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Treatment decision-making capacity in non-consensual psychiatric treatment: a multicentre study

Published online by Cambridge University Press:  09 March 2017

G. Mandarelli*
Affiliation:
Department of Neurology and Psychiatry, University of Rome ‘Sapienza’, viale dell'Università 30, 00185 Rome, Italy
F. Carabellese
Affiliation:
Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Piazza Giulio Cesare, 70124, Bari, Italy
G. Parmigiani
Affiliation:
Department of Neurology and Psychiatry, University of Rome ‘Sapienza’, viale dell'Università 30, 00185 Rome, Italy
F. Bernardini
Affiliation:
School of Psychiatry, University of Perugia, 06156 Perugia, Italy
L. Pauselli
Affiliation:
School of Psychiatry, University of Perugia, 06156 Perugia, Italy
R. Quartesan
Affiliation:
School of Psychiatry, University of Perugia, 06156 Perugia, Italy Department of Medicine, Division of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
R. Catanesi
Affiliation:
Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Piazza Giulio Cesare, 70124, Bari, Italy
S. Ferracuti
Affiliation:
Department of Neurology and Psychiatry, University of Rome ‘Sapienza’, viale dell'Università 30, 00185 Rome, Italy
*
*Address for correspondence: G. Mandarelli, Department of Neurology and Psychiatry, University of Rome ‘Sapienza’, viale dell'Università 30, Rome, Italy. (Email: gabriele.mandarelli@uniroma1.it)

Abstract

Aims.

To evaluate treatment decision-making capacity (DMC) to consent to psychiatric treatment in involuntarily committed patients and to further investigate possible associations with clinical and socio-demographic characteristics of patients.

Methods.

131 involuntarily hospitalised patients were recruited in three university hospitals. Mental capacity to consent to treatment was measured with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T); psychiatric symptoms severity (Brief Psychiatric Rating Scale, BPRS-E) and cognitive functioning (Mini Mental State Examination, MMSE) were also assessed.

Results.

Mental capacity ratings for the 131 involuntarily hospitalised patients showed that patients affected by bipolar disorders (BD) scored generally better than those affected by schizophrenia spectrum disorders (SSD) in MacCAT-T appreciation (p < 0.05) and reasoning (p < 0.01). Positive symptoms were associated with poorer capacity to appreciate (r = −0.24; p < 0.01) and reason (r = −0.27; p < 0.01) about one's own treatment. Negative symptoms were associated with poorer understanding of treatment (r = −0.23; p < 0.01). Poorer cognitive functioning, as measured by MMSE, negatively affected MacCAT-T understanding in patients affected by SSD, but not in those affected by BD (SSD r = 0.37; p < 0.01; BD r = −0.01; p = 0.9). Poorer MacCAT-T reasoning was associated with more manic symptoms in the BD group of patients but not in the SSD group (BD r = −0.32; p < 0.05; SSD r = 0.03; p = 0.8). Twenty-two per cent (n = 29) of the 131 recruited patients showed high treatment DMC as defined by having scored higher than 75% of understanding, appreciating and reasoning MacCAT-T subscales maximum sores and 2 at expressing a choice. The remaining involuntarily hospitalised patients where considered to have low treatment DMC. Chi-squared disclosed that 32% of BD patients had high treatment DMC compared with 9% of SSD patients (p < 0.001).

Conclusions.

Treatment DMC can be routinely assessed in non-consensual psychiatric settings by the MacCAT-T, as is the case of other clinical variables. Such approach can lead to the identification of patients with high treatment DMC, thus drawing attention to possible dichotomy between legal and clinical status.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2017 

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