The recovery of factors associated with decision-making capacity in individuals with psychosis

Fernández, Césareo Fernández; Kennedy, Harry; Kennedy, Mark

doi:10.1192/bjpo.bp.116.004226

Cited by 13 publications

(8 citation statements)

References 27 publications

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“…These limitations notwithstanding, the study provides evidence that a widely studied psychological mechanism associated with psychotic symptoms, the JTC bias, 13,14 may influence treatment decision-making capacity in this group. In addition, the study has also demonstrated that capacity in psychosis is modifiable by intervention, which is consistent with previous observational research, 43 and that it is feasible to perform RCTs with capacity as a primary outcome.…”

Section: Study Limitationssupporting

confidence: 87%

The Effect of Reducing the “Jumping to Conclusions” Bias on Treatment Decision-Making Capacity in Psychosis: A Randomized Controlled Trial With Mediation Analysis

Turner

MacBeth

Larkin

et al. 2018

Schizophrenia Bulletin

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This is the first experimental investigation of the effect of a psychological intervention on treatment decision-making capacity in psychosis. It provides early evidence that reducing the JTC bias is associated with large and rapid improvements in capacity. Due to limited resources, assessments were administered by the researchers delivering the intervention. Results should therefore be considered preliminary and a larger, definitive trial addressing methodological limitations is warranted.

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Section: Study Limitationssupporting

confidence: 87%

The Effect of Reducing the “Jumping to Conclusions” Bias on Treatment Decision-Making Capacity in Psychosis: A Randomized Controlled Trial With Mediation Analysis

Turner

MacBeth

Larkin

et al. 2018

Schizophrenia Bulletin

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“…In 56 patients with psychosis, Fernandez et al 28 studied their capacity to consent to treatment after involuntary hospital admission and at 6‐ and 12‐weeks following treatment. At the time of admission, 62.5% had decisional capacity and 37.5% of participants lacked it; this latter figure dropped to 17.9% at 6 weeks and to 5.4% at 12 weeks of treatment, showing that decision‐making capacity improved over 12 weeks of treatment 28 …”

Section: Resultsmentioning

confidence: 99%

The capacity of schizophrenia and bipolar disorder individuals to make autonomous decisions about pharmacological treatments for their illness in real life: A scoping review

Pons

Salvador‐Carulla

Calcedo‐Barba

et al. 2020

Health Science Reports

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Background and aim Having decision making capacity is central to the exercise of autonomy in mental health care. The objective of this scoping review is to summarize the evidence on the capacity of people with schizophrenia or bipolar disorder to make decisions about their treatment in real life to support medical practice. Methods Systematic search of observational studies on the assessment of capacity of patients with schizophrenia, psychosis, or bipolar disorder to make healthcare and treatment‐related decisions, conducted in any clinical setting published up to January 31, 2020 was performed. Free text searches and medical subject headings in English were combined in PubMed, Scopus, CINAHL, and PsycInfo. Publications were selected as per inclusion and exclusion criteria. The Newcastle‐Ottawa Scale for observational studies was used to assess the quality of publications. Results Thirty publications were reviewed. According to the Newcastle‐Ottawa Scale criteria, the publications reviewed were good quality. Findings showed that more than 70% of schizophrenia and schizoaffective disorder outpatients understood treatment options at the point of making decisions about their illness and healthcare. Patients treated voluntarily had considerably better scores for decisional capacity than those treated involuntarily. The burden of psychiatric symptoms could compromise decisional capacity temporarily. Decision‐making capacity improved over time from admission to discharge from hospital, and with treatment among psychiatry inpatients. Schizophrenia and bipolar disorder patients could be as competent as nonpsychiatric individuals in making decisions about their treatments in everyday life. Conclusions This scoping review provides a body of evidence for healthcare professionals in need of assessing the capacity of schizophrenia and bipolar disorder patients for autonomously decide about their treatments. Decisional capacity judgements should consider variations in capacity over time and be based on the type of decision to be made, the severity of symptoms, and the specific phase of the mental disorder.

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“…In addition to the psychotic symptoms and moral cognitions, the cognitive impairment experienced by many patients with schizophrenia may also play a role in impairing patients’ capacity to make sound judgments regarding moral behaviour when actively psychotic [55–57]. There may also be patients who are so cognitively impaired that they are incapable of moral reasoning [48, 57].…”

Section: Introductionmentioning

confidence: 99%

Moral cognition, the missing link between psychotic symptoms and acts of violence: a cross-sectional national forensic cohort study

et al. 2019

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BackgroundPeople with schizophrenia are ten times more likely to commit homicide than a member of the general population. The relationship between symptoms of schizophrenia and acts of violence is unclear. There has also been limited research on what determines the seriousness and form of violence, such as reactive or instrumental violence. Moral cognition may play a paradoxical role in acts of violence for people with schizophrenia. Thoughts which have moral content arising from psychotic symptoms may be a cause of serious violence.MethodWe investigated if psychotic symptoms and moral cognitions at the time of a violent act were associated with acts of violence using a cross-sectional national forensic cohort (n = 55). We examined whether moral cognitions were associated with violence when controlling for neurocognition and violence proneness. We explored the association between all psychotic symptoms present at the time of the violent act, psychotic symptoms judged relevant to the violent act and moral cognitions present at that time. Using mediation analysis, we examined whether moral cognitions were the missing link between symptoms and the relevance of symptoms for violence. We also investigated if specific moral cognitions mediated the relationship between specific psychotic symptoms, the seriousness of violence (including homicide), and the form of violence.ResultsPsychotic symptoms generally were not associated with the seriousness or form of violence. However, specific moral cognitions were associated with the seriousness and form of violence even when controlling for neurocognition and violence proneness. Specific moral cognitions were associated with specific psychotic symptoms present and relevant to violence. Moral cognitions mediated the relationship between the presence of specific psychotic symptoms and their relevance for violence, homicide, seriousness of violence, and the form of violence.ConclusionsMoral cognitions including the need to reduce suffering, responding to an act of injustice or betrayal, the desire to comply with authority, or the wish to punish impure or disgusting behaviour, may be a key mediator explaining the relationship between psychotic symptoms and acts of violence. Our findings may have important implications for risk assessment, treatment and violence prevention.

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The recovery of factors associated with decision-making capacity in individuals with psychosis

Cited by 13 publications

References 27 publications

The Effect of Reducing the “Jumping to Conclusions” Bias on Treatment Decision-Making Capacity in Psychosis: A Randomized Controlled Trial With Mediation Analysis

The Effect of Reducing the “Jumping to Conclusions” Bias on Treatment Decision-Making Capacity in Psychosis: A Randomized Controlled Trial With Mediation Analysis

The capacity of schizophrenia and bipolar disorder individuals to make autonomous decisions about pharmacological treatments for their illness in real life: A scoping review

Moral cognition, the missing link between psychotic symptoms and acts of violence: a cross-sectional national forensic cohort study

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