Hostname: page-component-6bf8c574d5-mggfc Total loading time: 0 Render date: 2025-02-24T09:21:37.689Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment decision-making capacity in non-consensual psychiatric treatment: a multicentre study

Published online by Cambridge University Press:  09 March 2017

G. Mandarelli Open the ORCID record for G. Mandarelli [Opens in a new window] ,
F. Carabellese ,
G. Parmigiani ,
F. Bernardini ,
L. Pauselli Open the ORCID record for L. Pauselli [Opens in a new window] ,
R. Quartesan ,
R. Catanesi  and
S. Ferracuti
G. Mandarelli*
Affiliation:
Department of Neurology and Psychiatry, University of Rome ‘Sapienza’, viale dell'Università 30, 00185 Rome, Italy
F. Carabellese
Affiliation:
Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Piazza Giulio Cesare, 70124, Bari, Italy
G. Parmigiani
Affiliation:
Department of Neurology and Psychiatry, University of Rome ‘Sapienza’, viale dell'Università 30, 00185 Rome, Italy
F. Bernardini
Affiliation:
School of Psychiatry, University of Perugia, 06156 Perugia, Italy
L. Pauselli
Affiliation:
School of Psychiatry, University of Perugia, 06156 Perugia, Italy
R. Quartesan
Affiliation:
School of Psychiatry, University of Perugia, 06156 Perugia, Italy Department of Medicine, Division of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
R. Catanesi
Affiliation:
Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Piazza Giulio Cesare, 70124, Bari, Italy
S. Ferracuti
Affiliation:
Department of Neurology and Psychiatry, University of Rome ‘Sapienza’, viale dell'Università 30, 00185 Rome, Italy
*
*Address for correspondence: G. Mandarelli, Department of Neurology and Psychiatry, University of Rome ‘Sapienza’, viale dell'Università 30, Rome, Italy. (Email: gabriele.mandarelli@uniroma1.it)
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

To evaluate treatment decision-making capacity (DMC) to consent to psychiatric treatment in involuntarily committed patients and to further investigate possible associations with clinical and socio-demographic characteristics of patients.

Methods.

131 involuntarily hospitalised patients were recruited in three university hospitals. Mental capacity to consent to treatment was measured with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T); psychiatric symptoms severity (Brief Psychiatric Rating Scale, BPRS-E) and cognitive functioning (Mini Mental State Examination, MMSE) were also assessed.

Results.

Mental capacity ratings for the 131 involuntarily hospitalised patients showed that patients affected by bipolar disorders (BD) scored generally better than those affected by schizophrenia spectrum disorders (SSD) in MacCAT-T appreciation (p < 0.05) and reasoning (p < 0.01). Positive symptoms were associated with poorer capacity to appreciate (r = −0.24; p < 0.01) and reason (r = −0.27; p < 0.01) about one's own treatment. Negative symptoms were associated with poorer understanding of treatment (r = −0.23; p < 0.01). Poorer cognitive functioning, as measured by MMSE, negatively affected MacCAT-T understanding in patients affected by SSD, but not in those affected by BD (SSD r = 0.37; p < 0.01; BD r = −0.01; p = 0.9). Poorer MacCAT-T reasoning was associated with more manic symptoms in the BD group of patients but not in the SSD group (BD r = −0.32; p < 0.05; SSD r = 0.03; p = 0.8). Twenty-two per cent (n = 29) of the 131 recruited patients showed high treatment DMC as defined by having scored higher than 75% of understanding, appreciating and reasoning MacCAT-T subscales maximum sores and 2 at expressing a choice. The remaining involuntarily hospitalised patients where considered to have low treatment DMC. Chi-squared disclosed that 32% of BD patients had high treatment DMC compared with 9% of SSD patients (p < 0.001).

Conclusions.

Treatment DMC can be routinely assessed in non-consensual psychiatric settings by the MacCAT-T, as is the case of other clinical variables. Such approach can lead to the identification of patients with high treatment DMC, thus drawing attention to possible dichotomy between legal and clinical status.

Keywords

Informed consentinvoluntary hospitalisationmental capacitysevere mental illness
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 27 , Issue 5 , October 2018 , pp. 492 - 499
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Appelbaum, PS (2007). Clinical practice. Assessment of patients’ competence to consent to treatment. New England Journal of Medicine 357, 1834–1840.Google Scholar
Aydin Er, R, Sehiralti, M, Aker, AT (2013). Preliminary Turkish study of psychiatric in-patients’ competence to make treatment decisions. Asia-Pacific Psychiatry 5, E9–E18.Google Scholar
Cairns, R, Maddock, C, Buchanan, A, David, AS, Hayward, P, Richardson, G, Szmukler, G, Hotopf, M (2005). Prevalence and predictors of mental incapacity in psychiatric in-patients. British Journal of Psychiatry 187, 379–385.Google Scholar
Candia, PC, Barba, AC (2011). Mental capacity and consent to treatment in psychiatric patients: the state of the research. Current Opinion in Psychiatry 24, 442–446.Google Scholar
Carabellese, F, Taratufolo, R, Candelli, C, Grattagliano, I, La Tegola, D (2012). ASO-TSO, emergency interventions: has anything changed? Old and new psychiatrist's professional responsibilities. Rivista di Psichiatria 47, 294–303.Google Scholar
Catanesi, R, Carabellese, F, Candelli, C, La Tegola, D, Taratufolo, R (2010). Evaluations for informed consent for various long-term psychiatric treatments. Rivista di Psichiatria 45, 170–178.Google Scholar
Dressing, H, Salize, HJ (2004). Compulsory admission of mentally ill patients in European Union Member States. Social Psychiatry and Psychiatric Epidemiology 39, 797–803.Google Scholar
Eyler, LT, Olsen, RK, Nayak, GV, Mirzakhanian, H, Brown, GG, Jeste, DV (2007). Brain response correlates of decisional capacity in schizophrenia: a preliminary fMRI study. Journal of Neuropsychiatry and Clinical Neurosciences 19, 137–144.Google Scholar
Folstein, M, Folstein, S, Mchugh, P (1975). Mini-Mental State: a practical guide for grading the cognitive state of the patient for the physician. Journal of Psychiatric Research 12, 189–198.Google Scholar
Fraguas, D, García-Solano, F, Chapela, E, Terán, S, de la Peña, JJ, Calcedo-Barba, A (2007). Do psychiatric patients improve their competency to consent to hospitalization after admission? A prospective study in an acute inpatient ward. General Hospital Psychiatry 29, 54–62.Google Scholar
Grisso, T, Appelbaum, P, Hill-Fotouhi, C (1997). The MacCAT-T: a clinical tool to assess patients’ capacities to make treatment decisions. Psychiatric Services 48, 1415–1419.Google Scholar
Howe, V, Foister, K, Jenkins, K, Skene, L, Copolov, D, Keks, N (2005). Competence to give informed consent in acute psychosis is associated with symptoms rather than diagnosis. Schizophrenia Research 77, 211–214.Google Scholar
Kallert, TW, Glöckner, M, Schützwohl, M (2008). Involuntary vs. voluntary hospital admission. A systematic literature review on outcome diversity. European Archives of Psychiatry and Clinical Neuroscience 258, 195–209.Google Scholar
Kim, SY, Appelbaum, PS, Swan, J, Stroup, TS, McEvoy, JP, Goff, DC, Jeste, DV, Lamberti, JS, Leibovici, A, Caine, ED (2007). Determining when impairment constitutes incapacity for informed consent in schizophrenia research. British Journal of Psychiatry 191, 38–43.Google Scholar
Koren, D, Poyurovsky, M, Seidman, LJ, Goldsmith, M, Wenger, S, Klein, EM (2005). The neuropsychological basis of competence to consent in first-episode schizophrenia: a pilot metacognitive study. Biological Psychiatry 57, 609–616.Google Scholar
Lepping, P, Stanly, T, Turner, J (2015). Systematic review on the prevalence of lack of capacity in medical and psychiatric settings. Clinical Medicine (London, England) 15, 337–343.Google Scholar
Mandarelli, G, Parmigiani, G, Tarsitani, L, Frati, P, Biondi, M, Ferracuti, S (2012). The relationship between executive functions and capacity to consent to treatment in acute psychiatric hospitalization. Journal of Empirical Research on Human Research Ethics 7, 63–70.Google Scholar
Mandarelli, G, Tarsitani, L, Parmigiani, G, Polselli, GM, Frati, P, Biondi, M, Ferracuti, S (2014). Mental capacity in patients involuntarily or voluntarily receiving psychiatric treatment for an acute mental disorder. Journal of Forensic Sciences 59, 1002–1007.Google Scholar
Okai, D, Owen, GS, McGuire, H, Singh, S, Churchill, R, Hotopf, M (2007). Mental capacity in psychiatric patients. British Journal of Psychiatry 191, 291–297.Google Scholar
Owen, GS, Richardson, G, David, AS, Szmukler, G, Hayward, P, Hotopf, M (2008). Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: cross sectional study. BMJ (Clinical Research ed.) 337, a448.Google Scholar
Owen, GS, Szmukler, G, Richardson, G, David, AS, Raymont, V, Freyenhagen, F, Martin, W, Hotopf, M (2013). Decision-making capacity for treatment in psychiatric and medical in-patients: cross-sectional, comparative study. British Journal of Psychiatry 203, 461–467.Google Scholar
Palmer, BW, Jeste, DV (2006). Relationship of individual cognitive abilities to specific components of decisional capacity among middle-aged and older patients with schizophrenia. Schizophrenia Bulletin 32, 98–106.Google Scholar
Palmer, BW, Dunn, LB, Appelbaum, P, Jeste, D (2004). Correlates of treatment-related decision-making capacity among middle-aged and older patients with schizophrenia. Archives of General Psychiatry 61, 230–236.Google Scholar
Palmer, BW, Dunn, LB, Appelbaum, PS, Mudaliar, S, Thal, L, Henry, R, Golshan, S, Jeste, DV (2005). Assessment of capacity to consent to research among older persons with schizophrenia, alzheimer disease, or diabetes mellitus. Archives of General Psychiatry 62, 726–733.Google Scholar
Palmer, BW, Dunn, LB, Depp, CA, Eyler, LT, Jeste, D (2007). Decisional capacity to consent to research among patients with bipolar disorder: comparison with schizophrenia patients and healthy subjects. Journal of Clinical Psychiatry 68, 689–696.Google Scholar
Parmigiani, G, Mandarelli, G, Dacquino, C, Pompili, P, Lelli Chiesa, G, Ferracuti, S (2016). Decisional capacity to consent to clinical research involving placebo in psychiatric patients. Journal of Forensic Sciences 61, 388–393.Google Scholar
Raymont, V, Bingley, W, Buchanan, A, David, AS, Hayward, P, Wessely, S, Hotopf, M (2004). Prevalence of mental incapacity in medical in-patients and associated risk factors: cross-sectional study. Lancet 364, 1421–1427.Google Scholar
Steinert, T, Noorthoorn, EO, Mulder, CL (2014). The use of coercive interventions in mental health care in Germany and the Netherlands. A comparison of the developments in two neighboring countries. Frontiers in Public Health 2, 141.Google Scholar
Szmukler, G, Kelly, BD (2016). We should replace conventional mental health law with capacity-based law. British Journal of Psychiatry 209, 449–453.Google Scholar
Szmukler, G, Daw, R, Callard, F (2014). Mental health law and the UN convention on the rights of persons with disabilities. International Journal of Law and Psychiatry 37, 245–252.Google Scholar
Ventura, J, Lukoff, D, Nuechterlein, KH, Liberman, RP, Green, M, Shaner, A (1993). Appendix 1: brief Psychiatric Rating Scale (BPRS) Expanded Version (4.0) scales, anchor points and administration manual. International Journal of Methods in Psychiatric Research 3, 227–243.Google Scholar