Evaluating capacities in persons with serious mental illness.

Abstract

Capacity for psychiatric treatment consent and independent living are com mon concerns in working with individuals with schizophrenia in an inpatient psychiatric setting.• Core symptoms of schizophrenia, such as cognitive deficits, negative symp toms (e.g., apathy or impoverished speech), and positive symptoms (e.g., delusions or thought disorder), may compromise capacity in different ways.• Capacity evaluations for individuals in inpatient psychiatric settings may present multiple challenges, including but not limited to assessment in the context of psychiatric instability, the establishment and maintenance of rap port, and the assessment and optimization of task engagement. DEFINITION OF THE ISSUEPersons with schizophrenia may experience diminished decision-making and functional capacity. Common domains of concern in this population, particularly in an inpatient psychiatric setting, include the capacity to consent to psychiatric treatment and the capacity to live independently. An evaluation of decision-making capacity in adults and older adults with schizophrenia in anCopyright American Psychological Association. Not for further distribution. Symptom ProfileSchizophrenia and its variants are distinguished symptomatically from other mental health disorders by their prominent positive (e.g., thought disorder, hallucinations, and delusions) and negative (e.g., deficits in motivation, pleasure, speech, and emotion expression) symptoms. The Diagnostic and Statistical Manual of Mental Disorders (fifth ed.; DSM-5; American Psychiatric Association, 2013) presents a commonly used classification system for differentiating schizophrenia and its variants, which include delusional disorder, brief psychotic disorder, schizophreniform disorder, schizoaffective disorder, and schizotypal personality disorder (American Psychiatric Association, 2013). Although all of the diagnoses, except schizotypal personality disorder, share an emphasis on the presence of delusions or hallucinations (or both), the diagnoses are largely differentiated from one another by the presence, prominence, or duration of these and other positive and negative symptoms. Symptom Onset and CourseSchizophrenia occurs in approximately 4.0 per 1,000 individuals over their lifetime (Saha, Chant, Welham, & McGrath, 2005), and the prevalence in older adults may be similar to that in young adults (Meesters et al., 2012). Although schizophrenia is associated with a shorter life expectancy (Olfson, Gerhard, Huang, Crystal, & Stroup, 2015), many individuals with schizophrenia will become older adults, as the number of aging individuals with a schizophrenia diagnosis is increasing in concert with the general aging of the population (Cohen et al., 2000).