Confabulations fantastiques ou délire ?

Abstract

Introduction Confabulations are inaccurate narratives purporting to convey information about the world or the self. Fantastic utterances from brain-injured patients are difficult to interpret as confabulation or delusion. Methods Starting from two clinical observations, we analyse the terms “spontaneous confabulations” and “delusion”. Results Two brain-injured patients presented with fantastic utterances; the adhesion was complete for both patients. They also suffered from amnesic and executive disorders. Clinical interviews with neuropsychologist and psychopathologist could not distinct between spontaneaous confabulations and delusion. Discussion Neuropsychological interpretations of spontaneous confabulations are (1) the deficient strategic retrieval process arising from executive failures and (2) confusion of the temporal order of information within memory. These hypotheses cannot explain the fantastic utterances described. Are spontaneous fantastic confabulations a specific entity or did these patients present a morbid association of neurological and psychiatric disorders? Fantastic confabulations are very scarcely described and the association of neurological and psychiatric impairments enables us to better describe the clinical observations. Spontaneous confabulations reported after amnesic and executive disorders are indeed typically composed of the patient's past experiences and do not usually comprehend fantastic utterances. Conclusion Neurological and psychological analyses of the fantastic utterances from two brain-injured patients do not respond to the definition of spontaneous confabulation. Fantastic confabulations are a rare entity and we propose another explanation consisting of the association of neurological and psychiatric disorders.