Mental capacity to consent to treatment in anorexia nervosa: explorative study

Abstract

BackgroundMental capacity to consent to treatment in anorexia nervosa is a neglected area in clinical decision-making.AimsTo examine clinical and neuropsychological parameters associated with diminished mental capacity in anorexia nervosa.MethodAn explorative study was conducted in 70 adult female patients with severe anorexia nervosa. Mental capacity to consent to treatment was assessed by experienced psychiatrists. Further measurements included the MacCAT-T (to assess mental capacity status), a range of clinical measures (body mass index (BMI) and comorbidity) and neuropsychological tests assessing decision-making, central coherence and set-shifting capacity.ResultsDiminished mental capacity occurs in a third of patients with severe anorexia nervosa and is associated with a low BMI, less appreciation of illness and treatment, previous treatment for anorexia nervosa, low social functioning and poor set shifting.ConclusionsAssessment of diminished mental capacity in anorexia nervosa requires careful evaluation of not only BMI, but also the degree of appreciation of illness and treatment, history and the tendency to have a rigid thinking style.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Mental capacity to consent to treatment and the association with outcome: A longitudinal study in patients with anorexia nervosa

“…It has good interrater reliability and construct validity and has been used in mental capacity studies in several psychiatric populations 26 . As previously reported, 29 appreciation of disorder and treatment was significantly lower in the group with diminished mental capacity. Therefore, we repeated this MacCAT-T measurement at follow-up.…”

“…Therefore, a longitudinal study was conducted in our treatment centre. Baseline results from this sample of 70 adult people who are severely ill with AN were reported on previously 29 . One-third of participants had diminished mental capacity at baseline (as assessed by psychiatrists).…”

Perspectives on Involuntary Treatment of Anorexia Nervosa

“…Motivation to change has also been shown to increase gradually during admission (33). These changes could reflect an improvement in the decision-making capacity found in a third of patients admitted with anorexia nervosa (29) or patients giving up their resistance to treatment (23). Hence, changes in motivation and the perception of admission need have been a crucial argument for persuading patients into admission.…”

“…Attitude toward treatment is an important topic when discussing the involuntary treatment of anorexia nervosa, as these patients often lack the motivation to change or refuse to accept they have a treatment need (28). Their decision-making capacity and their attitudes toward treatment are affected by the ego syntonic nature of the disease (23,29,30). At the intrapsychic level, Seed et al (23) argue that the self is occupied by the illness and Tan et al (31) describe how patients' value system changes because of anorexia nervosa, resulting in weight-related issues overshadowing other aspects of their life.…”

Developments in the psychological treatment of anorexia nervosa and their implications for daily practice

“…The study offers accurate information on drug treatment in eating disorder by providing an overview of the evidence so far. However, it is important to consider a patient's illness-related impairments in making decisions: patients with an eating disorder may be impaired in the emotional and reward-based components of decision-making [ 47 ]. These play an important role, next to intellectual and rational decision-making, in food-related decisions.…”