Cognition et délire: de la croyance à la Cognition et délire: de la croyance à la fabulationfabulation

Gianfranco Dalla BarbaGianfranco Dalla Barba

Phénomènes Délirants et Traumatismes crâniensPhénomènes Délirants et Traumatismes crâniens

Paris13/12/2013Paris13/12/2013

Délire et confabulationDélire et confabulation

- Similarités:Similarités:

- Délires et confabulations sont des fausses Délires et confabulations sont des fausses croyancescroyances

- Le patient délirant « croit » en son délireLe patient délirant « croit » en son délire

- Le confabulateur « croit » en ses Le confabulateur « croit » en ses confabulationsconfabulations

- Le délire et la confabulation sont résistants Le délire et la confabulation sont résistants aux critiquesaux critiques

- Mais il y a une ambigüité: en réalité dans le Mais il y a une ambigüité: en réalité dans le délire et dans la confabulation il s’agit de délire et dans la confabulation il s’agit de « vrais » croyances subjectives considérées « vrais » croyances subjectives considérées comme « fausses » croyances objectives. comme « fausses » croyances objectives.

Fausses croyances « normales »Fausses croyances « normales »

Confabulations « normales »Confabulations « normales »

-Kopelman, 1987

-Confusion entre réalité et imagination

-Convictions erronée sur les souvenirs

-Faux souvenirs des enfants

Délire et confabulationDélire et confabulation

- Différences:Différences:

- Signes psychiatriques Signes psychiatriques vsvs signes signes neurologiques neurologiques

- Les confabulations concernent la mémoire et Les confabulations concernent la mémoire et la temporalité en généralla temporalité en général

- Les confabulations sont rarement Les confabulations sont rarement accompagnées par d’autres phénomènes accompagnées par d’autres phénomènes psychotiquespsychotiques

- Il n’y a pas ou peu de traitements cognitifs ou Il n’y a pas ou peu de traitements cognitifs ou pharmachologiquespharmachologiques

Distorsions MnésiquesDistorsions Mnésiques

• ConfabulationsConfabulations

• IntrusionsIntrusions

• Fausses reconnaissancesFausses reconnaissances

• ParamnesiesParamnesies

• ““Déjà vu”Déjà vu”

• Etc….Etc….

Distorsions mnésiques ?Distorsions mnésiques ?

• SocialesSociales

• MédicalesMédicales

• ThéoriquesThéoriques

False memories: SocialFalse memories: Social• Eyewitness misattributionEyewitness misattribution

– 75,000 criminal trials/year decided on the 75,000 criminal trials/year decided on the basis of eyewitness testimonybasis of eyewitness testimony

– 36/40 (90%) cases in which DNA evidence 36/40 (90%) cases in which DNA evidence established the innocence of wrongfully established the innocence of wrongfully imprisoned individuals involved mistaken imprisoned individuals involved mistaken eyewitness identificationeyewitness identification

False memories: MedicalFalse memories: Medical

• False memories may impair the ability of False memories may impair the ability of patients to live independentlypatients to live independently

• For example, patients may believe that For example, patients may believe that they turned off the stove when they have they turned off the stove when they have only thought about turning it off.only thought about turning it off.

False memories: TheoreticalFalse memories: Theoretical

• The study of false memories may provide The study of false memories may provide valuable information on the functions of valuable information on the functions of normal memorynormal memory

• The role of executive functions The role of executive functions

• The role of encoding and retrieval The role of encoding and retrieval processesprocesses

• Temporal ConsciousnessTemporal Consciousness

Definition of confabulationDefinition of confabulation

• ””falsification of memory”falsification of memory” (Berlyne, 1972) (Berlyne, 1972)

• ””an extreme form of lying or deception” an extreme form of lying or deception” (Joseph, 1986)(Joseph, 1986)

• ””an honest lying” an honest lying” (Moscovitch, 1989)(Moscovitch, 1989)

• ……

Definition of confabulationDefinition of confabulation

• A particular symptom, observable in amnesic patients A particular symptom, observable in amnesic patients unaware of their memory deficit, which consists of both unaware of their memory deficit, which consists of both actions and verbal statements that are unintentionally actions and verbal statements that are unintentionally incongruous to the patients’ history, background, present incongruous to the patients’ history, background, present and future situation. (Dalla Barba, 1993)and future situation. (Dalla Barba, 1993)

Hypotheses on the origin of Hypotheses on the origin of confabulationconfabulation

• Moscovitch, 1989, 1995Moscovitch, 1989, 1995

– Associative Associative vs vs Strategic retrievalStrategic retrieval

• Confabulation = deficit of strategic retrievalConfabulation = deficit of strategic retrieval

Hypotheses on the origin of Hypotheses on the origin of confabulationconfabulation

• Johnson 1991: Reality monitoringJohnson 1991: Reality monitoring

• Schnider & Ptak 1999: Reality filteringSchnider & Ptak 1999: Reality filtering

Hypotheses on the origin of Hypotheses on the origin of confabulationconfabulation

• Conway & Tacchi, 1996Conway & Tacchi, 1996

• Wishful thinkingWishful thinking

Temporal Consciousness (TC)Temporal Consciousness (TC)

- A specific form of consciousness that A specific form of consciousness that allows individuals to remember their allows individuals to remember their personal past, to be oriented in their personal past, to be oriented in their present world and to predict their present world and to predict their personal future.personal future.

- It is specific because it cannot be It is specific because it cannot be confounded with other forms of confounded with other forms of consciousness, perception, imagination consciousness, perception, imagination

Temporal Consciousness (TC)Temporal Consciousness (TC)

- If, for instance the average person If, for instance the average person perceive a tiger in front of them, they will perceive a tiger in front of them, they will be scared, but if they remember or be scared, but if they remember or imagine such an event, they may not be imagine such an event, they may not be scared at all.scared at all.

- "Re-experiencing the past" "Re-experiencing the past"

- TC is opposed to KC which allows TC is opposed to KC which allows individuals to address the past, the individuals to address the past, the present and the future impersonally present and the future impersonally

Temporal Consciousness (TC)Temporal Consciousness (TC)

- It is experimentally measurable and and It is experimentally measurable and and dissociable from impersonal temporalitydissociable from impersonal temporality

- It is lost in amnesia following bilateral It is lost in amnesia following bilateral hippocampal damage and it is hippocampal damage and it is malfunctioning in confabulationmalfunctioning in confabulation

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Examples of confabulations in IDKE Examples of confabulations in IDKE questionsquestions

• Do you remember what you did on March 13, 1985?

• We spent the day at the Senart Forest

Examples of confabulations in IDKE Examples of confabulations in IDKE questionsquestions

• Do you remember what you had for dinner on Tuesday two weeks ago?

• Steak with French fries

Examples of confabulations in IDKE Examples of confabulations in IDKE questionsquestions

• Do you remember what you did on October 9, 1991?

• We spent the day with our children. We played cards and talked about next holydays

Examples of confabulations in IDKE Examples of confabulations in IDKE questionsquestions

• Do you remember what you did for your 27th birthday?

• Wait a minute… I came back from the army when I was 23, so the 27th birthday… I think… Yes! I had dinner at my future wife’s place

Examples of confabulations in IDKE Examples of confabulations in IDKE questionsquestions

• Do you remember what you were doing one year ago?

• One year ago… I was with my wife and my children

Examples of confabulations in IDKE Examples of confabulations in IDKE questionsquestions

• Do you remember what you were wearing on the first day of summer in 1979?

• A short and a T-shirt

La Corte, et al., 2010

Cognition et délire: de la croyance à la Cognition et délire: de la croyance à la fabulationfabulation

Gianfranco Dalla BarbaGianfranco Dalla Barba

Phénomènes Délirants et Traumatismes crâniensPhénomènes Délirants et Traumatismes crâniens

Paris13/12/2013Paris13/12/2013

• DélireDélire

• ConfabulationConfabulation

• Croyances socialesCroyances sociales

• Croyances politiquesCroyances politiques

• IdéologiesIdéologies

• Croyances religieusesCroyances religieuses

• AmourAmour

• Délire, confabulation… religion…Délire, confabulation… religion…

• Psychopathologie = « Connaissance Psychopathologie = « Connaissance Totale »Totale »

Noyau

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