Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-10T08:30:02.076Z Has data issue: false hasContentIssue false
  • English
  • Français

Regaining mental capacity for treatment decisions following psychiatric admission: a clinico-ethical study

Published online by Cambridge University Press:  29 March 2010

G. S. Owen ,
I. Chis. Ster ,
A. S. David ,
G. Szmukler ,
P. Hayward ,
G. Richardson  and
M. Hotopf
G. S. Owen*
Affiliation:
Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, Western Education Centre, London, UK
I. Chis. Ster
Affiliation:
Department of Biostatistics, Institute of Psychiatry, King's College London, UK MRC Centre for Paediatric Epidemiology and Biostatistics, University College London, UK
A. S. David
Affiliation:
Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, Western Education Centre, London, UK
G. Szmukler
Affiliation:
Health Service Research Department, Institute of Psychiatry, King's College London, UK
P. Hayward
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, UK
G. Richardson
Affiliation:
School of Law, King's College London, UK
M. Hotopf
Affiliation:
Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, Western Education Centre, London, UK
*
*Address for correspondence: Dr G. S. Owen, Wellcome Trust Clinical Fellow, Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, Western Education Centre, Cutcombe Road, London SE5 9RJ, UK. (Email: Gareth.1.Owen@kcl.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Mental capacity is an emerging ethical legal concept in psychiatric settings but its relation to clinical parameters remains uncertain. We sought to investigate the associations of regaining capacity to make treatment decisions following approximately 1 month of in-patient psychiatric treatment.

Method

We followed up 115 consecutive patients admitted to a psychiatric hospital who were judged to lack capacity to make treatment decisions at the point of hospitalization. We were primarily interested in whether the diagnosis of schizophrenia and schizoaffective disorder associated with reduced chances of regaining capacity compared with other diagnoses and whether affective symptoms on admission associated with increased chances of regaining capacity. In addition, we examined how change in insight was associated with regaining capacity in schizophrenia, bipolar affective disorder (BPAD)-mania, and depression.

Results

We found evidence that the category of ‘schizophrenia or schizoaffective disorder’ associated with not regaining capacity at 1 month compared with BPAD-mania [odds ratio (OR) 3.62, 95% confidence intervals (CI) 1.13–11.6] and depression (OR 5.35, 95% CI 1.47–9.55) and that affective symptoms on admission associated with regaining capacity (OR 1.23, 95% CI 1.02–1.48). In addition, using an interaction model, we found some evidence that gain in insight may not be a good indicator of regaining capacity in patients with depression compared with patients with schizophrenia and BPAD-mania.

Conclusions

We suggest that clinico-ethical studies using mental capacity provide a way of assessing the validity of nosological and other clinical concepts in psychiatry.

Keywords

Empirical ethicsethicsinsightmental capacitynosologypsychopathology
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 1 , January 2011 , pp. 119 - 128
Copyright
Copyright © Cambridge University Press 2010

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

Alloy, LB, Abramson, LY (1979). Judgment of contingency in depressed and nondepressed students: sadder but wiser? Journal of Experimental Psychology General 108, 441–485.CrossRefGoogle ScholarPubMed
Appelbaum, PS (1995). Almost a Revolution: Mental Health Law and the Limits of Change. Oxford University Press: Oxford.Google Scholar
Appelbaum, PS (2003). Law & psychiatry: dangerous persons, moral panic, and the uses of psychiatry. Psychiatric Servives 54, 441–442.CrossRefGoogle ScholarPubMed
Appelbaum, PS (2007). Assessment of patient's competence to consent to treatment. The New England Journal of Medicine 357, 1834–1840.CrossRefGoogle ScholarPubMed
Appelbaum, PS, Grisso, T (1995). The MacArthur Treatment Competence Study. I: mental illness and competence to consent to treatment. Law & Human Behavior 19, 105–126.CrossRefGoogle Scholar
Cairns, R, Maddock, C, David, AS, Hayward, P, Richardson, G, Szmukler, G, Hotopf, M (2005). Prevalence and predictors of mental incapacity in psychiatric in-patients. The British Journal of Psychiatry 187, 379–385.CrossRefGoogle ScholarPubMed
Cutting, J (1997). Principles of Psychopathology. Oxford Medical Publications: Oxford.CrossRefGoogle Scholar
Fennell, P (1996). Treatment without Consent: Law, Psychiatry and the Treatment of Mentally Disordered People since 1845. Routledge: London.Google Scholar
Ghaemi, SN (2007). Feeling and time: the phenomenology of mood disorders, depressive realism, and existential psychotherapy. Schizophernia Bulletin 33, 122–130.CrossRefGoogle ScholarPubMed
Ghaemi, SN, Rosenquist, KL (2004). Insight in mood disorder: an empirical and conceptual review. In Insight and Psychosis (ed. Amador, X. and David, A. S.), pp. 101–115. Oxford University Press: Oxford.Google Scholar
Grisso, T, Appelbaum, PS (1995). Comparison of standards for assessing patients' capacities to make treatment decisions. American Journal of Psychiatry 152, 1033–1037.Google ScholarPubMed
Grisso, T, Appelbaum, PS (1998). Assessing Competence to Consent to Treatment. Oxford University Press: New York.CrossRefGoogle Scholar
Jacob, R, Clare, ICH, Holland, A, Watson, PC, Maimaris, C, Gunn, M. 2005. Self harm capacity and refusal of treatment: implications for emergency practice. A prospective observational study. Emergency Medicine Journal 22, 799–802.CrossRefGoogle ScholarPubMed
Jeste, DV, Palmer, BW, Golshan, S, Eyler, LT, Dunn, LB, Meeks, T, Glorioso, D, Fellows, I, Kraemer, H, Appelbaum, PS (2009). Multimedia consent for research in people with schizophrenia and normal subjects: a randomized controlled trial. Schizophrenia Bulletin 35, 719–729.CrossRefGoogle ScholarPubMed
Kirkbride, JB, Fearon, P, Morgan, C, Dazzan, P, Morgan, K, Tarrant, J, Lloyd, T, Holloway, J, Hutchinson, G, Leff, JP, Mallett, RM, Harrison, GL, Murray, RM, Jones, PB (2006). Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study. Archives of General Psychiatry 63, 250–258.CrossRefGoogle ScholarPubMed
Kirmayer, LJ, Corin, E, Jarvis, GE (2004). Inside knowledge: cultural constructions of insight in psychosis. In Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders (ed. Amador, X. and David, A.), pp. 197–229. Oxford University Press: Oxford.Google Scholar
Leonhard, K (1957). The Classifcation of Endogenous Psychoses. Irvington Publishers, Inc.: New York.Google Scholar
Okai, D, Owen, G, McGuire, H, Singh, S, Churchill, R, Hotopf, M (2007). Mental capacity in psychiatric patients: Systematic review. British Journal of Psychiatry 191, 291–297.CrossRefGoogle ScholarPubMed
Owen, GS, David, AS, Richardson, G, Szmuker, G, Hayward, P, Hotopf, M (2009). Mental capacity, diagnosis and insight. Psychological Medicine 39, 1389–1398.CrossRefGoogle ScholarPubMed
Owen, GS, Richardson, G, David, A, Szmuker, G, Hayward, P, Hotopf, M (2008). Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: a cross sectional study. British Medical Journal 337, 448.CrossRefGoogle Scholar
Pini, S, Cassano, GB, Dell'Osso, L, Amador, XF (2001). Insight into illness in schizophrenia, schizoaffective disorder, and mood disorders with psychotic features. American Journal of Psychiatry 158, 122–125.CrossRefGoogle ScholarPubMed
PsychCorp (1999). Wechsler Abbreviated Scale of Intelligence – Manual. PsychCorp: Oxford, UK.Google Scholar
Richardson, G (2005). The European Convention and mental health law in England and Wales: moving beyond process. International Journal of Law and Psychiatry 28, 127–139.CrossRefGoogle Scholar
Richardson, G (2007). Balancing autonomy and risk: a failure of nerve in England and Wales? International Journal of Law and Psychiatry 30, 71–80.CrossRefGoogle Scholar
Royston, P (2004). Multiple imputation of missing values. Stata Journal 4, 227–241.CrossRefGoogle Scholar
Royston, P (2005 a). Multiple impuation of missing values: update of ice. Stata Journal 5, 527–536.CrossRefGoogle Scholar
Royston, P (2005 b). Multiple imputation of missing values: update. Stata Journal 5, 188–201.CrossRefGoogle Scholar
Rubin, DB (1976). Inference and missing data (with discussion). Biometrika 63, 581–592.CrossRefGoogle Scholar
Sanz, M, Constable, G, Lopez-Ibor, I, Kemp, R, David, AS (1998). A comparative study of insight scales and their relationship to psychopathological and clinical variables. Psychological Medicine 28, 437–446.CrossRefGoogle ScholarPubMed
Singh, SP, Greenwood, N, White, S, Churchill, R (2007). Ethnicity and the Mental Health Act 1983. British Journal of Psychiatry 191, 99–105.CrossRefGoogle ScholarPubMed
The Law Commission (1995). Mental Incapacity. HMSO: London.Google Scholar
van Os, J, McKenna, P (2003). Does schizophrenia exist? Maudsley Discussion Paper, No. 12. (http://www.iop.kcl.ac.uk/departments/?locator=525). Accessed 23 January 2010.Google Scholar
Ventura, J, Green, MF, Shaner, A, Liberman, RP (1993). Training and quality assurance with the Brief Psychiatric Rating Scale: ‘the drift buster’. International Journal of Methods in Psychiatric Research 3, 221–244.Google Scholar
Vollmann, J, Bauer, A, Danker-Hopfe, H, Helmchen, H (2003). Competence of mentally ill patients: a comparative empirical study. Psychological Medicine 33, 1463–1471.CrossRefGoogle ScholarPubMed
Wong, JG, Clare, ICH, Holland, AJ, Watson, PC, Gunn, M (2000). The capacity of people with a ‘mental disability’ to make a health care decision. Psychological Medicine 30, 295–306.CrossRefGoogle ScholarPubMed
WHO (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO: Geneva.Google Scholar