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Forum Name: Neurology Topics

Question: Neurological Research


 Anonymous - Mon Jan 06, 2003 4:17 pm

I am trying to find out about a disease which is closely linked to schyzophrenia, or I believe it is. All I need to know is, if a person were totally immersed within an alternate/fantasy life, completely unaware of his/her true life, what disease would he/she be diagnosed with.
 Dr. Tamer Fouad - Mon Jan 06, 2003 8:10 pm

User avatar Dear Guest,
First of all I am not a psychiatrist. However, I can give you a doctor's perspective and hope that will help guide your research.
Psychiatric diseases are extremely complex diseases. There is always a degree of overlap between their manifestations. Infact there is even a large degree of overlap between what is considered a disease and what is considered normal.
So modern psychiatry depends on the grouping of manifestations together into diagnostic criteria. That is basically like a scoring system where if a patient has a sum of certain manifestations he is diagnosed with a certain disease. If not then he hasn't met the criteria for this diagnosis.

For example:
Diagnostic criteria for schizophrenia (DSM-IV):

A. Characteristic symptoms: At least two (2) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):

1. delusions

2. hallucinations

3. disorganized speech (e.g. frequent derailment or incoherence)

4. grossly disorganized or catatonic behavior

5. negative symptoms, i.e., affective flattening, alogia, or avolition

Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.

Now the manifestation you mentioned is I believe to be called confabulation.

Confabulation is the phenomenon whereby patients with memory disorders may produce false memories. For example, the patient may tell you in graphic detail how his or her parents visited last night, and later you discover that the mother died four years ago and the father died twenty years ago! The person is not aware that they are producing false memories.

There are probably differing kinds of mechanisms that underlie these forms of confabulation. Spontaneous confabulation, which may rove over a number of themes, sometimes is bizarre, and the content of which is often very preoccupying for the patient, seems to be the result of damage to the frontal lobes, particularly in the bottom part (ventro-medial) of the frontal lobes of the brain.

Many causes of damage to the frontal lobes can cause this, whether they be traumatic (example a car accident) or due to an infection (encephalitis). It can also manifest with schizophrenia.

In encephalitis, the primary site of damage is usually elsewhere than the ventro-medial portion of the frontal lobes: for example, in herpes encephalitis, the medial aspects of the temporal lobes are most commonly affected, causing severe memory impairment. However, the ventro-medial portion of the frontal lobes are sometimes affected as well, giving rise to confabulation.

Unfortunately, there is no very effective drug treatment for this form of confabulation, although there are certain medications that can be tried. Most commonly, it is seen in the early stages of an illness, when the patient is confused, and often it will settle with time. In occasional cases it may be persistent.

Good luck with your research!
Dr. Tamer.

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