1
|
Lawrence RE, Appelbaum PS. Ethics in placebo-controlled, acute treatment trials in schizophrenia: Two rival ethical frameworks. Schizophr Res 2024; 264:372-377. [PMID: 38237358 DOI: 10.1016/j.schres.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 03/01/2024]
Abstract
Placebo-controlled, acute treatment trials in schizophrenia enroll acutely symptomatic persons, randomize them to receive placebo or antipsychotic medication for several weeks, and evaluate whether symptoms improve. These trials can have scientific benefits, especially when they test drugs with novel mechanisms of action. However, the use of placebo is ethically problematic inasmuch as standard treatment is withheld and participants are subjected to prolonged psychotic symptoms and associated risks. We propose that both deontological (duty-based) and utilitarian analyses are relevant, that it may be impossible to satisfy the ideals of both frameworks, and that researchers who conduct these trials will unavoidably encounter ethical tension and criticism even when they give careful attention to ethical aspects of study design.
Collapse
Affiliation(s)
- Ryan E Lawrence
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, United States of America.
| | - Paul S Appelbaum
- Center for Law, Ethics, and Psychiatry, Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| |
Collapse
|
2
|
Kim JP, Ryan K, Tsungmey T, Kasun M, Roberts WA, Dunn LB, Roberts LW. Perceived protectiveness of research safeguards and influences on willingness to participate in research: A novel MTurk pilot study. J Psychiatr Res 2021; 138:200-206. [PMID: 33865169 PMCID: PMC8513533 DOI: 10.1016/j.jpsychires.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 11/27/2022]
Abstract
Little is known about how individuals with mood disorders view the protectiveness of research safeguards, and whether their views affect their willingness to participate in psychiatric research. We conducted an online survey with 80 individuals (self-reported mood disorder [n = 25], self-reported good health [n = 55]) recruited via MTurk. We assessed respondents' perceptions of the protectiveness of five common research safeguards, as well as their willingness to participate in research that incorporates each safeguard. Perceived protectiveness was strongly related to willingness to participate in research for four of the safeguards. Our findings add to a limited literature on the motivations and perspectives of key stakeholders in psychiatric research.
Collapse
Affiliation(s)
- Jane Paik Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA, 94304, USA.
| | - Katie Ryan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA, USA, 94304
| | - Tenzin Tsungmey
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA, USA, 94304
| | - Max Kasun
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA, USA, 94304
| | - Willa A. Roberts
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401Quarry Road, Stanford, CA, USA, 94305-5717
| | - Laura B. Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401Quarry Road, Stanford, CA, USA, 94305-5717
| | - Laura Weiss Roberts
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401Quarry Road, Stanford, CA, USA, 94305-5717
| |
Collapse
|
3
|
Deshpande SN, Nimgaonkar VL, Bhatia T, Mishra NN, Nagpal R, Parker LS. Ethical Practices and Legal Challenges in Mental Health Research. Asian Bioeth Rev 2020; 12:87-102. [PMID: 33717331 PMCID: PMC7747337 DOI: 10.1007/s41649-020-00116-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022] Open
Abstract
Considerations of justice and concern for well-being support conducting mental health research and addressing ethical concerns specific to mental health research are critical. We discuss these concerns, provide recommendations to enable the ethical conduct of mental health research, and argue that participants' interests should be given primary weight in resolving apparent dilemmas. We also comment on provisions of two legislative actions in India relevant to mental health research: Rights of Persons with Disability Act 2016 and the Mental Health Care Act 2017. Both conform to the 2006 United Nations Convention on Rights of Persons with Disabilities of which India is a signatory. Both provide protections and enumerate rights relevant to people with mental health conditions but with differing focus. The commonalities and differences between the three are discussed in the background of international literature on research in mental health conditions. Studies involving deception and future directions for ethical requirements regarding genetic research are discussed.
Collapse
Affiliation(s)
- Smita N. Deshpande
- Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, India
- Department of Psychiatry, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Vishwajit L. Nimgaonkar
- Program for Genetics and Psychosis, Department of Psychiatry and Department of Genetics, University of Pittsburgh, Pittsburgh, PA USA
| | - Triptish Bhatia
- Indo-US Projects, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | | | | | - Lisa S. Parker
- Center for Bioethics & Health Law, University of Pittsburgh, Pittsburgh, PA USA
| |
Collapse
|
4
|
Tsungmey T, Kim JP, Dunn LB, Ryan K, Lane-McKinley K, Roberts LW. Negative association of perceived risk and willingness to participate in innovative psychiatric research protocols. J Psychiatr Res 2020; 122:9-16. [PMID: 31891880 PMCID: PMC7243412 DOI: 10.1016/j.jpsychires.2019.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 02/06/2023]
Abstract
Psychiatric researchers grapple with concerns that individuals with mental illness may be less likely to appreciate risks of research participation, particularly compared to people not suffering from mental illness. Therefore, empirical studies that directly compare the perspectives of such individuals are needed. In addition, it is important to evaluate perspectives regarding varied types of research protocols, particularly as innovative psychiatric research protocols emerge. In this pilot study, respondents with a mood disorder (n = 25) as well as respondents without a mood disorder (n = 55) were recruited using Amazon's Mechanical Turk (MTurk) platform. These respondents were surveyed regarding four psychiatric research projects (i.e., experimental medication [pill form]; non-invasive magnetic brain stimulation; experimental medication [intravenous infusion]; and implantation of a device in the brain). Regardless of health status, respondents rated the four research protocols as somewhat to highly risky. The brain-device implant protocol was seen as the most risky, while the magnetic brain stimulation project was viewed as "somewhat risky". Respondents, on average and regardless of health status, rated their willingness at or below "somewhat willing." Respondents were least willing to participate in the brain-device implant protocol, whereas they were "somewhat willing" to participate in the magnetic brain stimulation protocol. Trust in medical research was negatively associated with perceived risk of research protocols. Perceived risk was negatively associated with willingness to participate, even when adjusting for potential confounders, suggesting that attunement to risk crosses diagnostic, gender, and ethnic categories, and is more salient to research decision-making than trust in medical research and dispositional optimism. The findings of this study may offer reassurance about the underlying decision-making processes of individuals considering participation in innovative neuroscience studies.
Collapse
Affiliation(s)
- Tenzin Tsungmey
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Jane Paik Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717.
| | - Laura B Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Katie Ryan
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Kyle Lane-McKinley
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Laura Weiss Roberts
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| |
Collapse
|
5
|
Bixo L, Cunningham JL, Ekselius L, Öster C, Ramklint M. 'Sick and tired': Patients reported reasons for not participating in clinical psychiatric research. Health Expect 2019; 24 Suppl 1:20-29. [PMID: 31605443 PMCID: PMC8137497 DOI: 10.1111/hex.12977] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 01/04/2023] Open
Abstract
Background Meaningful and generalizable research depends on patients' willingness to participate. Studies often fail to reach satisfactory representativeness. Objective This paper aims to investigate reasons for not participating in research among young adult patients with psychiatric illness. Method A quantitative cross‐sectional study was performed based on questionnaires reported on by 51 psychiatric patients (14 males, 35 females and two unspecified) who had previously declined participation in an ongoing research project. Thereafter, a qualitative interview with subsequent content analysis was conducted with ten additional patients (five males, five females). Results The questionnaires indicate being ‘too tired/too sick to participate’ as the most common barrier. Lack of time and fear of needles were other common barriers. Lack of trust or belief in the value of research was less inhibitive. In the interviews, disabling psychiatric symptoms were confirmed as the main reason for not participating. Several potential ways to increase participation were identified, such as simplification of procedures and information as well as providing rewards and feedback, and building relationships before asking. Conclusion This study is unusual as it focuses on the group of young people attending psychiatry outpatient clinics we know very little about – those who do not partake in research. Our results indicate that fatigue and sickness reduce research participation and identify factors that may facilitate enrolment of this important group.
Collapse
Affiliation(s)
- Liv Bixo
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Janet L Cunningham
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Lisa Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Caisa Öster
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Mia Ramklint
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| |
Collapse
|
6
|
Bracken-Roche D, Bell E, Racine E. The "Vulnerability" of Psychiatric Research Participants: Why This Research Ethics Concept Needs to Be Revisited. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:335-9. [PMID: 27254842 PMCID: PMC4872238 DOI: 10.1177/0706743716633422] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dearbhail Bracken-Roche
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Québec Biomedical Ethics Unit, McGill University, Montréal, Québec
| | - Emily Bell
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Québec
| | - Eric Racine
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Québec Biomedical Ethics Unit, McGill University, Montréal, Québec Département de Médecine, Université de Montréal, Montréal, Québec
| |
Collapse
|
7
|
Morán-Sánchez I, Luna A, Pérez-Cárceles MD. Assessment of Capacity to Consent to Research Among Psychiatric Outpatients: Prevalence and Associated Factors. Psychiatr Q 2016; 87:89-105. [PMID: 25952945 DOI: 10.1007/s11126-015-9365-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mental capacity is an emerging ethical legal concept in psychiatric settings but its relation to clinical parameters remains yet uncertain. The aim of this study is to evaluate the association between capacity to consent research and different psychiatric disorders and to characterize predictors of impairments in research decision-making capacity across diagnostic groups in a cross-sectional study. 139 consecutively referred outpatients with DSM-IV TR diagnoses of psychotic, mood and anxiety disorders were interviewed and a binary judgment of incapacity was made guided by the MacArthur competence assessment tool for consent research (MacCAT-CR). Demographics and clinical information were assessed by cases notes. Patients with anxiety disorders performed the best on the MacCAT-CR, and patients with psychotic disorders had the worst performance, however, there was considerable heterogeneity within each group. Cognitive impairment and global functioning were strongly correlated with MacCAT-CR subscales scores. 30.6% participants lacked research-related decisional capacity. Low Understanding score OR 0.07 (IC 95% 0.01-0.32) and Low Reasoning score OR 0.30 (IC 95% 0.11-0.82) were the factors most closely associated with lack of capacity. No absolute statements about decisional capacity can be driven merely due to the diagnosis. We found several risk factors which may be considered to decide which populations may require more thorough capacity assessments. The issues under consideration in the present study are by no means unique to people with psychiatric conditions. Ignoring this caveat, risks further inappropriate stigmatization of those with serious mental illness.
Collapse
Affiliation(s)
- Inés Morán-Sánchez
- Mental Health Centre, Health Service of Murcia, 30201, Cartagena, Murcia, Spain.
| | - Aurelio Luna
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence "Campus Mare Nostrum", Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Maria D Pérez-Cárceles
- Department of Legal and Forensic Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence "Campus Mare Nostrum", Faculty of Medicine, University of Murcia, Murcia, Spain
| |
Collapse
|
8
|
Kim JP, Roberts LW. Demonstrating Patterns in the Views Of Stakeholders Regarding Ethically-Salient Issues in Clinical Research: A Novel Use of Graphical Models in Empirical Ethics Inquiry. AJOB Empir Bioeth 2015; 6:33-42. [PMID: 25961066 DOI: 10.1080/23294515.2014.995836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Empirical ethics inquiry works from the notion that stakeholder perspectives are necessary for gauging the ethical acceptability of human studies and assuring that research aligns with societal expectations. Although common, studies involving different populations often entail comparisons of trends that problematize the interpretation of results. Using graphical model selection - a technique aimed at transcending limitations of conventional methods - this report presents data on the ethics of clinical research with two objectives: (1) to display the patterns of views held by ill and healthy individuals in clinical research as a test of the study's original hypothesis and (2) to introduce graphical model selection as a key analytic tool for ethics research. METHODS In this IRB-approved, NIH-funded project, data were collected from 60 mentally ill and 43 physically ill clinical research protocol volunteers, 47 healthy protocol-consented participants, and 29 healthy individuals without research protocol experience. Respondents were queried on the ethical acceptability of research involving people with mental and physical illness (i.e., cancer, HIV, depression, schizophrenia, and post-traumatic stress disorder) and non-illness related sources of vulnerability (e.g., age, class, gender, ethnicity). Using a statistical algorithm, we selected graphical models to display interrelationships among responses to questions. RESULTS Both mentally and physically ill protocol volunteers revealed a high degree of connectivity among ethically-salient perspectives. Healthy participants, irrespective of research protocol experience, revealed patterns of views that were not highly connected. CONCLUSION Between ill and healthy protocol participants, the pattern of views is vastly different. Experience with illness was tied to dense connectivity, whereas healthy individuals expressed views with sparse connections. In offering a nuanced perspective on the interrelation of ethically relevant responses, graphical model selection has the potential to bring new insights to the field of ethics.
Collapse
Affiliation(s)
- Jane Paik Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Laura Weiss Roberts
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| |
Collapse
|
9
|
Roberts LW, Kim JP. Do investigators understand ethically-important perspectives of clinical research participants?: a 'piggy-back' study of attunement and alignment in serious illness research. J Psychiatr Res 2014; 52:36-43. [PMID: 24507883 DOI: 10.1016/j.jpsychires.2014.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/07/2014] [Accepted: 01/17/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The authors sought to compare investigators' predictions of clinical research participants' attitudes regarding ethically-important considerations in serious illness research with attitudes expressed by participants ("attunement"), to compare the personal attitudes of investigators and clinical research participants ("alignment"), and to explore the association between views expressed and covariates. METHOD The authors queried clinical research participants with either physical or mental illness (n=100) and faculty investigators conducting the clinical research protocols in which these participants were enrolled (n=77). Outcomes included attitudes regarding importance of medical research, attributes of seriously ill people in the research situation, and influences on enrollment decisions by seriously ill people. Generalized estimating equations and linear regression models were used. RESULTS Investigators underestimated the importance of research about physical illness, mental illness, and healthy people to participants (βPI=0.59, 95% CI [0.36, 0.83]; βMI=0.60, 95% CI [0.27, 0.92]; βH=0.93, 95% CI [0.57, 1.29]). Investigators incorrectly predicted that participants would assess seriously ill people as more vulnerable in the research situation than participants did (β=-0.68, 95% CI [-1.11, -0.25]). Investigators and participants were aligned on the importance of illness research. Participants expressed greater agreement than investigators regarding the influences of ill individuals indicative of will and cognition in their enrollment decisions (β=0.69, 95% CI [0.25, 1.13]). CONCLUSIONS Investigators are attuned to and aligned with research participants in many, but not all, respects. Investigators may bring a protective bias in their predictions of the vulnerabilities of ill volunteers.
Collapse
Affiliation(s)
- Laura Weiss Roberts
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA.
| | - Jane Paik Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA.
| |
Collapse
|
10
|
Rose D, Russo J, Wykes T. Taking part in a pharmacogenetic clinical trial: assessment of trial participants understanding of information disclosed during the informed consent process. BMC Med Ethics 2013; 14:34. [PMID: 24025622 PMCID: PMC3847084 DOI: 10.1186/1472-6939-14-34] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/20/2013] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study is the first to examine the understandings that participants have of the consent process in a pharmacogenetic trial of anti-depressant medication. METHODS This was a qualitative cross sectional study. There were 76 participants residing in London, Mannheim, Arhuus and Poznan. RESULTS Only one quarter of participants (none in Poznan) could articulate the concept of pharmacogenetics. Heritability and testing medication were also given as the purpose of the trial. Most participants had not appreciated harms that could derive from the trial. Even when shown the consent sheet, participants were confused about DNA profiling. There was evidence that participants appreciated weekly contact with researchers. Most said they would participate in a trial again but would like choice over the intervention they were assigned to. CONCLUSION Participants in this study showed a poor level of informed consent. Although this is not the first time this argument has been made, it is in the case of a pharmacogenetic trial. Further work should investigate the associations between extraneous factors such as information and social support on beneficial or untoward outcomes of antidepressant treatment.
Collapse
Affiliation(s)
- Diana Rose
- Institute of Psychiatry, King's College London, de Crespigny Park, London SE5 8AF, UK
| | - Jasna Russo
- Institute of Psychiatry, King's College London, de Crespigny Park, London SE5 8AF, UK
| | - Til Wykes
- Institute of Psychiatry, King's College London, de Crespigny Park, London SE5 8AF, UK
| |
Collapse
|
11
|
Ethical considerations in clinical training, care and research in psychopharmacology. Int J Neuropsychopharmacol 2011; 14:413-24. [PMID: 20860879 DOI: 10.1017/s1461145710001112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Psychopharmacology is a powerful tool in psychiatry; however, it is one that demands responsibility in order to deal with the ethical complexities that accompany advances in the field. It is important that questions are asked and that ethical mindfulness and sensitivity are developed along with clinical skills. In order to cultivate and deepen ethical awareness and subsequently solve issues in optimal fashion, investment should be made in the development of an ethical decision-making process as well as in education in the ethics of psychopharmacology to trainees in the field at all stages of their educational development. A clear approach to identifying ethical problems, engaging various ethical concepts in considering solutions and then applying these principles in problem resolution is demanded. An openness in identifying and exploring issues has become crucial to the future development and maturation of psychopharmacologists, both research and clinical. Consideration must be given to the social implications of psychopharmacological practice, with the best interests of patients always paramount. From both a research and clinical perspective, psychopharmacology has to be practised with fairness, sensitivity and ethical relevance to all. While ethical issues related to psychopharmacological practice are varied and plentiful, this review focuses on advances in technology and biological sciences, personal integrity, special populations, and education and training.
Collapse
|
12
|
Edlinger M, Deisenhammer EA, Fiala M, Hofer A, Kemmler G, Strauss R, Widschwendter CG, Fleischhacker WW. Attitudes of patients with schizophrenia and depression towards psychiatric research. Psychiatry Res 2010; 177:172-6. [PMID: 20362343 DOI: 10.1016/j.psychres.2008.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Revised: 10/21/2008] [Accepted: 12/31/2008] [Indexed: 10/19/2022]
Abstract
The success of clinical research depends heavily on patients' willingness to participate in studies. In recent years much work has been dedicated to studying the problems of conducting research in psychiatry, mainly in schizophrenia patients. In an attempt to replicate previous findings and extend results beyond schizophrenia, we interviewed patients suffering from schizophrenia or depression in a large academic centre concerning their attitudes towards psychiatric research. Ninety-five patients with a diagnosis of schizophrenia (48) or depression (47) completed the "Hamburg General Attitudes to Psychiatric Research Questionnaire" self-report instrument. Furthermore, demographic and clinical data were collected. Illness severity was evaluated using Clinical Global Impression and Global Assessment of Functioning scores. In general, patients approved of psychiatric research, and attitudes towards specific areas of research and research methods were rather positive. There were no significant differences between the two diagnostic groups regarding reasons for participation or non-participation in a clinical trial. The theoretical willingness to participate in studies was highest for studies using a questionnaire. Receiving sufficient information about a study before taking part was stated to be highly important. Our findings confirm and extend those of other groups. This should encourage psychiatrists at least in academic settings where most of this research has been done to approach patients to take part in clinical research.
Collapse
Affiliation(s)
- Monika Edlinger
- Medical University Innsbruck, Department of Psychiatry and Psychotherapy, University Clinic of Biological Psychiatry, Anichstrasse 35, A-6020 Innsbruck, Austria.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Capdevielle D, Raffard S, Bayard S, Garcia F, Baciu O, Bouzigues I, Boulenger JP. Competence to consent and insight in schizophrenia: is there an association? A pilot study. Schizophr Res 2009; 108:272-9. [PMID: 19162443 DOI: 10.1016/j.schres.2008.12.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Revised: 12/15/2008] [Accepted: 12/16/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The capacity to consent to treatment or research of patients with severe mental disorders is the focus of important ethical and clinical debate. Many studies evaluate the links between clinical symptoms and the capacity to consent. The aim of this study was to explore the correlations existing between the competence to consent to treatment and the level of awareness of the disease (insight) in patients suffering from schizophrenia in a cross-sectional study. METHOD Participants included 60 outpatients meeting the criteria for a DSM-IV diagnosis of schizophrenia. Measures included the MacArthur Competence Assessment tool for Treatment (MacCAT-T), the Scale to Assess Unawareness of Mental Disorder (SUMD) and psychopathology rating scales including the Positive and Negative Syndrome Scale (PANSS). RESULTS The MacCAT-T dimension "Understanding" was found to be negatively correlated with negative and total PANSS scores but was not found to be correlated with any of the SUMD dimensions. However a systematic negative correlation was observed between the MacCAT-T "Appreciation" and "Reasoning" dimensions and the five SUMD dimensions. Finally, the MacCAT-T "Expressing a choice" dimension was found to be negatively correlated with two SUMD dimensions: "Having a mental disorder" and "consequences of the mental disorder". CONCLUSIONS These findings suggest an important correlation between the competence to consent to treatment and insight, a clinical variable currently assessed by clinicians. We hypothesized that this link could be mediated by cognitive impairments in schizophrenia. Emphasis should be placed on developing prospective studies comparing the courses of insight, cognitive disorders and capacity to consent in schizophrenia.
Collapse
Affiliation(s)
- Delphine Capdevielle
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHU Montpellier, University Montpellier 1, France.
| | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW To summarize important recent contributions to the literature on the subject of ethics in psychiatric research. RECENT FINDINGS Current literature reflects an expansion in the range of psychiatric research on ethics topics. Articles continue to appear on core ethics subjects such as informed consent, but many recent contributions focus on diverse issues such as third-party privacy, the ethics of Internet-based research, revisiting the wisdom of imposing medical ethics requirements on observational research, and psychiatric research ethics as applied to special populations such as children or older persons. SUMMARY Psychiatric research is critical for the elucidation, prevention, and treatment of mental diseases. Increased attention and novel approaches taken to obtain informed consent, correcting therapeutic misconception, and guarding privacy will advance the research enterprise and continue to ensure that the subjective experiences of participants in psychiatric research remain positive.
Collapse
|
15
|
Rosen C, Grossman LS, Sharma RP, Bell CC, Mullner R, Dove HW. Subjective evaluations of research participation by persons with mental illness. J Nerv Ment Dis 2007; 195:430-5. [PMID: 17502809 DOI: 10.1097/01.nmd.0000253785.81700.7d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The present study focuses on the subjective experience of psychiatric patients who participate in psychobiological research, based on patients' self-reported evaluations of the experience. We studied 313 persons with mental illness admitted to an inpatient research unit. Each participant was administered the Patient Satisfaction Questionnaire, a structured self-report questionnaire designed to assess satisfaction with research participation and clinical care. Individuals who completed the research protocol were significantly more satisfied globally and more likely to express that treatment had been effective. Factors contributing to willingness to participate in future research included favorable perceptions of: (a) psychoeducation, (b) safety, and (c) comfort level with research procedures. Research participants were willing to participate in future research regardless of their perception of medication efficacy. This study emphasizes the importance of understanding the opinions of persons with mental illness who participate in research. Overall, the data suggest that persons with mental illness find psychiatric research to be beneficial. Although therapeutic misconception cannot be ruled out given the methodology used, at the very least the data indicate no sign that subjects found research participation to be harmful. Further studies should explore the source of this perception and attempt to separate the effect of "therapeutic misconception" from possible real benefit of protocol-driven assessment and treatment in a reputable clinical environment.
Collapse
Affiliation(s)
- Cherise Rosen
- Department of Psychiatry, University of Illinois, Chicago, Illinois 60612, USA.
| | | | | | | | | | | |
Collapse
|
16
|
Lakhan SE. Schizophrenia proteomics: biomarkers on the path to laboratory medicine? Diagn Pathol 2006; 1:11. [PMID: 16846510 PMCID: PMC1538632 DOI: 10.1186/1746-1596-1-11] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Accepted: 07/17/2006] [Indexed: 01/12/2023] Open
Abstract
Over two million Americans are afflicted with schizophrenia, a debilitating mental health disorder with a unique symptomatic and epidemiological profile. Genomics studies have hinted towards candidate schizophrenia susceptibility chromosomal loci and genes. Modern proteomic tools, particularly mass spectrometry and expression scanning, aim to identify both pathogenic-revealing and diagnostically significant biomarkers. Only a few studies on basic proteomics have been conducted for psychiatric disorders relative to the plethora of cancer specific experiments. One such proteomic utility enables the discovery of proteins and biological marker fingerprinting profiling techniques (SELDI-TOF-MS), and then subjects them to tandem mass spectrometric fragmentation and de novo protein sequencing (MALDI-TOF/TOF-MS) for the accurate identification and characterization of the proteins. Such utilities can explain the pathogenesis of neuro-psychiatric disease, provide more objective testing methods, and further demonstrate a biological basis to mental illness. Although clinical proteomics in schizophrenia have yet to reveal a biomarker with diagnostic specificity, methods that better characterize the disorder using endophenotypes can advance findings. Schizophrenia biomarkers could potentially revolutionize its psychopharmacology, changing it into a more hypothesis and genomic/proteomic-driven science.
Collapse
|
17
|
Dunn LB. Capacity to consent to research in schizophrenia: the expanding evidence base. BEHAVIORAL SCIENCES & THE LAW 2006; 24:431-45. [PMID: 16883608 DOI: 10.1002/bsl.698] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Capacity to consent to research, fundamental to informed consent and thus vital to the ethical conduct of research, may be impaired among a variety of research populations. Until recently, relatively little empirical evidence has been available to inform discussion and policy-making regarding whose capacity should be assessed, what should be measured, and how it should be measured. Capacity to consent to research has emerged as a central topic in the field of "empirical ethics," an important area of biomedical research devoted to bringing evidence-based methods to the study of ethically salient issues in biomedical and biopsychosocial research. In this paper, empirical studies of capacity to consent to research are reviewed, with a particular focus on studies involving people with schizophrenia. These studies provide intriguing data regarding the nature, correlates, and modifiability of decisional abilities among potentially vulnerable research populations, including individuals with serious neuropsychiatric illnesses. Areas in need of further empirical ethics research are highlighted.
Collapse
Affiliation(s)
- Laura B Dunn
- VA San Diego Health Care System, San Diego, CA 92161, USA.
| |
Collapse
|
18
|
Abstract
Empirical studies of ethical issues, which have increased in number and scope in recent years, may themselves raise both practical and ethical issues. One example of such an issue is the question of who may be legitimately enrolled in studies of decision-making capacity; must all participants in studies of consent capacity have capacity to consent? This question may pose a "Catch-22": For example, if some of the participants in a study of consent capacity are deemed by a particular standard to be incapable of consent. In weighing the risks and benefits of studies of consent capacity, how should reviewers consider the context of actual versus hypothetical trials for which the participant's consent is being sought? Here, we explore these "meta-consent" issues by describing the dimensions of the issue and potential solutions, centering around the concept of "active assent" (requiring expressed understanding of the purpose of the study and its voluntary nature, as well as expression of a choice to participate).
Collapse
Affiliation(s)
- Elyn R Saks
- University of Southern California Law School, USA.
| | | | | |
Collapse
|
19
|
Jeste DV, Depp CA, Palmer BW. Magnitude of impairment in decisional capacity in people with schizophrenia compared to normal subjects: an overview. Schizophr Bull 2006; 32:121-8. [PMID: 16192413 PMCID: PMC2632179 DOI: 10.1093/schbul/sbj001] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The capacity of individuals with schizophrenia to make decisions related to research participation or clinical treatment has received increasing empirical attention. A number of studies have compared patients with schizophrenia to nonpsychiatric comparison subjects (NPCs) on structured measures of decision-making capacity. In this review, we evaluated the magnitude of the difference between schizophrenia and NPC groups reported across these studies, as well as the influence of sample characteristics on observed effect sizes. We also computed the effect sizes of group differences in psychopathology and cognitive deficits. Twelve studies met the search criteria; a majority of them reported data using the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) or for Treatment (MacCAT-T). The mean effect size (evaluated in terms of Cohen's d) for group differences on the Understanding subscale of the MacCAT instruments was 0.88 (SD = 0.40); it was twice as high among inpatient samples as among outpatients. Similar differences were observed in terms of Appreciation and Reasoning subscales, but the effect sizes for Expression of Choice were small (mean d = 0.29, SD = 0.24). Notably, these observed effect sizes were generally smaller than those for differences between schizophrenia and NPC groups in psychopathology (mean d = 2.06, SD = 1.03) and cognition (mean d = 1.01, SD = 0.61). The published studies demonstrate a substantial heterogeneity in decision-making capacity among people with schizophrenia, as well as among NPCs, suggesting that the presence of schizophrenia does not necessarily mean the patient has impairment in capacity.
Collapse
Affiliation(s)
- Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, USA.
| | | | | |
Collapse
|
20
|
Abstract
Many challenging ethical questions come with the scientific efforts to understand the nature and treatment of schizophrenia. The empirical study of ethical aspects of schizophrenia research has sought to clarify and resolve many of these questions. In this article we provide an overview of the existing data-based literature on schizophrenia research ethics and outline directions for future inquiry. We examine 5 broad categories of inquiry into the ethics of schizophrenia research: (1) Scientific designs (eg, placebo-controlled studies and medication-free intervals, prodromal and high-risk research, and genetics research); (2) informed consent and decision-making capacity, including assessment of decisional abilities, as well as intervention studies; (3) understanding and perceptions of risk and benefit (including the therapeutic misconception); (4) influences on research participation (including voluntarism, altruism, and other motivations); and (5) key participant safeguards, such as protocol review and participant advocates. We discuss how empirical work in each of these areas answers certain questions and raises new ones. Finally, we highlight important gaps in our understanding of ethically relevant aspects of schizophrenia research and offer a specific research agenda for empirical ethics.
Collapse
Affiliation(s)
- Laura B Dunn
- Department of Psychiatry, University of California, San Diego, USA.
| | | | | |
Collapse
|