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Morena D, Lippi M, Di Fazio N, Delogu G, Rinaldi R, Frati P, Fineschi V. Capacity to Consent in Healthcare: A Systematic Review and Meta-Analysis Comparing Patients with Bipolar Disorders and Schizophrenia Spectrum Disorders. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:764. [PMID: 38792947 PMCID: PMC11123007 DOI: 10.3390/medicina60050764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024]
Abstract
Background: Mental capacity is a fundamental aspect that enables patients to fully participate in various healthcare procedures. To assist healthcare professionals (HCPs) in assessing patients' capacity, especially in the mental health field, several standardized tools have been developed. These tools include the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), and the Competence Assessment Tool for Psychiatric Advance Directives (CAT-PAD). The core dimensions explored by these tools include Understanding, Appreciation, Reasoning, and Expression of a choice. Objective: This meta-analysis aimed to investigate potential differences in decision-making capacity within the healthcare context among groups of patients with bipolar disorders (BD) and schizophrenia spectrum disorders (SSD). Methods: A systematic search was conducted on Medline/Pubmed, and Scopus. Additionally, Google Scholar was manually inspected, and a manual search of emerging reviews and reference lists of the retrieved papers was performed. Eligible studies were specifically cross-sectional, utilizing standardized assessment tools, and involving patients diagnosed with BD and SSD. Data from the studies were independently extracted and pooled using random-effect models. Hedges' g was used as a measure for outcomes. Results: Six studies were identified, with three studies using the MacCAT-CR, two studies the MacCAT-T, and one the CAT-PAD. The participants included 189 individuals with BD and 324 individuals with SSD. The meta-analysis revealed that patients with BD performed slightly better compared to patients with SSD, with the difference being statistically significant in the domain of Appreciation (ES = 0.23, 95% CI: 0.01 to 0.04, p = 0.037). There was no statistically significant difference between the two groups for Understanding (ES = 0.09, 95% CI:-0.10 to 0.27, p = 0.352), Reasoning (ES = 0.18, 95% CI: -0.12 to 0.47, p = 0.074), and Expression of a choice (ES = 0.23, 95% CI: -0.01 to 0.48, p = 0.60). In the sensitivity analysis, furthermore, when considering only studies involving patients in symptomatic remission, the difference for Appreciation also resulted in non-significant (ES = 0.21, 95% CI: -0.04 to 0.46, p = 0.102). Conclusions: These findings indicate that there are no significant differences between patients with BD and SSD during remission phases, while differences are minimal during acute phases. The usefulness of standardized assessment of capacity at any stage of the illness should be considered, both for diagnostic-therapeutic phases and for research and advance directives. Further studies are necessary to understand the reasons for the overlap in capacity between the two diagnostic categories compared in this study.
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Affiliation(s)
| | | | | | | | | | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (D.M.); (M.L.); (N.D.F.); (G.D.); (R.R.); (V.F.)
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Marcó-García S, Ariyo K, Owen GS, David AS. Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis. Psychol Med 2024; 54:1074-1083. [PMID: 38433596 DOI: 10.1017/s0033291724000242] [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] [Indexed: 03/05/2024]
Abstract
Decision-making capacity (DMC) among psychiatric inpatients is a pivotal clinical concern. A review by Okai et al. (2007) suggested that most psychiatric inpatients have DMC for treatment, and its assessment is reliable. Nevertheless, the high heterogeneity and mixed results from other studies mean there is considerable uncertainty around this topic. This study aimed to update Okai's research by conducting a systematic review with meta-analysis to address heterogeneity. We performed a systematic search across four databases, yielding 5351 results. We extracted data from 20 eligible studies on adult psychiatric inpatients, covering DMC assessments from 2006 to May 2022. A meta-analysis was conducted on 11 papers, and a quality assessment was performed. The study protocol was registered on PROSPERO (ID: CRD42022330074). The proportion of patients with DMC for treatment varied widely based on treatment setting, the specific decision and assessment methods. Reliable capacity assessment was feasible. The Mini-Mental State Examination (MMSE), Global Assessment of Function (GAF), and Brief Psychiatric Rating Scale (BPRS) predicted clinical judgments of capacity. Schizophrenia and bipolar mania were linked to the highest incapacity rates, while depression and anxiety symptoms were associated with better capacity and insight. Unemployment was the only sociodemographic factor correlated with incapacity. Assessing mental capacity is replicable, with most psychiatric inpatients able to make treatment decisions. However, this capacity varies with admission stage, formal status (involuntary or voluntary), and information provided. The severity of psychopathology is linked to mental capacity, though detailed psychopathological data are limited.
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Affiliation(s)
- Silvia Marcó-García
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Etiopathogenesis and treatment of severe mental disorders (MERITT), Sant Joan de Déu Research Institute, Sant Joan de Déu Foundation, Barcelona, Spain
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, 08035 Barcelona, Spain
| | - Kevin Ariyo
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gareth S Owen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony S David
- Division of Psychiatry, UCL Institute of Mental Health, University College London, London, UK
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Casetta C, Santosh P, Bayley R, Bisson J, Byford S, Dixon C, Drake RJ, Elvins R, Emsley R, Fung N, Hayes D, Howes O, James A, James K, Jones R, Killaspy H, Lennox B, Marchant L, McGuire P, Oloyede E, Rogdaki M, Upthegrove R, Walters J, Egerton A, MacCabe JH. CLEAR - clozapine in early psychosis: study protocol for a multi-centre, randomised controlled trial of clozapine vs other antipsychotics for young people with treatment resistant schizophrenia in real world settings. BMC Psychiatry 2024; 24:122. [PMID: 38355533 PMCID: PMC10865566 DOI: 10.1186/s12888-023-05397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/22/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Clozapine is an antipsychotic drug with unique efficacy, and it is the only recommended treatment for treatment-resistant schizophrenia (TRS: failure to respond to at least two different antipsychotics). However, clozapine is also associated with a range of adverse effects which restrict its use, including blood dyscrasias, for which haematological monitoring is required. As treatment resistance is recognised earlier in the illness, the question of whether clozapine should be prescribed in children and young people is increasingly important. However, most research to date has been in older, chronic patients, and evidence regarding the efficacy and safety of clozapine in people under age 25 is lacking. The CLEAR (CLozapine in EARly psychosis) trial will assess whether clozapine is more effective than treatment as usual (TAU), at the level of clinical symptoms, patient rated outcomes, quality of life and cost-effectiveness in people below 25 years of age. Additionally, a nested biomarker study will investigate the mechanisms of action of clozapine compared to TAU. METHODS AND DESIGN This is the protocol of a multi-centre, open label, blind-rated, randomised controlled effectiveness trial of clozapine vs TAU (any other oral antipsychotic monotherapy licenced in the British National Formulary) for 12 weeks in 260 children and young people with TRS (12-24 years old). AIM AND OBJECTIVES The primary outcome is the change in blind-rated Positive and Negative Syndrome Scale scores at 12 weeks from baseline. Secondary outcomes include blind-rated Clinical Global Impression, patient-rated outcomes, quality of life, adverse effects, and treatment adherence. Patients will be followed up for 12 months and will be invited to give consent for longer term follow-up using clinical records and potential re-contact for further research. For mechanism of action, change in brain magnetic resonance imaging (MRI) biomarkers and peripheral inflammatory markers will be measured over 12 weeks. DISCUSSION The CLEAR trial will contribute knowledge on clozapine effectiveness, safety and cost-effectiveness compared to standard antipsychotics in young people with TRS, and the results may guide future clinical treatment recommendation for early psychosis. TRIAL REGISTRATION ISRCTN Number: 37176025, IRAS Number: 1004947. TRIAL STATUS In set-up. Protocol version 4.0 01/08/23. Current up to date protocol available here: https://fundingawards.nihr.ac.uk/award/NIHR131175# /.
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Affiliation(s)
- C Casetta
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - P Santosh
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R Bayley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - S Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - C Dixon
- Wonford House Hospital, Devon Partnership NHS Trust, Exeter, UK
| | - R J Drake
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - R Elvins
- Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - R Emsley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - N Fung
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - D Hayes
- South London and Maudsley NHS Foundation Trust, London, UK
| | - O Howes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A James
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - K James
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - R Jones
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - H Killaspy
- Division of Psychiatry, University College London, London, UK
| | - B Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - L Marchant
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - P McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - E Oloyede
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - M Rogdaki
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Birmingham Early Intervention Service, Birmingham Womens and Childrens NHS Foundation Trust, Birmingham, UK
| | - J Walters
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - A Egerton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J H MacCabe
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Raffard S, Bayard S, Tattard P, Laraki Y, Capdevielle D. Cross-sectional study on the dissociation of decision-making capacity for antipsychotic treatment and COVID-19 vaccination in individuals with schizophrenia. Front Psychiatry 2023; 14:1308666. [PMID: 38156326 PMCID: PMC10753010 DOI: 10.3389/fpsyt.2023.1308666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Objective Decision-making capacity for treatment is impaired in schizophrenia but it remains unknown if schizophrenia affects distinct decision-making capacities differently. Methods In this study, we assessed concomitantly two decision-making capacities (i.e., antipsychotic treatment and COVID-19 vaccination) in 27 schizophrenia patients. Sociodemographic variables, psychotic symptoms, global cognition and insight were also assessed. Results We found that among individuals incompetent to consent to antipsychotic treatment, one-third had preserved capacity to consent to vaccination. No significant associations between the two different decision-making capacities were found. Psychotic symptoms and cognition were associated with the capacity to consent to antipsychotic treatment and to vaccination, respectively. Conclusion Clinicians should be aware that capacity to consent to treatment is not unidimensional and vary across domains in individuals with schizophrenia. Being incompetent regarding one treatment does not mean to be incompetent for another treatment in this clinical population.
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Affiliation(s)
- Stéphane Raffard
- Université Paul Valéry Montpellier 3, EPSYLON EA 4556, Montpellier, France
- University Department of Adult Psychiatry, CHU Montpellier, Montpellier, France
- FondaMental Academic Advanced Center of Expertise for Schizophrenia (FACE-SZ), Créteil, France
| | - Sophie Bayard
- Université Paul Valéry Montpellier 3, EPSYLON EA 4556, Montpellier, France
| | - Philippe Tattard
- University Department of Adult Psychiatry, CHU Montpellier, Montpellier, France
| | - Yasmine Laraki
- Université Paul Valéry Montpellier 3, EPSYLON EA 4556, Montpellier, France
- University Department of Adult Psychiatry, CHU Montpellier, Montpellier, France
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, CHU Montpellier, Montpellier, France
- FondaMental Academic Advanced Center of Expertise for Schizophrenia (FACE-SZ), Créteil, France
- IGF, Université de Montpellier, CNRS, INSERM, Montpellier, France
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Beebe LH. Psychiatric Nursing Research in Schizophrenia: Call to Action. J Psychosoc Nurs Ment Health Serv 2023; 61:2-4. [PMID: 36720051 DOI: 10.3928/02793695-20230109-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Lora Humphrey Beebe
- College of Nursing Chair, Institutional Review Board University of Tennessee Knoxville, Tennessee
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Joury S, Asman O, Gold A. Caregivers' perceptions of compulsory treatment of physical illness in involuntarily psychiatric hospitalization. Nurs Ethics 2023; 30:423-436. [PMID: 36715421 DOI: 10.1177/09697330221140493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Physical morbidity is rife among patients with serious mental illness. When they are involuntarily hospitalized and even treated, they may still refuse treatment for physical illness leading clinicians to wonder about the ethics of coercing such treatments. RESEARCH AIM This survey study explored psychiatric caregivers' perceptions on whether compulsory treatment of physical illness is legal and whether it is justifiable in patients with serious mental illness and under what circumstances. RESEARCH DESIGN A questionnaire that included two case vignettes of an involuntarily hospitalized psychiatric patient with diabetes refusing treatment with insulin for various reasons. The cases differed in terms of diabetes severity. Participants answered questions regarding the appropriateness of involuntary treatment. PARTICIPANTS AND RESEARCH CONTEXT Psychiatric medical doctors and nurses working in a mental health center. (N = 89, 50 female, ages 26-66). ETHICAL CONSIDERATIONS The study was approved by the Medical Centre Institutional Review Board (IRB) and the University Ethics Committee. The respondents' anonymity was kept. Participation was voluntary and consent was obtained. RESULTS The severity of the patient's medical condition and their reason for refusing treatment were associated with participants' willingness to give insulin despite patient objection [(F(1, 87) = 49.41, p < .01; (F(1, 87) = 33.44, p < .01), respectively]. Participants were more inclined to support compulsory treatment if the patient's refusal was "illness-oriented" (i.e. directly related to psychiatric illness). Participants presented diverse views regarding the perceived legality of compulsory treatment of physical illness in such situations (illegal 63.09%; legal 23.8%; 13% unsure). The majority (53.5%-55.3%) of those who thought it was illegal supported compulsory treatment in high-severity, illness-oriented refusal situations. CONCLUSIONS The severity of the medical condition and the reason for treatment refusal influence psychiatric caregivers' willingness to provide compulsory treatment for physical illness in involuntary hospitalized psychiatric patients. Beyond the legal framework, ethical guidelines for these situations are warranted, while decisions should be made on a case-by-case basis.
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Affiliation(s)
| | | | - Azgad Gold
- 61168Be'er Yaakov Mental Health Center, Israel
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Curley A, Watson C, Kelly BD. Capacity to consent to treatment in psychiatry inpatients - a systematic review. Int J Psychiatry Clin Pract 2022; 26:303-315. [PMID: 34941467 DOI: 10.1080/13651501.2021.2017461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Mental capacity for treatment decisions in psychiatry inpatients is an important ethical and legal concern, especially in light of changes in mental capacity legislation in many jurisdictions. AIMS To conduct a systematic review of literature examining the prevalence of mental capacity for treatment decisions among voluntary and involuntary psychiatry inpatients, and to assess any correlations between research tools used to measure mental capacity and binary judgements using criteria such as those in capacity legislation. METHOD We searched PsycINFO, Ovid MEDLINE and EMBASE for studies assessing mental capacity for treatment decisions in people admitted voluntarily and involuntarily to psychiatric hospitals. RESULTS Forty-five papers emanating from 33 studies were identified. There was huge variability in study methods and often selective populations, but the prevalence of decision-making capacity varied between 5% and 83.7%. These figures resulted from studies using cut-off scores or categorical criteria only. The prevalence of decision-making capacity among involuntary patients ranged from 7.7% to 42%, and among voluntary patients ranged from 29% to 97.9%. Two papers showed positive correlations between clinicians' judgement of decision-making capacity and scores on the MacArthur Competence Assessment Tool for Treatment; two papers showed no such correlation. CONCLUSIONS Not all voluntary psychiatry inpatients possess mental capacity and many involuntary patients do. This paradox needs to be clarified and resolved in mental health legislation; supported decision-making can help with this task.Key PointsLegislative changes for mental capacity are taking place in many jurisdictions.This is an important human rights issue for many people, including psychiatry inpatients.In our review, we found the prevalence of decision-making capacity varies between 5% and 83.7% in psychiatry inpatients.Not all voluntary inpatients have decision-making capacity.Many involuntary inpatients have mental capacity to make decisions.Supported decision-making can help those with impairments in their mental capacity.
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Affiliation(s)
- Aoife Curley
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin, Ireland.,Cavan Monaghan Mental Health Service, Monaghan, Ireland
| | - Carol Watson
- Cavan Monaghan Mental Health Service, Monaghan, Ireland
| | - Brendan D Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin, Ireland
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Doedens P, Ter Riet G, Vermeulen J, Boyette LL, Latour C, de Haan L. Influence of nursing staff characteristics on seclusion in acute mental health care-A prospective two-year follow-up study. Arch Psychiatr Nurs 2021; 35:491-498. [PMID: 34561064 DOI: 10.1016/j.apnu.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Seclusion still occurs on mental health wards, despite absence of therapeutic efficacy and high risks of adverse patient effects. Literature on the effect of nursing teams, and the role of psychological characteristics in particular, on frequency of seclusion is scarce. AIM To explore the influence of demographic, professional or psychological, nursing team-level, and shift characteristics on the frequency of use of seclusion. METHODS Prospective two-year follow-up study. RESULTS We found that the probability of seclusion was lower when nursing teams with at least 75% males were on duty, compared to female only teams, odds ratio (OR = 0.283; 95% CrI 0.046-0.811). We observed a trend indicating that teams scoring higher on the openness personality dimension secluded less, (OR = 0.636; 95% CrI 0.292-1.156). DISCUSSION Higher proportions of male nurses in teams on duty were associated with lower likelihood of seclusion. We found an indication that teams with a higher mean openness personality trait tended to seclude less. These findings, if causal, could serve as an incentive to reflect on staff mix if circumstances demand better prevention of seclusion.
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Affiliation(s)
- Paul Doedens
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, the Netherlands; Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Gerben Ter Riet
- Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Jentien Vermeulen
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Lindy-Lou Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Corine Latour
- Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, the Netherlands; Arkin, Amsterdam, the Netherlands
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Jimoh OF, Ryan H, Killett A, Shiggins C, Langdon PE, Heywood R, Bunning K. A systematic review and narrative synthesis of the research provisions under the Mental Capacity Act (2005) in England and Wales: Recruitment of adults with capacity and communication difficulties. PLoS One 2021; 16:e0256697. [PMID: 34469482 PMCID: PMC8409627 DOI: 10.1371/journal.pone.0256697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The Mental Capacity Act (MCA, 2005) and its accompanying Code of Practice (2007), govern research participation for adults with capacity and communication difficulties in England and Wales. We conducted a systematic review and narrative synthesis to investigate the application of these provisions from 2007 to 2019. METHODS AND FINDINGS We included studies with mental capacity in their criteria, involving participants aged 16 years and above, with capacity-affecting conditions and conducted in England and Wales after the implementation of the MCA. Clinical trials of medicines were excluded. We searched seven databases: Academic Search Complete, ASSIA, MEDLINE, CINAHL, PsycArticles, PsycINFO and Science Direct. We used narrative synthesis to report our results. Our review follows Preferred Reporting Items for Systematic Reviews and is registered on PROSPERO, CRD42020195652. 28 studies of various research designs met our eligibility criteria: 14 (50.0%) were quantitative, 12 (42.9%) qualitative and 2 (7.1%) mixed methods. Included participants were adults with intellectual disabilities (n = 12), dementia (n = 9), mental health disorders (n = 2), autism (n = 3) and aphasia after stroke (n = 2). We found no studies involving adults with acquired brain injury. Diverse strategies were used in the recruitment of adults with capacity and communication difficulties with seven studies excluding individuals deemed to lack capacity. CONCLUSIONS We found relatively few studies including adults with capacity and communication difficulties with existing regulations interpreted variably. Limited use of consultees and exclusions on the basis of capacity and communication difficulties indicate that this group continue to be under-represented in research. If health and social interventions are to be effective for this population, they need to be included in primary research. The use of strategic adaptations and accommodations during the recruitment process, may serve to support their inclusion.
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Affiliation(s)
- Oluseyi Florence Jimoh
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Hayley Ryan
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Ciara Shiggins
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne Victoria, Australia
| | - Peter E. Langdon
- Centre for Educational Development, Appraisal and Research, New Education Building, Westwood Campus, University of Warwick, Coventry, United Kingdom
| | - Rob Heywood
- School of Law, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Karen Bunning
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
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Ismail MA, Midin M. Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study. Front Psychiatry 2021; 12:680800. [PMID: 34381387 PMCID: PMC8350437 DOI: 10.3389/fpsyt.2021.680800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/25/2021] [Indexed: 01/19/2023] Open
Abstract
Introduction: Shared decision-making (SDM) is recognized as a promising strategy for improving collaboration between clinicians and their patients in achieving recovery. In Malaysia, SDM among people with schizophrenia is still lacking both in practice and in research. This study aimed to determine the level of SDM and role preference and their associated factors among patients with schizophrenia in Malaysia. Methods: A cross-sectional study was conducted on 86 outpatient attendees with schizophrenia at a teaching hospital in Kuala Lumpur, Malaysia. The nine-item Shared Decision Making Questionnaire and Control Preference Scale were used to assess perceived SDM experience and role preference, respectively. Linear and logistic regression models were used to analyze the factors associated with SDM and role preference, respectively. Factors with a p <0.25 from the simple regression analyses were controlled as the covariates in the multiple regression analyses. Results: The study respondents were predominantly female, single, and unemployed, with a mean age of 44 years. Only 35% of the participants reported having high SDM experiences, even though the majority (56%) preferred autonomous role preference. Among the participants who preferred autonomous roles, only 40% experienced high SDM. High SDM was found to be significantly associated with being younger (B = -0.33, 95% CI = -0.67 to -0.003) and being non-clozapine users (B = 19.90, 95% CI = 9.39-30.41), while autonomous role preference was significantly associated with a lower level of insight [adjusted odds ratio (AOR) = 0.84, 95% CI = 0.72-0.99] and being on oral antipsychotic drugs only (AOR = 2.94, 95% CI = 1.10-7.82). Conclusion: The practice of SDM is still lacking in the treatment of patients with schizophrenia in Malaysia, even though many of them preferred to be involved in the decision-making pertaining to their treatment. This study indicates the need for clinicians to improve their patients' involvement in the treatment process. More research is needed on how SDM can be implemented in patients with schizophrenia, especially in Asian population settings.
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Affiliation(s)
| | - Marhani Midin
- Psychiatry Department, Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia
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11
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Chiang YS, Chang YC, Liu YP, Tzeng WC. Quality of life in patients with comorbid serious mental illness and chronic diseases: A structural equation model. J Adv Nurs 2020; 77:1271-1283. [PMID: 33230880 DOI: 10.1111/jan.14663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/20/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022]
Abstract
AIMS To investigate the factors affecting the quality of life among adults with comorbid serious mental illness and chronic diseases. DESIGN Descriptive, cross-sectional study design. METHODS In total, 204 patients with serious mental illness were recruited from two hospitals. Self-reported data were collected using the Brief Psychiatric Rating Scale, Internalised Stigma of Mental Illness, Patient Activation Measure and brief version of the World Health Organization Quality of Life Instrument. Data were collected between July 2018 - January 2019. The structural equation model was applied to examine the associations among the study variables. RESULTS Internalized stigma (β = -0.479, p = .002) had the greatest direct effect on quality of life, followed by patient activation (β = 0.238, p = .002), severity of comorbidities (β = -0.207, p = .002) and psychiatric symptoms (β = -0.186, p = .006). In addition, psychiatric symptoms directly influenced the severity of comorbidities, which in turn directly influenced internalized stigma and then in turn directly influenced patient activation and ultimately influenced quality of life. CONCLUSION The relationship between internalized stigma and quality of life is significantly mediated by patient activation. This finding provides a theoretical basis for developing patient activation interventions for patients with comorbid mental and chronic diseases, which potentially improve the quality of life of this population. IMPACT Multiple comorbidities cause impaired quality of life in patients with serious mental illnesses. We found that patient activation plays an important role in the management of chronic diseases for achieving more favourable quality of life, but this is negatively affected by internalized stigma. These findings can help mental health professionals develop tailored intervention strategies to enhance quality of life by promoting patient activation and reducing internalized stigma, psychiatric symptoms, and comorbidity severity in patients with comorbid serious mental illnesses and chronic diseases.
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Affiliation(s)
- Yu-Shuang Chiang
- Department of Nursing, Tri-Service General Hospital Beitou Branch, Taipei City, Taiwan.,School of Nursing, National Defense Medical Center, Taipei City, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei City, Taiwan
| | - Yia-Ping Liu
- Department of Psychiatry, Cheng-Hsin General Hospital, Taipei City, Taiwan.,Laboratory of Cognitive Neuroscience, Departments of Physiology and Psychiatry, National Defense Medical Center, Taipei City, Taiwan
| | - Wen-Chii Tzeng
- School of Nursing, National Defense Medical Center, Taipei City, Taiwan
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12
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Dakić T. No research for the decisionally-impaired mentally ill: a view from Montenegro. BMC Med Ethics 2020; 21:47. [PMID: 32517748 PMCID: PMC7285582 DOI: 10.1186/s12910-020-00489-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/03/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Many of the important elements of a valid informed consent - comprehension, voluntariness, and capacity - can be compromised or unmet in the context of psychiatric research. The inability to protect their own interests puts mentally ill subjects at an increased likelihood of being wronged or harmed and makes them particularly vulnerable in the context of clinical research. Therefore, they are due extra protection. Sometimes, these additional safeguards can significantly limit the possibilities for research involving subjects deemed unable to consent due to their mental illness. Montenegro, a middle-income country in Southern-Eastern Europe, goes so far in their policy to protect these subjects from harms of research, as to ban all biomedical research on mentally ill persons who are unable to provide consent. MAIN BODY Mental health research is often neglected and very low on the list of health research priorities, especially in low- and middle-income countries. Despite the fact that mental health disorders are among leading causes of disability, the need for evidence-based services and interventions for those affected remains unmet. To exclude all members of a certain group of subjects seems extremely restrictive and unnecessary. Such a policy is discriminatory and unethical, because it inflicts further harms and exclusion of those patients from participation in society. This unjust exclusion policy obstructs research of certain psychiatric disorders and implies that new treatments for conditions that directly affect these incapacitated subjects will not be developed. CONCLUSIONS Scientific and clinical development must not be precluded by overly restrictive, discriminatory and unjust practices, such as the normative ban on research on decisionally-impaired mentally ill subjects. Rather, there should be a regulative framework that ensures that those who cannot consent for themselves are respected and protected in research, the anticipated benefits maximized, risks minimized, their autonomy recognized and extended. These patient-subjects must be appropriately included unless there is a clear and compelling rationale and justification that inclusion is inappropriate with respect to the health of the participants or the purpose of the research.
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Affiliation(s)
- Tea Dakić
- Clinical Center of Montenegro, Clinic for Psychiatry, Ljubljanska bb, Podgorica, 81000, Montenegro.
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13
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Wang WL, Zhou YQ, Chai NN, Li GH, Liu DW. Mediation and moderation analyses: exploring the complex pathways between hope and quality of life among patients with schizophrenia. BMC Psychiatry 2020; 20:22. [PMID: 31941476 PMCID: PMC6964047 DOI: 10.1186/s12888-020-2436-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The underlying mechanism between hope and quality of life is as yet unknown. We aim to examine the potential mediating effect of depression and resilience and the moderated effect of sex in this well-established association. METHODS Two hundred seven patients diagnosed with schizophrenia were administered a questionnaire battery that measured hope, depression, resilience and QOL. A multiple mediation model was used to examine the mediating effect of resilience and depression on the association between hope and QOL. A subgroup analysis was performed and a moderated mediation model was examined to find and test the moderated effect of sex on the mediation model. We used Mplus to perform moderation and mediation analyses so that the mediators and moderator could function together in the same model. RESULT Sex was the moderator on the direct path between hope and QOL. The relationship between hope and QOL was mediated by resilience and depression in both sexes. When compared with female patients, the effect of hope on QOL was completely mediated by resilience and depression in males. In female patients, the model was partially mediated, and the direct effect of hope on QOL was significantly negatively correlated with the level of hope. CONCLUSION We present a conceptual model containing the mediated effects of resilience and depression and the moderated effect of sex between hope and QOL, which we believe facilitates the understanding of these associations. This model should be useful in the formulation of strategies to improve QOL.
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Affiliation(s)
- Wei-Liang Wang
- grid.410736.70000 0001 2204 9268School of Nursing, Harbin Medical University (Daqing), Daqing, Heilongjiang China
| | - Yu-Qiu Zhou
- School of Nursing, Harbin Medical University (Daqing), Daqing, Heilongjiang, China.
| | - Nan-Nan Chai
- grid.443353.60000 0004 1798 8916School of Nursing, Chifeng University, Chifeng, the Autonomous Region China
| | - Guo-Hua Li
- Chifeng Anding Hospital, Chifeng, the Autonomous Region China
| | - Dong-Wei Liu
- grid.410736.70000 0001 2204 9268School of Nursing, Harbin Medical University (Daqing), Daqing, Heilongjiang China
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14
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Curley A, Murphy R, Fleming S, Kelly BD. Age, psychiatry admission status and linear mental capacity for treatment decisions. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 66:101469. [PMID: 31706384 DOI: 10.1016/j.ijlp.2019.101469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/02/2019] [Indexed: 06/10/2023]
Abstract
The relationship between age and mental capacity among psychiatry inpatients is not fully understood. We aimed to assess mental capacity for treatment decisions in voluntary and involuntary psychiatry inpatients in Ireland and, in this analysis of our data-set, to elucidate the linear relationship, if any, between linear (as opposed to categorical) mental capacity and age. We used the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) to assess mental capacity for treatment decisions in 215 psychiatry inpatients (176 voluntary and 39 involuntary) in four psychiatry admission units in Ireland. Mean age was 46.2 years and majorities were male (58.1%), never married (74.0%), unemployed (64.2%) and of Irish ethnicity (87.0%). The most common primary diagnoses were schizophrenia and related disorders (42.8%) followed by affective disorders (36.7%). On multi-variable linear regression analysis, linear mental capacity was significantly associated with voluntary admission status, being employed, having a primary diagnosis other than schizophrenia or a related disorder, and younger age. Together, these factors accounted for 44.4% of the variance in mental capacity between participants. Overall, while increased age is associated with diminished mental capacity, other factors appear more significant, including involuntary admission status which is likely an indicator of symptom severity. There is a need for further research to (a) elucidate the relationships between the significant factors identified in this study and the cognitive status of patients (which impacts on assessments of mental capacity); (b) identify and elucidate other factors of likely relevance to mental capacity (e.g. medical illness, medication use); and (c) translate these findings into targeted interventions to support decision-making in clinical practice among psychiatry inpatients, especially those with involuntary status.
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Affiliation(s)
- Aoife Curley
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin D24 NR0A, Ireland.
| | - Ruth Murphy
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin D24 NR0A, Ireland.
| | - Sean Fleming
- Department of Medicine, Midland Regional Hospital, Dublin Road, Portlaoise, County Laois R32 RW61, Ireland.
| | - Brendan D Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin D24 NR0A, Ireland.
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15
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Corsico P. The risks of risk. Regulating the use of machine learning for psychosis prediction. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 66:101479. [PMID: 31706401 DOI: 10.1016/j.ijlp.2019.101479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/21/2019] [Accepted: 07/24/2019] [Indexed: 06/10/2023]
Abstract
Recent advances in Machine Learning (ML) have the potential to revolutionise psychosis prediction and psychiatric assessment. This article has two objectives. First, it clarifies which aspects of English Law are relevant in order to regulate the use of ML in clinical research on psychosis prediction. It is argued that its lawful implementation will depend upon the legal requirements regarding the balance between potential harms and benefits, particularly with reference to: (i) any additional risks introduced by the use of ML for data analysis and outcome prediction; and (ii) the inclusion of vulnerable research populations such as minors or incapacitated adults. Second, this article investigates how clinical prediction via ML might affect the practice of risk assessment under mental health legislation, with reference to English Law. It is argued that there is a potential for virtuous applications of clinical prediction in psychiatry. However, reaffirming the distinction between psychosis risk and risk of harm is paramount. Establishing psychosis risk and assessing a person's risk of harm are discrete practices, and so should remain when using artificial intelligence for psychiatric assessment. Evaluating whether clinical prediction via ML might benefit individuals with psychosis will depend on which risk we try to assess and on what we try to predict, whether this is psychosis transition, a psychotic relapse, self-harm and suicidality, or harm to others.
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Affiliation(s)
- Paolo Corsico
- Centre for Social Ethics and Policy, Department of Law, School of Social Sciences, The University of Manchester, United Kingdom.
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16
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Vermeulen JM, Doedens P, Boyette LLNJ, Spek B, Latour CHM, de Haan L. "But I did not touch nobody!"-Patients' and nurses' perspectives and recommendations after aggression on psychiatric wards-A qualitative study. J Adv Nurs 2019; 75:2845-2854. [PMID: 31222795 PMCID: PMC6899923 DOI: 10.1111/jan.14107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 11/28/2022]
Abstract
AIMS To gain a deeper understanding of the differences in patients and staff perspectives in response to aggression and to explore recommendations on prevention. DESIGN Qualitative, grounded theory study. METHODS We conducted semi-structured interviews with patients and nurses involved in an aggressive incident. Data collection was performed from May 2016 - March 2017. RESULTS Thirty-one interviews were conducted concerning 15 aggressive incidents. Patients and nurses generally showed agreement on the factual course of events, there was variation in agreement on the perceived severity (PS). Patients' recommendations on prevention were mostly personally focussed, while nurses suggested general improvements. CONCLUSION Patients are often capable to evaluate aggression and give recommendations on prevention shortly after the incident. Patients and nurses differ in the PS of aggression. Recommendations on prevention of patients and nurses are complementary. IMPACT What problem did the study address? Perspectives of patients and nurses differ with respect to aggression, but how is unclear. What were the main findings? Patients and nurses generally described a similar factual course of events concerning the incident, patients often perceive the severity less than nurses. Patients are capable to give recommendations on prevention of aggressive incidents, shortly after the incident. Where and on whom will the research have impact? Factual course of events can be a common ground to start evaluating aggressive incidents and post-incident review should address the severity of incidents. Asking recommendations from patients on how to improve safety and de-escalation can lead to innovative and personal de-escalation strategies and supports patients autonomy.
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Affiliation(s)
- Jentien M Vermeulen
- Psychiatry, Amsterdam UMC (location Academic Medical Center), University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Doedens
- Psychiatry, Amsterdam UMC (location Academic Medical Center), University of Amsterdam, Amsterdam, The Netherlands.,ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Lindy-Lou N J Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Bea Spek
- Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC (location Academic Medical Center), University of Amsterdam, Amsterdam, The Netherlands
| | - Corine H M Latour
- ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Psychiatry, Amsterdam UMC (location Academic Medical Center), University of Amsterdam, Amsterdam, The Netherlands.,Arkin, Amsterdam, The Netherlands
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17
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Curley A, Murphy R, Plunkett R, Kelly BD. Categorical mental capacity for treatment decisions among psychiatry inpatients in Ireland. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 64:53-59. [PMID: 31122640 DOI: 10.1016/j.ijlp.2019.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 06/09/2023]
Abstract
This study aimed to assess mental capacity for treatment decisions among psychiatry inpatients in Ireland and explore the relationship, if any, between mental capacity and various demographics and clinical variables. We assessed mental capacity for treatment decisions in 215 psychiatry inpatients in four psychiatry admission units. Almost half of the participants were female and the most common diagnoses were schizophrenia or a related disorder and affective disorders. Overall, 1.9% of participants lacked mental capacity for treatment decisions; 50.7% had partial mental capacity; and 47.4% had full mental capacity. These proportions did not differ between female and male patients. On multi-variable regression analysis, greater mental capacity was significantly associated with, in order of strength of association, voluntary admission status, Irish ethnicity, being employed and younger age. However, while these relationships were statistically significant (i.e. were unlikely to have occurred by chance), together they accounted for just 27.6% of the variance in mental capacity between participants (i.e. they were not very strong). The relatively high rate of "partial mental capacity" identified in our work suggests that decision-making supports are likely to be of substantial importance in assisting psychiatry inpatients making decisions about treatment, especially involuntary inpatients whose mental capacity is especially likely to be impaired. Future research could usefully clarify and quantify the role of cognitive and other factors in relation to the unexplained variance (72.4%) in mental capacity identified in this study; and explore which models of supported decision-making are most likely to assist the substantial proportion (50.7%) of psychiatry inpatients who have partial mental capacity for treatment decisions, as well as the minority lacking such mental capacity (1.9%).
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Affiliation(s)
- Aoife Curley
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin 24 D24 NR0A, Ireland.
| | - Ruth Murphy
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin 24 D24 NR0A, Ireland
| | - Róisín Plunkett
- Department of Liaison Psychiatry, Beaumont Hospital, Beaumont Road, Dublin 9 D09 A0KH, Ireland.
| | - Brendan D Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin 24 D24 NR0A, Ireland.
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18
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Murphy R, Fleming S, Curley A, Duffy RM, Kelly BD. Who can decide? Prevalence of mental incapacity for treatment decisions in medical and surgical hospital inpatients in Ireland. QJM 2018; 111:881-885. [PMID: 30295869 DOI: 10.1093/qjmed/hcy219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of mental incapacity for treatment decisions among medical and surgical hospital inpatients is poorly understood or not known in many countries, including Ireland. AIM To assess the prevalence of mental incapacity in hospital inpatients in Ireland. DESIGN Cross-sectional observational study of mental incapacity for treatment decisions. METHODS We assessed mental capacity in 300 randomly selected hospital inpatients in 2 general hospitals in Dublin (urban) and Portlaoise (rural), in Ireland, using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). RESULTS Mean MacCAT-T score was 14.80 (SD: 8.40) out of a possible maximum of 20 (with a higher score indicating greater mental capacity). Over one quarter of participants (27.7%; n = 83) lacked the mental capacity for treatment decisions; 1.7% (n = 5) had partial capacity and 70.7% (n = 212) had full capacity. Scores for each of the four sub-scales of the MacCAT-T were generally consistent across the four key areas of understanding, appreciation, reasoning and expressing a choice. CONCLUSIONS Mental incapacity for treatment decisions is common in medical and surgical hospital inpatients in Ireland. This issue both merits and requires greater attention in clinical practice, research and legislation.
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Affiliation(s)
- R Murphy
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
| | - S Fleming
- Department of Medicine, Midland Regional Hospital, Portlaoise, County Laois, Ireland
| | - A Curley
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
- Department of Psychiatry, Crosslanes, Drogheda, County Louth, Ireland
| | - R M Duffy
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
- Department of Adult Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland
| | - B D Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
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