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Marazia C, Rucci P, Fangerau H, Voßberg D, Rolfes V, Iozzino L, Iommi M, Gosek P, Heitzman J, Ferrari C, Macis A, Markiewicz I, Picchioni M, Salize HJ, Stompe T, Wancata J, Appelbaum PS, de Girolamo G. Treatment Decision-Making Capacity in Forensic vs Non-forensic Psychiatric Patients: A European Comparison. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac037. [PMID: 39144784 PMCID: PMC11205899 DOI: 10.1093/schizbullopen/sgac037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Background Consent to treatment is a cornerstone of medical ethics and law. Nevertheless, very little empirical evidence is available to inform clinicians and policymakers regarding the capacities of forensic patients with schizophrenia spectrum disorders (SSDs) to make decisions about their treatment, with the risk of clinical and legal inertia, silent coercion, stigmatization, or ill-conceived reforms. Study Design In this multinational study, we assessed and compared with treatment-related decisional capacities in forensic and non-forensic patients with SSD. 160 forensic and 139 non-forensic patients were used in Austria, Germany, Italy, Poland, and England. Their capacity to consent to treatment was assessed by means of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Multiple generalized linear regression models were used to identify the socio-demographic and clinical variables associated with MacCAT-T scores. Study Results In total, 55 forensic (34.4%) and 58 non-forensic patients (41.7%) showed high treatment-related decisional capacity, defined as scoring ≥75% of the maximum scores for the understanding, appreciation and reasoning, and 2 for expressing a choice. Forensic patients showed differences in their capacity to consent to treatment across countries. Of all socio-demographic and clinical variables, only "social support" was directly relevant to policy. Conclusions Forensic patients have treatment-related decisional capacities comparable with their non-forensic counterparts. Social contacts might provide a substantial contribution towards enhancing the decisional autonomy of both forensic and non-forensic patients, hence improving the overall quality and legitimacy of mental health care.
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Affiliation(s)
- Chantal Marazia
- Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Heiner Fangerau
- Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Dilara Voßberg
- Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Vasilija Rolfes
- Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Laura Iozzino
- Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Pawel Gosek
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Janusz Heitzman
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Clarissa Ferrari
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Ambra Macis
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Inga Markiewicz
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Marco Picchioni
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- St Magnus Hospital, Haslemere, UK
| | - Hans Joachim Salize
- Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
| | - Thomas Stompe
- Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Giovanni de Girolamo
- Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Bogaerts S, Spreen M, Masthoff E, Jankovic M. Longitudinal Network Structure and Changes of Clinical Risk and Protective Factors in a Nationwide Sample of Forensic Psychiatric Patients. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2020; 64:1533-1550. [PMID: 32468885 PMCID: PMC7495686 DOI: 10.1177/0306624x20923256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this study, we investigated network configurations of 14 Clinical risk and protective factors in a sample of 317 male forensic psychiatric patients across two time points: at the time of admission to the forensic psychiatric centers (T1) and at the time of unconditional release (T2). In terms of network structure, the strongest risk edge was between "hostility-violation of terms" at T1, and between "hostility-impulsivity" at T2. "Problem insight-crime responsibility" was the strongest protective edge, and "impulsivity-coping skills" was the strongest between-cluster edge, at both time points, respectively. In terms of strength centrality, "cooperation with treatment" had the highest strength centrality at both measurement occasions. This study expands the risk assessment field toward a better understanding of dynamic relationships between individual clinical risk and protective factors and points to the highly central risk and protective factors, which would be the best for future treatment targets.
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Affiliation(s)
- Stefan Bogaerts
- Tilburg University, the Netherlands
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, the Netherlands
| | - Marinus Spreen
- NHL Stenden University of Applied Sciences, Leeuwarden, the Netherlands
| | - Erik Masthoff
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, the Netherlands
| | - Marija Jankovic
- Tilburg University, the Netherlands
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, the Netherlands
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