Orbitofrontal reality filtering

Behaviourally spontaneous confabulation denotes a particular form of confabulation characterized by confusion of reality. The patients are disoriented and act according to their confabulations. This chapter describes the clinical course of the disorder and shows how the experimental exploration of patients opened ways to study the underlying mechanism in healthy subjects using brain imaging, electrophysiology, and other methods. These studies revealed a distinct mechanism, now called orbitofrontal reality filtering, which depends on the orbitofrontal cortex and parts of the brain’s reward system. It automatically verifies the relation of upcoming thoughts and memories with ongoing reality. Its relevance for children’s sense of reality is discussed. Comparison with single-cell recordings in animals and investigations in patients suggest that the mechanism depends on a phylogenetically old faculty: an orbitofrontal signal akin to the one necessary for behavioural extinction.