the Brain. Retrieved from the
newsletter of the Memory Disorders Project at Rutgers University, Winter, 2010.

Re-introducing healgracefully

It has been close to a year since I have participated in this website. So much has happened that this last year has ben a blur. Now with wonderful family events, and lots of schooling behind me, I intend to concentrate on my practice and continue learning what it takes to integrate numerous modalities of healing into a currently severely injured if not outright dying health care system.
Much talk of horrible food sources, water sources, allergies, inflammatory conditions, mental health issues, worsening politics around medications and worsening medical care outcomes have become so evident by so many Americans. Transparency in medicine, although a huge hope, remains illusive…
As I recover from the work of completing of my doctoral degree, I am reminded that my job is to continue to provide a bridge to exploring and understanding options in health care.
One of my patients yesterday told me that after he saw me at a previous visit, he went to work and told his co-workers that he had never been told that he has a choice in how he takes care of his body. He had never been told such a thing by a provider before and he felt empowered so much by the simple truth, that it motivated him to take charge. What a concept.

Settling in at the new office

As we enter into the Labor day weekend, I want to offer my sincere gratitude to all the wonderful angels, friends, family, who helped me transfer so smoothly to the new office. This has been challenging for me, for the new staff, and for the staff left behind. It has been especially difficult for the numerous wonderful patients who have been displaced during this process.
I offer many thanks to Dr. Holder and his family/ staff for allowing this transition with ease.
The details of the new facility are noted in the contact section but I repeat it here for convenience:
New address: 720 E. Thunderbird Suite 3 Phoenix, Az. 85022
Work number: 602-866-8603
(from Scottsdale, take Cactus west until it becomes Thunderbird at Cave Creek road).
For a few weeks, we are having to slow down on admitting new patients until we can get enough providers to take on the increased health care load. Have patience please and if you run into trouble getting an appointment, check your insurance and if urgent, then choose according to your insurance. If not urgent, please check back in a few weeks when our new providers are hired.
My wish is for your optimum health and excellent care.

New Location Beginning July 8th, 2013

After a stressful month, Dr. Del Sordi and I have new offices from which to continue our practices. Due to time constraints, we are not in the same office. We are both very sad that we could not work together at this time and many of you know that we have worked together off and on for about six years separated by babies born, and other prior commitments along the way.

If you want to go with either Dr. Del Sordi or myself, please sign a release form from Comprehensive Family Medicine for lab work, recent progress note, radiology reports and any pertinent information you want to transfer. We ask that if you are interested in Dr. McHenry's N1 program, please let the N1 staff know right away.

I am very grateful for the last four years at Comprehensive Family and am very honored to have had the opportunity to serve. I know that Dr. Del Sordi believes the same.
We both wish you the very best of health.

Below are both office addresses.

Kathleen's address: Thunderbird Family Practice: J. Michael Holder, D.O.
720 E. Thunderbird Rd. Suite 3, Phoenix, Az. 85022
602-866-8603 Fax: 602-866-2413

Dr. Del Sordi's address: Scottsdale Family Physicians
10210 N. 92nd Street, Suite 106, Scottsdale, Az. 85258
480-661-1755 fax: 480-661-9636


Times they are a changin'

June 2013 has been quite a month and the explosion of change continues.

After 4 years working at Comprehensive Family Medicine, I will shortly be moving to a new location. I expect to be situated in a new location by mid July and I welcome anyone interested in joining me.

All challenges bring opportunity and this is no exception. It has been a very stressful transition and I look forward to continuing to provide the best care possible.

Please stay tuned and I will let you know where both Dr. DelSordi and I will be going very soon.

Thank You,

Three inspiring words

Through many conversations with patients lately, I have found three words that have the ability to continue us on our path with purpose and peace no matter what drama surrounds us.
The premise of these words is that we chose or were assigned to the planetary adventure this lifetime to learn and grow, and above all experience.
The three words/phrases for our life purpose:
1. seek joy
2. be curious
3. feel gratitude
Ok, easier said than done, of course, and I believe this may be due to fear and incorrect beliefs about our purpose here.
A very dear friend once told me, 'when you finally get it, that will be your last breath"....
so breathe deeply in through the nose, out through your nose and experience on.
Be Well.

Welcome to Heal Gracefully

Explore the many complementary modalities for healing your mind, body, and spirit

  • The human body is a conduit for the vast expression of your life with all your
    past and future lesson plans. This body is capable of communicating with you to
    enrich and assist in your ultimate goal of seeking and living in joy. When
    the body senses that you are moving away from that joy, it gives out warning
    notices. Usually starting out softly and quietly, it can become very loud,
    painful, and intolerable.
  • There are ways to re-connect with your body's communication methods,
    understand the issues, alleviate your body's distress and resume your personal path.
  • Please understand, healing does not always mean cure. Although some disease processes
    do resolve, many will remain in some form or another as reminders to stay
    present and on your own journey. Your gift to yourself is to learn and use all
    the tools available to you, to bring your mind, body, and spirit into harmony.
  • Kathleen firmly believes that in order to heal and remain well, you must have a
    variety of tools at your disposal. Her mission is to provide enough time and knowledge
    to help you access those tools.


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