Fotopoulou Aikaterini
Institute of Cognitive Neuroscience, University College London, 17 Queen Square, London, UK.
Cogn Neuropsychiatry. 2010 Jan;15(1):38-63. doi: 10.1080/13546800903250949.
The paper reviews the history of the scientific understanding of the role of emotion in confabulation and delusion. I argue that the significance of emotion in the pathogenesis of these symptoms was obscured by academic polarisation between psychodynamic and neurocognitive traditions and was also often obfuscated by rigid distinctions between psychogenic and neurogenic explanations. This tradition of epistemic dualism was implicitly maintained in the fields of cognitive neuropsychology and cognitive neuropsychiatry. This paper focuses on memory-related confabulation following ventromedial frontal lobe lesions, awareness-related confabulation following right perisylvian lesions, and delusions of various aetiologies. Ambiguity regarding the definition and taxonomy of symptoms renders direct comparison difficult, but certain overriding principles are becoming discernible. Recent findings suggest that emotion and motivation influence both confabulation and delusion. These influences may be instigated directly by neural dysfunction or indirectly by life changes and altered social circumstances, or by a combination of these. Importantly, the rejection of epistemic dualism in the conceptualisation of both symptoms can allow us to study them in parallel and draw conclusions about the relation between cognition and emotion. Specifically, confabulation and delusion can be described as faulty attempts to balance the conflicting demands of accurate and self-serving reality representation.
本文回顾了对情感在虚构和妄想中作用的科学理解的历史。我认为，情感在这些症状发病机制中的重要性被心理动力学和神经认知传统之间的学术两极分化所掩盖，并且也常常被心因性和神经源性解释之间的严格区分所混淆。这种认知二元论传统在认知神经心理学和认知神经精神病学领域中被隐含地维持着。本文重点关注腹内侧额叶病变后与记忆相关的虚构、右侧颞叶周围病变后与意识相关的虚构以及各种病因的妄想。症状定义和分类的模糊性使得直接比较变得困难，但某些首要原则正变得清晰可辨。最近的研究结果表明，情感和动机影响虚构和妄想。这些影响可能直接由神经功能障碍引发，或间接由生活变化和社会环境改变引发，或由这些因素共同引发。重要的是，在两种症状的概念化中摒弃认知二元论可以使我们并行研究它们，并得出关于认知与情感关系的结论。具体而言，虚构和妄想可以被描述为平衡准确和利己的现实表征这两种相互冲突需求的错误尝试。
