The Effect of Psychopathology on the Ability of Schizophrenic Patients to Give Informed Consent

Schachter, Debbie; Kleinman, Irwin; Prendergast, Peter; Remington, Gary; Schertzer, Stephen

doi:10.1097/00005053-199406000-00009

Cited by 37 publications

(17 citation statements)

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“…Early work pointed to the mixed role of psychotic symptoms in decisional impairment. For example, before, during, and after MacArthur, 133,135,149 conceptual disorganization (as measured with the Brief Psychiatric Rating Scale 150 ) was found to be correlated with impaired understanding of treatment disclosures among schizophrenia patients. In more recent studies using the MacCAT-CR and other measures of decisional abilities, psychotic symptoms have not been as strongly or consistently associated with decisional abilities as cognitive functioning (Table 2).…”

Section: Descriptive Studiesmentioning

confidence: 99%

“…45,130 ) In addition, investigators began to examine consent procedures themselves, suspecting that difficulties with informed consent resided at least partially in those procedures and not just in characteristics or symptoms of the patients. Intriguing results emerged from these early studies, including findings that (1) many consent forms and disclosures were inadequate, but even with improved disclosures, many patients continued to have difficulty understanding research; 129 (2) many participants in research did not understand randomization and double-blind procedures and seemed to believe that the research was conducted for their personal benefit; 129,131,132 (3) cognitive symptoms, conceptual disorganization, and acute psychosis were related to decision-making abilities; [133][134][135][136] and (4) patients with neuropsychiatric disorders showed both heterogeneity, as well as strengths, in informed consent contexts (relating both to research and treatment). [134][135][136][137][138][139] The highly innovative multiyear, multisite MacArthur competency study, which laid much of the groundwork for inquiry into decisional abilities, was the largest systematic study of capacity to consent.…”

Section: Descriptive Studiesmentioning

confidence: 99%

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Reviews: Emerging Empirical Evidence on the Ethics of Schizophrenia Research

Dunn

Candilis

Roberts

2005

Schizophrenia Bulletin

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Many challenging ethical questions come with the scientific efforts to understand the nature and treatment of schizophrenia. The empirical study of ethical aspects of schizophrenia research has sought to clarify and resolve many of these questions. In this article we provide an overview of the existing data-based literature on schizophrenia research ethics and outline directions for future inquiry. We examine 5 broad categories of inquiry into the ethics of schizophrenia research: (1) Scientific designs (eg, placebo-controlled studies and medication-free intervals, prodromal and high-risk research, and genetics research); (2) informed consent and decision-making capacity, including assessment of decisional abilities, as well as intervention studies; (3) understanding and perceptions of risk and benefit (including the therapeutic misconception); (4) influences on research participation (including voluntarism, altruism, and other motivations); and (5) key participant safeguards, such as protocol review and participant advocates. We discuss how empirical work in each of these areas answers certain questions and raises new ones. Finally, we highlight important gaps in our understanding of ethically relevant aspects of schizophrenia research and offer a specific research agenda for empirical ethics.

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Section: Descriptive Studiesmentioning

confidence: 99%

Section: Descriptive Studiesmentioning

confidence: 99%

Reviews: Emerging Empirical Evidence on the Ethics of Schizophrenia Research

Dunn

Candilis

Roberts

2005

Schizophrenia Bulletin

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“…Schachter ve arkadaşları, 38 şizofreni hastasın-dan oluşan örneklemde sanrıların, varsanıların ve düşüncelerdeki dağınıklığın onam verme kapasitesini olumsuz etkilediğini görmüşlerdir. [32] Howe ve arkadaşları yatarak tedavi gören 110 (64'ü şizofreni, 25'i şizoaffektif bozukluk, 21'i bipolar bozukluk tanısı almış) katılımcıyı onam verme yeterliliği açısından karşılaştırmışlar ve tanı grupları arasında bir farklılık bulmamışlardır. Özellikle bilişlerle ilgili pozitif belirtiler ve yeterlilik arasında negatif bir ilişki olduğu saptanmıştır.…”

Section: Psikiyatrik Belirtilerunclassified

Informed Consent and Capacity to Give Consent in Mental Disorders

Maçkalı¹

2014

Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychia

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ÖzetSağlık alanında etik davranışları belirleyen dört temel ilke (özerkliğe saygı, faydalı olma, zarar vermeme ve adalet) içinde en çok 'özerkliğe saygı' prensibiyle ilişkili olan bilgilendirilmiş onam aynı zamanda danışanın karar verme hakkı ve hastaya/danışana ve özerkliğine verilen değeri de yansıtır. Bilgilendirilmiş onam, bireyin pek çok farklı seçenek içinden kendisi için en uygun yöntemi seçmek üzere mantıklı bir karar almasını ve klinisyen ile etkileşimi de kapsayan bilgi paylaşım sürecidir. Bu kavram gizliliğin sınırlarına, yetkinliğe, uygun ve yeterli bilgi paylaşımına, gönüllülüğe dair ölçütle-rin neler olduğuna ilişkin klinisyenlere ışık tutmaktadır. Bir kuramsal derleme olan bu çalışmada bilgilendirilmiş onam kavramının tanımları ve içeriği paylaşıldıktan sonra, psikoterapistlerin psikoterapi sürecinde kullanacakları onam formunun neleri kapsaması, bilgilendirilmiş onam bileşenleri irdelenmiştir. Ardından yukarıda belirtilen tanı grupları kapsamında ruhsal bozukluklar ve onam verme kapasitesi ilişkisi incelenmiştir. AbstractAmong four basic principles (respect for autonomy, beneficence, non-malfeasance, and justice) which determine ethical behaviors in healthcare, informed consent is mostly related to 'respect for autonomy'. Also, it reflects patient/client's right for decision and the value given for the client and his/her autonomy. Informed consent is an information sharing process including both rational decision-making about the most appropriate method among many different options and the interaction between the clinician and the client. This concept sheds light on criteria regarding the limits of confidentiality, competency, appropriate and sufficient information sharing and voluntariness. In this theoretical review, the definitions and the content of informed consent were shared, and then a section regarding the required content of informed consent for psychotherapy process was provided. Then, the components of informed consent were discussed and the relationship between capacity to consent and mental disorders in terms of aforementioned diagnostic groups was examined.

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“…schizophrenia are able to participate in medical decision making, the severity of their symptoms may reduce the ability of some patients to understand the information presented during the informed consent process (5,6).…”

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confidence: 99%

Psychiatrists' Documentation of Informed Consent: A Representative Survey

Schachter

Kleinman

2006

Can J Psychiatry

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M edical practitioners obtain informed consent for treatment prior to all medical interventions. This process reflects our respect for the autonomy of the individual. The elements of informed consent are that the patient has the capacity or ability to consent, that the individual has received an adequate disclosure of the relevant information, and that the patient provides consent voluntarily (1). The informed consent process gives patients information about the nature of the proposed treatment, the benefits and risks of the proposed treatment, and the benefits and risks of alternative treatments, including the option of no treatment. The standard of disclosure is to disclose the information that a reasonable patient in the patient's situation would want to have to make an informed decision (2,3). Canadian judicial decisions have stated that all material risks need to be disclosed as part of the informed consent disclosure (3,4). Informed consent therefore permits patients to make treatment decisions according to their own values and beliefs. The informed consent process for antipsychotic medications is particularly important and complex, for several reasons. First, many patients for whom antipsychotic medications are prescribed have schizophrenia. Although many patients with

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The Effect of Psychopathology on the Ability of Schizophrenic Patients to Give Informed Consent

Cited by 37 publications

References 0 publications

Reviews: Emerging Empirical Evidence on the Ethics of Schizophrenia Research

Reviews: Emerging Empirical Evidence on the Ethics of Schizophrenia Research

Informed Consent and Capacity to Give Consent in Mental Disorders

Psychiatrists' Documentation of Informed Consent: A Representative Survey

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