Confabulosis

In modern psychiatry, there is a type of mental disorder known as confabulation, which is related to paramnesia or paramnestic syndromes (memory disorders or deceptions) that can develop in acute and protracted symptomatic psychoses.

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Causes confabulosa

To date, the pathogenesis of the psychotic condition defined as confabulation has not been fully studied, that is, it is not yet known exactly what pathological processes occur in the structures of the brain that produce false memories. This may include damage to the hippocampus and pathologies of blood circulation in the posterior cerebral arteries that supply blood to the middle occipital lobes, the lower parts of the temporal lobes of the brain, its trunk and cerebellum.

The occurrence of confabulation and confabulation is associated with a number of somatic diseases and pathologies, which are characterized by the manifestation of symptoms in the form of various psychoses of exogenous etiology.

Listing the most probable causes of confabulation, psychiatrists name:

• common infectious diseases, including anthropozoonotic rickettsioses (typhus) and a number of zoonotic transmissible infections (for example, malaria);
• primary and secondary encephalitis of various etiologies;
• traumatic brain injury;
• being in a coma;
• intoxication (when a psychotic state occurs as a result of the effect of various toxic substances on the brain or the abuse of psychotropic drugs);
• disorders of craniocerebral circulation after stroke and cerebral hemorrhage (hemorrhagic stroke) and chronic cerebral vascular insufficiency;
• endocrine pathologies (long-term hypoglycemia, hypothyroidism);
• neurorheumatism (accompanied by pathological changes in the vessels and membranes of the brain);
• brain tumors (especially those localized in the subcortex);
• Vitamin B1 deficiency (causing Wernicke-Gaye syndrome ).

In addition, confabulations and confabulations – the replacement of real events that have fallen out of memory with vivid inventions and fantasies – are characteristic of: progressive amnestic dementia; Korsakov's syndrome with retrograde, anterograde and transient amnesia; paralytic dementia; chronic alcoholism (in which expansive confabulations may be observed); paraphrenic delusional syndrome (which is characteristic of schizophrenia, progressive paralysis, encephalopathic and alcoholic psychoses).

Symptoms confabulosa

The main symptoms of confabulation are expressed in the fact that a person, keeping in memory long-past events and facts, describes his actions and events of the present time in an embellished form and makes up things that did not actually happen. In particular, the most incredible "scenarios" are invented, in which the narrator performs selfless acts and shows heroism (saves someone from death, prevents an accident, etc.), makes discoveries, communicates with celebrities, etc. At the same time, the stories are very thorough and abound with a lot of details, and the style of narration is quite calm.

The first signs of this symptomatic psychosis can be noticed when the patient is asked questions about recent facts from his life, the answers to which take the form of obvious confabulation - descriptions of fictitious events.

As experts note, the mood of patients is elevated, and in the presence of delusional states, close to euphoria (which is what distinguishes temporary symptomatic confabulation from progressive confabulations in schizophrenia or amnestic dementia).

In the case of acute symptomatic psychosis, confabulation occurs unexpectedly and spontaneously passes after some time. When the patient comes out of this state, he remembers it and can even treat the content of his story critically. That is, the person's mental abilities do not suffer. But when the psychotic state passes, patients most often experience a feeling of fatigue and general weakness, decreased vascular tone, heaviness and pain in the head, hyperhidrosis (increased sweating), sleep disorders and other manifestations of asthenia.

If confabulations and confabulation progress and are accompanied by disorientation in time and clouding of consciousness, then this may indicate vascular (atherosclerotic) dementia, which develops against the background of severe sclerosis of the cerebral arteries and leads to transient ischemic attacks in individual structures of the brain.

In this case, there may be complications such as general memory impairment, decreased cognitive abilities and intellectual capabilities with the inevitable addition of neurological symptoms.

In vascular lesions of the brain, the progression of confabulations has consequences in the form of persistent shifts in personality traits - up to the development of irreversible mental disorders.

Diagnostics confabulosa

The identification of any symptomatic psychoses, including the diagnosis of confabulation, is carried out by psychiatrists and neurologists and is based on the clinical manifestations of the pathology.

Special testing of patients is carried out. And to identify the etiology of confabulations (except for such obvious reasons as craniocerebral trauma), blood tests are necessary: biochemical, sugar level, thyroid hormones, TDP, tumor markers, etc. Based on the test results, infectious disease specialists, endocrinologists, and oncologists may be involved in the diagnostic process.

Instrumental diagnostics include: EEG (electroencephalography), REG (rheoencephalography), Doppler ultrasound examination (USDG) of the state of the cerebral vessels, CT (computer tomography) and MRI (magnetic resonance imaging) of the brain.

Differential diagnosis

The appointment of the correct treatment for confabulation and confabulosis is ensured by differential diagnostics, during which it is necessary to distinguish confabulosis as a manifestation of symptomatic psychosis from schizophrenia, delusional psychoses, paranoid and manic-depressive states, senile dementia and other pathologies.

Treatment confabulosa

All psychiatry manuals note that treatment of confabulation is carried out only taking into account its etiology. That is, they treat, first of all, the disease that provoked this disorder (a description of methods for treating encephalitis, craniocerebral trauma or hypothyroidism is beyond the scope of this publication).

As for symptomatic therapy prescribed by neurologists and psychiatrists, there is no single treatment plan for confabulation and it is based on the clinical picture of each individual patient.

Prescribed medications may include antipsychotics - neuroleptics or anxiolytics - depending on the reactive state of the patient's nervous system, and they are taken under conditions of constant monitoring of the central nervous system.

To improve cerebral circulation and metabolism in nerve cells, Piracetam (Piramem, Nootropil, Cerebropan, Gabatset and other trade names) is often recommended, which helps to increase the speed of impulses passing through synapses to neurons in the neocortical areas of the brain. Capsules (0.4 g) or tablets (0.2 g) are supposed to be taken orally in a daily dosage of 0.4-0.8 g (in 2-3 doses, before meals) for 1.5-2 months. If patients have kidney problems, the attending physician should monitor the level of creatinine in the blood. Among the contraindications for this drug, in addition to renal failure, are cerebral hemorrhage and childhood under 12 months. Piracetam can cause side effects such as hyperkinesis, weight gain, skin allergic reactions, headache, sleep disturbance, anxiety.

The drug Ceraxon (Citicoline, Neipilept, Somazina) in the form of a 10% solution for oral administration relieves swelling of brain tissue, thereby improving their trophism and functioning. Adults are supposed to take this medicine 2 ml three times a day; children - 1 ml. The course of treatment is 40-45 days. As a result of taking Ceraxon, blood pressure may decrease, so it is not prescribed to hypotensive patients.

In the treatment of confabulation and confabulosis, the drug Pyriditol (Pyritinol, Encephabol, Bonifen, Neuroxin) is used, which activates metabolism in brain tissue and protects them from hypoxia. The standard dosage is one tablet (0.1 g) three times a day (after meals); the maximum daily dose is 0.6 g. The duration of administration and specific doses are determined by the doctor individually. Side effects include nausea, headache and insomnia; a history of epilepsy, as well as psychomotor agitation and a tendency to seizures are contraindicated.

The drug Tanakan, which has no contraindications and contains a powerful angioprotector - an extract of the plant ginkgo biloba, is used one tablet (40 mg) three times a day. Possible side effects include headaches and stomach upsets.

For symptomatic psychoses, doctors also recommend taking vitamins A, C, E and group B. And physiotherapy treatment for confabulations can be carried out using hydrotherapy (iodine-bromine baths) and aeroionotherapy (sessions of breathing ionized air).

Forecast

The prognosis of symptomatic psychoses also depends on their cause. If infectious diseases and cerebral vascular insufficiency are cured, confabulation also goes away. However, somatic diseases often become chronic or acquire a subacute form, which is accompanied by protracted organic psychosyndromes.