Evaluation of the capacity to consent to treatment among patients with bipolar disorder: Comparison between the acute psychopathological episode and the stable mood phase

Koukopoulos, Alexia E.; Mandarelli, Gabriele; Maglio, Gino; Macellaro, Monica; Cifrodelli, Mariarosaria; Kotzalidis, Georgios D.; Tarsitani, Lorenzo; Biondi, Massimo; Ferracuti, Stefano

doi:10.1016/j.jadr.2020.100037

Cited by 3 publications

(3 citation statements)

References 54 publications

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“…Fourth, although patients with cognitive impairment were included in the exclusion criteria, this study did not conduct a thorough evaluation of patients' ability to express consent or to conduct the study. Considering that the populations of bipolar patients, even in the euthymic phase, have varying degrees of ability to express consent, it may be necessary to carry out a preliminary assessment of the ability to express consent to the study [ 61 ]. Likewise, if the patient's ability to conduct the study had been checked more closely, the number of dropouts due to handling error could have been reduced.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of factors associated with medication adherence in patients with bipolar disorder using a medication event monitoring system: a 6‐month follow‐up prospective study

et al. 2022

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Background Non-adherence in patients with bipolar disorder (BD) results in symptoms, such as aggravation, BD recurrence, emergency room visits, re-hospitalization, and poor psychosocial outcomes. Though non-adherence rates have been reported to range between 30–50% in patients with BD, the problem of adherence is often either overlooked by the physician or denied by the patient. An essential first step to enhancing medication adherence is to objectively estimate adherence. The Medication Event Monitoring System (MEMS), which is a pill bottle cap with a microprocessor, is an accurate device for assessing medication adherence. Using the MEMS, we aimed to measure medication adherence in patients with BD and evaluate the factors associated with and 6-month changes in medication adherence. Methods Participants with BD were recruited from the psychiatric outpatient clinic of the Korea University Guro Hospital. The medication adherence of each participant was assessed using the MEMS, a self-report, pill count, and clinician rating. MEMS-measured adherence was reassessed after 6 months. Patient demographics were recorded and clinical assessments were conducted. Data were analyzed using Kappa statistics and Pearson’s correlation analysis. Results Of the 59 participants, 50 records were included in the analysis. Patient adherence and adherence rate assessed by the MEMS were lower than those assessed by the other measures. MEMS-measured adherence was correlated more closely with pill counts than with self-reports or clinician ratings. MEMS-measured adherence was negatively associated with prescription duration and the Brief Psychiatric Rating Scale—Affect Subscale Score. Six-month changes in MEMS-measured adherence were positively associated with attitude toward drugs and negatively associated with weight gain assessed by the Udvalg for Kliniske Undersøgelser Side Effect Rating Scale. Conclusions Clinicians may have to consider the limited accuracy of self-reporting and clinician rating methods and exercise caution when assessing the medication adherence of patients with BD using these methods. Our findings may assist clinicians in the assessment and improvement of medication adherence in patients with BD and, consequently, may be useful for the treatment and prevention of BD recurrence.

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Section: Discussionmentioning

confidence: 99%

Evaluation of factors associated with medication adherence in patients with bipolar disorder using a medication event monitoring system: a 6‐month follow‐up prospective study

et al. 2022

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“…The CAT-PAD consists of three subscales: understanding (rated 0-20), appreciation (rated 0-6), and reasoning (rated 0-10), totaling 18 items. Its construct is similar to the MacCAT-T Alternative Treatment (AT) variant, which measures the ability to make a valid choice between two proposed alternative treatments, including the current one, in case of a possible future acute phase of illness [29].…”

Section: Studies Participants and Treatment Characteristicsmentioning

confidence: 99%

“…However, it is worth noting that this data remains somewhat controversial [27,28]. Koukopoulos et al [29] found that patients hospitalized for a manic/hypomanic episode scored worse than outpatients in Understanding, Reasoning, and Expressing a choice, but not in Appreciation. Outpatients in a phase of clinical stability were more capable in the dimension of Understanding the characteristics of an alternative advance treatment decision.…”

Section: Introductionmentioning

confidence: 99%

Capacity to Consent in Healthcare: A Systematic Review and Meta-Analysis Comparing Patients with Bipolar Disorders and Schizophrenia Spectrum Disorders

Morena,

Lippi,

Di Fazio

et al. 2024

Medicina

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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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Clinical and legal issues of inmates’ food refusal: the importance of decision-making capacity assessment

Petroni,

Mandarelli,

Parmigiani

et al. 2024

International Review of Psychiatry

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Evaluation of the capacity to consent to treatment among patients with bipolar disorder: Comparison between the acute psychopathological episode and the stable mood phase

Cited by 3 publications

References 54 publications

Evaluation of factors associated with medication adherence in patients with bipolar disorder using a medication event monitoring system: a 6‐month follow‐up prospective study

Evaluation of factors associated with medication adherence in patients with bipolar disorder using a medication event monitoring system: a 6‐month follow‐up prospective study

Capacity to Consent in Healthcare: A Systematic Review and Meta-Analysis Comparing Patients with Bipolar Disorders and Schizophrenia Spectrum Disorders

Clinical and legal issues of inmates’ food refusal: the importance of decision-making capacity assessment

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