Prevalence and correlates of adequate performance on a measure of abilities related to decisional capacity: Differences among three standards for the MacCAT-CR in patients with schizophrenia

Dunn, Laura B.; Palmer, Barton W.; Appelbaum, Paul S.; Saks, Elyn R.; Aarons, Gregory A.; Jeste, Dilip V.

doi:10.1016/j.schres.2006.08.005

Cited by 54 publications

(49 citation statements)

References 43 publications

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“…When such assessments are done by means of formal instruments such as the MacCAT-T, suggesting these refinements does not question the validity or the reliability of them, but making these refinements to the instruments aims to improve, in particular, the content validity of such instruments. To improve the content validity in this way will be congruent with the calls for further refinement of capacity assessment procedures [36].…”

Section: Resultsmentioning

confidence: 85%

“…Some of these dimensions of insight overlap with the understanding and the reasoning abilities in the MacCAT-T, but it is, in particular, failure of appreciation that is coupled with a lack of insight [10,18,36]. The English and Welsh Law Commission favoured the term 'using' instead of 'appreciation' [12].…”

Section: From Insight To Acceptance In Capacity Assessmentsmentioning

confidence: 99%

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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: Resultsmentioning

confidence: 85%

Section: From Insight To Acceptance In Capacity Assessmentsmentioning

confidence: 99%

Acceptance and insight: incapacity to give informed consent

Staden¹

2009

Current Opinion in Psychiatry

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“…1) (Weinstock et al 1984;Veliz & James, 1987;Norko et al 1990;Bean et al 1994;Grisso et al , 1997Carpenter et al 2000;Moser et al 2002Moser et al , 2005Moser et al , 2006Valletto et al 2002;Wong et al 2000Wong et al , 2005Bellhouse et al 2003;Kovnick et al 2003;Vollmann et al 2003;Cohen et al 2004;Palmer et al 2004Palmer et al , 2005Srebnik et al 2004;Cairns et al 2005;Eyler et al 2005Eyler et al , 2007Koren et al 2005;Stroup et al 2005;Candilis et al 2006Candilis et al , 2008Dunn et al 2007;Moye et al 2008;Kavanagh et al 2008;Jeste et al 2009;Owen et al 2009aOwen et al , 2011De Marco et al 2010;Capdevielle et al 2009;Linder et al 2012;Di & Cheng, 2013;Fischer et al 2013;Kumar et al 2013;Lan et al 2013;Raffard et al 2013;Skipworth et al 2013;Chiu et al 2014). A clinician with expertise in the field [G Shields (GS)] ...…”

Section: Resultsmentioning

confidence: 99%

“…a Dunn et al (2007) used three standards as their binary outcome so the 'most' standard was selected as this required scoring in 'understanding', 'appreciation', and 'reasoning', rather than the other two standards, which just required scores in 'understanding'. Dunn also used two presented data on two summary summary neurocognitive scores (DRS and a neurocognitive z score), the neurocognitive z score is presented here.…”

Section: Dmc-t V Dmc-r In Schizophreniamentioning

confidence: 99%

Diversity or disarray? A systematic review of decision-making capacity for treatment and research in schizophrenia and other non-affective psychoses

et al. 2017

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Background. Valid consent for treatment or research participation requires that an individual has decision-making capacity (DMC), which is the ability to make a specific decision. There is evidence that the psychopathology of schizophrenia can compromise DMC. The objective of this review was to examine the presence or absence of DMC in schizophrenia and the socio-demographic/psychopathological factors associated.Methods. We searched three databases Embase, Ovid MEDLINE(R), and PsycINFO for studies reporting data on the proportion of DMC for treatment and research (DMC-T and DMC-R), and/or socio-demographic/psychopathological associations with ability to make such decisions, in people with schizophrenia and related illnesses.Results. A total of 40 studies were identified. While high levels of heterogeneity limited direct comparison, meta-analysis of inpatient data showed that DMC-T was present in 48% of people. Insight was strongly associated with DMC-T. Neurocognitive deficits were strongly associated with lack of DMC-R and to a lesser extent DMC-T. With the exception of years of education, there was no evidence for an association with socio-demographic factors.Conclusions. Insight and neurocognitive deficits are most closely associated with DMC in schizophrenia. The lack of an association with socio-demographic factors dispels common misperceptions regarding DMC and characteristics such as age. Although our results reveal a wide spectrum of DMC-T and DMC-R in schizophrenia, this could be partly due to the complexity of the DMC construct and the heterogeneity of existing studies. To facilitate systematic review research, there is a need for improvement within research study design and increased consistency of concepts and tools.

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“…General consensus exists that as the degree of risk increases, a higher level of capacity is desirable. Thus, no particular level of ability is determinative of adequate capacity in all circumstances [35]. Mean levels of MacCAT-CR performance vary widely within diagnostic groups.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Capacity to Consent to Research Among Psychiatric Outpatients: Prevalence and Associated Factors

Morán-Sánchez¹,

Luna

Pérez-Cárceles

2015

Psychiatr Q

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Mental capacity is an emerging ethical legal concept in psychiatric settings but its relation to clinical parameters remains yet uncertain. The aim of this study is to evaluate the association between capacity to consent research and different psychiatric disorders and to characterize predictors of impairments in research decision-making capacity across diagnostic groups in a cross-sectional study. 139 consecutively referred outpatients with DSM-IV TR diagnoses of psychotic, mood and anxiety disorders were interviewed and a binary judgment of incapacity was made guided by the MacArthur competence assessment tool for consent research (MacCAT-CR). Demographics and clinical information were assessed by cases notes. Patients with anxiety disorders performed the best on the MacCAT-CR, and patients with psychotic disorders had the worst performance, however, there was considerable heterogeneity within each group. Cognitive impairment and global functioning were strongly correlated with MacCAT-CR subscales scores. 30.6% participants lacked research-related decisional capacity. Low Understanding score OR 0.07 (IC 95% 0.01-0.32) and Low Reasoning score OR 0.30 (IC 95% 0.11-0.82) were the factors most closely associated with lack of capacity. No absolute statements about decisional capacity can be driven merely due to the diagnosis. We found several risk factors which may be considered to decide which populations may require more thorough capacity assessments. The issues under consideration in the present study are by no means unique to people with psychiatric conditions. Ignoring this caveat, risks further inappropriate stigmatization of those with serious mental illness.

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Prevalence and correlates of adequate performance on a measure of abilities related to decisional capacity: Differences among three standards for the MacCAT-CR in patients with schizophrenia

Cited by 54 publications

References 43 publications

Acceptance and insight: incapacity to give informed consent

Acceptance and insight: incapacity to give informed consent

Diversity or disarray? A systematic review of decision-making capacity for treatment and research in schizophrenia and other non-affective psychoses

Assessment of Capacity to Consent to Research Among Psychiatric Outpatients: Prevalence and Associated Factors

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