Decisional capacity in mental illness and substance use disorders: empirical database and policy implications

Jeste, Dilip V.; Saks, J.D. Elyn

doi:10.1002/bsl.707

Cited by 45 publications

(28 citation statements)

References 93 publications

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“…(DSM-IV-TR) criteria [25]; and the ability to speak French. The exclusion criteria was a reduced capacity to consent [26]. Patients were evaluated at baseline (t0), and a subsample was retested at 6 months to explore sensitivity to change (t1).…”

Section: Methodsmentioning

confidence: 99%

Toward Meeting the Needs of Homeless People with Schizophrenia: The Validity of Quality of Life Measurement

et al. 2013

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ObjectiveTo provide new evidence regarding the suitability of using quality of life (QoL) measurements in homeless people with schizophrenia, we assess the acceptability and psychometric properties of a specific QoL instrument (S-QoL 18) in a population of homeless people with schizophrenia, and we compare their QoL levels with those observed in non-homeless people with schizophrenia.MethodsThis multi-centre prospective study was conducted in the following 4 French cities: Lille, Marseille, Paris and Toulouse. Two hundred and thirty-six homeless patients with schizophrenia were recruited over a 12 month-period. The S-QoL 18 was tested for construct validity, reliability, external validity and sensitivity to change. The QoL of the 236 homeless patients was compared with 236 French age- and sex-matched non-homeless patients with schizophrenia.ResultsThe eight-factor structure of the S-QoL 18 was confirmed by confirmatory factor analysis (RMSEA = 0.035, CFI = 0.95, GFI = 0.99 and SRMR = 0.015). Internal consistency, reliability and sensitivity to change were satisfactory. External validity was confirmed via correlations between S-QoL 18 dimension scores and SF-36, symptomatology and recovery scores. The percentage of missing data did not exceed 5%. Finally, homeless patients had significantly lower QoL levels than non-homeless patients with schizophrenia.ConclusionsThese results demonstrate the satisfactory acceptability and psychometric properties of the S-QoL 18, suggesting the validity of QoL measurement among homeless patients with schizophrenia. Our study also reported that QoL levels in homeless patients with schizophrenia were dramatically low, highlighting the need for new policies to eradicate homelessness and tackle poverty.

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Section: Methodsmentioning

confidence: 99%

Toward Meeting the Needs of Homeless People with Schizophrenia: The Validity of Quality of Life Measurement

et al. 2013

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“…Addiction-related damage to distributed neural networks responsible for emotional processing may compromise emotionality and decision-making in ways similar to the dementias or ventromedial prefrontal cortex lesions [103][104][105][106][107]. This empirical evidence has policy implications [108]. In the same way that much of bodily processing is accomplished by automatic or non-conscious processes [22], addicts are likely to experience some aspects of addictionfostering decisions like drug-seeking as being outside their conscious control.…”

Section: Neuroethics Of Addiction Research and Treatmentmentioning

confidence: 98%

The Neuroethics of Pleasure and Addiction in Public Health Strategies Moving Beyond Harm Reduction: Funding the Creation of Non-Addictive Drugs and Taxonomies of Pleasure

Mackenzie

2010

Neuroethics

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We are unlikely to stop seeking pleasure, as this would prejudice our health and well-being. Yet many psychoactive substances providing pleasure are outlawed as illicit recreational drugs, despite the fact that only some of them are addictive to some people. Efforts to redress their prohibition, or to reform legislation so that penalties are proportionate to harm have largely failed. Yet, if choices over seeking pleasure are ethical insofar as they avoid harm to oneself or others, public health strategies should foster ethical choice by moving beyond current risk management practices embodied in the harm reduction movement. The neuroscience of pleasure has much to offer neuroethics and public health strategies. Distinguishing between 'wanting' and 'liking' fosters new understandings of addiction. These hold promise for directing the search for pharmacotherapies which prevent addiction and relapse or disrupt associated neuromechanisms. They could inform new research into creating lawful psychoactive substances which give us pleasure without provoking addiction. As the health and well being of human and other animals rests upon the experience of pleasure, this would be an ethical objective within public health strategy. Were ethical and neurobiological obstacles to ending addiction to be overcome, problems associated with excessive consumption, the lure of unlawful psychoactive substances and the paucity of lawful means to achieve pleasurable altered states would remain. Nonaddictive designer drugs, which reliably provided lawful access to pleasures and altered states, would ameliorate these public health concerns insofar as they fostered citizens' informed, ethical choices according to a neurobiological taxonomy of pleasures.

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“…The issue of whether drug dependent patients have diminished capacity has been raised [28]. Even if not acutely intoxicated, drug craving, or changes in motivation and decision making associated with addiction might impair capacity [40] [41]. In CTN-0051 this concern was addressed through a thorough informed consent process.…”

Section: Ethical Issues Encountered In the Design Processmentioning

confidence: 99%

Ethical and clinical safety considerations in the design of an effectiveness trial: A comparison of buprenorphine versus naltrexone treatment for opioid dependence

Nunes

Lee²,

Sisti

et al. 2016

Contemporary Clinical Trials

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We examine ethical challenges encountered in the design of an effectiveness trial (CTN-0051; X:BOT), comparing sublingual buprenorphine-naloxone (BUP-NX), an established treatment for opioid dependence, to the newer extended-release injectable naltrexone (XR-NTX). Ethical issues surrounded: 1) Known poor effectiveness of one possible, commonly used Treatment as Usual control condition—detoxification followed by counseling without medication; 2) The role of patients' preferences for treatments, given that treatments were clinically approved and available to the population; 3) Differences between the optimal “usual treatment” clinical settings for different treatments making it challenging to design a fair comparison; 4) Vested interest groups favoring different treatments exerting potential influence on the design process; 5) Potentially vulnerable populations of substance users and prisoners; 6) Potential therapeutic misconception in the implementation of safety procedures; and 7) High cost of a large trial limiting questions that could be addressed. We examine how the design features underlying these ethical issues are characteristic of effectiveness trials, which are often large trials that compare treatments with varying degrees of existing effectiveness data and familiarity to patients and clinicians, in community-based treatment settings, with minimal exclusion criteria that could involve vulnerable populations. Hence, investigators designing effectiveness trials may wish to remain alert to the possibility of similar ethical issues.

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Decisional capacity in mental illness and substance use disorders: empirical database and policy implications

Cited by 45 publications

References 93 publications

Toward Meeting the Needs of Homeless People with Schizophrenia: The Validity of Quality of Life Measurement

Toward Meeting the Needs of Homeless People with Schizophrenia: The Validity of Quality of Life Measurement

The Neuroethics of Pleasure and Addiction in Public Health Strategies Moving Beyond Harm Reduction: Funding the Creation of Non-Addictive Drugs and Taxonomies of Pleasure

Ethical and clinical safety considerations in the design of an effectiveness trial: A comparison of buprenorphine versus naltrexone treatment for opioid dependence

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