Functional mental capacity is not independent of the severity of psychosis

Rutledge, Emer; Kennedy, Mark; O'Neill, H. Katherine; Kennedy, Harry

doi:10.1016/j.ijlp.2007.11.002

Cited by 33 publications

(33 citation statements)

References 11 publications

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“…The connection between a lack of insight and incapacity has been reported in several recent publications [2,16,19,20,22,24,25,26]. Most convincingly, the study by Owen et al [12] reports that, among a range of psychopathological variables, insight is the best discriminator of capacity status in patients with psychotic and manic disorders, but less so in nonpsychotic disorders.…”

Section: Connections Between Insight and Incapacitymentioning

confidence: 92%

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Acceptance and insight: incapacity to give informed consent

Staden¹

2009

Current Opinion in Psychiatry

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Outline• Abstract • Introduction• Causal connection between mental disorder and particular inabilities• Insight, acceptance and appreciation in assessments of capacity to give informed consent • Connections between insight and incapacity• From insight to acceptance in capacity assessments • Conclusion• References and recommended reading AbstractPurpose of review: To highlight areas for potential refinement in assessments of capacity to give informed consent. Recent findings:The clinical assessment of the patient's capacity to give informed consent may be informed and guided by sophisticated criteria or assessment instruments. The approach of most assessment instruments and the literature on (in)capacity departs from the abilities that underpin giving informed consent. This approach may be refined, however, by assessing clinically for a causal connection between the mental disorder in the mind of a particular person and the particular inability. It may furthermore be refined by assessing that aspect of insight that is best connected to incapacity, for insight has been found to be the best clinical discriminator of capacity status in patients with psychotic and manic disorders. Summary:To find that a person is incapable by virtue of a mental disorder, a causal connection between the mental disorder and the particular inability should be assessed clinically for the very patient.Furthermore, the term 'acceptance' is more apt than 'appreciation' and 'belief' in capturing that aspect of insight by which a person with psychotic and manic disorders may be rendered incapable of giving informed consent.

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Section: Connections Between Insight and Incapacitymentioning

confidence: 92%

“…It involves poor treatment adherence [27,28,29,30], forming a therapeutic alliance [31], and responding to cognitive behavioural therapy [25,32] and fitness to plead . [19].…”

Section: Connections Between Insight and Incapacitymentioning

confidence: 99%

Acceptance and insight: incapacity to give informed consent

Staden¹

2009

Current Opinion in Psychiatry

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“…Rutledgea, Kennedy, O'Neilla, and Kennedy (2008) compared the MacCAT-T to the Positive and Negative Symptom Scale and the General Adaptive Functioning scale, both commonly used clinical instruments. They concluded that while structured assessments offer a basis for judgement of decision-making capacity, functionspecifi c measures of decision making abilities such as those contained in the MacCAT-T produce similar results to measures of mental state and global functioning.…”

Section: Ordersmentioning

confidence: 99%

Capacity, consent, and mental health legislation: Time for a new standard?

O’Brien

2010

Contemporary Nurse

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Recent international reforms in mental health legislation have introduced a capacity test as a criterion for civil commitment. There are proposals that a common test of incapacity should apply in both mental and physical health under a single legislative framework for all cases in which the normally accepted standard of informed consent for treatment is not met. Capacity is a complex concept, but can be reliably assessed in clinical practice. Nurses need to be involved in the policy debate about capacity and consent in mental health care.

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“…Looking especially at clinical competence, previous research highlighted that patients with schizophrenia, bipolar mood disorder and major depression have significant impairments in decisional abilities (Grisso and Appelbaum, 1995; Howe et al, 2005; Appelbaum and Redlich, 2006). Additionally, studies demonstrated that for patients with acute psychosis, treatment consent capacity was related to the extent and severity of symptoms, especially positive symptoms such as delusions and hallucinations (Howe et al, 2005; Rutledge et al, 2008). However, for patients with chronic psychosis, Palmer et al (2004) showed a relationship between cognitive and negative symptoms (unusual thought content, conceptual disorganization) and impaired medical decision-making capacity.…”

Section: Introductionmentioning

confidence: 99%

Behavioral and Psychological Symptoms Impact Clinical Competence in Alzheimer’s Disease

Bertrand

Duinkerken

Landeira-Fernández

et al. 2017

Front. Aging Neurosci.

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Decision-making is considered a fundamental aspect of personal autonomy and can be affected in psychiatric and neurologic diseases. It has been shown that cognitive deficits in dementia impact negatively on decision-making. Moreover, studies highlighted impaired clinical competence in neuropsychiatric disorders, such as schizophrenia and bipolar disorder. In this context, the current study explored the relationship between behavioral and psychological symptoms of dementia (BPSD) and clinical competence, especially the capacity to consent to treatment, in Alzheimer’s disease (AD). Seventy-one patients with mild to moderate AD participated, completing assessments for capacity to consent to treatment, general cognition and neuropsychiatric disturbances. For each neuropsychiatric symptom, patients with and without the particular disturbance were compared on the different subscales of the MacArthur Competence Tool for Treatment (MacCAT-T; Understanding, Appreciation, Reasoning and Expression). The results showed that patients presenting delusions, as well as apathetic patients, had a lower ability to express a clear treatment choice compared to patients without these symptoms. By contrast, patients with dysphoria/depression had higher scores on this variable. Additionally, AD patients with euphoria had more difficulties discussing consequences of treatment alternatives compared to patients without this disturbance. None of the differences were confounded by global cognition. There were no between-group differences in clinical decision-making for patients with hallucinations, agitation/aggression, anxiety, irritability, disinhibition and aberrant motor behavior. These findings highlight the importance of taking BPSD into account when assessing decision-making capacity, especially clinical competence, in AD. Furthermore, reducing BPSD may lead to better clinical competence in patients with AD, as well as to improvements in patients and caregivers’ quality of life.

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Functional mental capacity is not independent of the severity of psychosis

Cited by 33 publications

References 11 publications

Acceptance and insight: incapacity to give informed consent

Acceptance and insight: incapacity to give informed consent

Capacity, consent, and mental health legislation: Time for a new standard?

Behavioral and Psychological Symptoms Impact Clinical Competence in Alzheimer’s Disease

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