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Mental capacity, diagnosis and insight in psychiatric in-patients: a cross-sectional study

Published online by Cambridge University Press:  22 October 2008

G. S. Owen ,
A. S. David ,
G. Richardson ,
G. Szmukler ,
P. Hayward  and
M. Hotopf
G. S. Owen*
Affiliation:
Departments of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, UK
A. S. David
Affiliation:
Departments of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, UK
G. Richardson
Affiliation:
School of Law, King's College London, UK
G. Szmukler
Affiliation:
Department of Health Service and Population Research, Institute of Psychiatry, King's College London, UK
P. Hayward
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, UK
M. Hotopf
Affiliation:
Departments of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, UK
*
*Address for correspondence: Dr G. S. Owen, Institute of Psychiatry, Weston Education Centre, Cutcombe Rd, London SE5 9RJ, UK. (Email: g.owen@iop.kcl.ac.uk)
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Abstract

Background

Mental capacity is now a core part of UK mental health law and clinicians will increasingly be expected to assess it. Because it is a legal concept there is a need to clarify associations with variables that clinicians are more familiar with, especially insight.

Method

In this cross-sectional study we recruited consecutive psychiatric admissions to the Maudsley Hospital, London. We carried out structured assessments of decision making using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), resulting in a clinical judgement about capacity status. We analysed associations with a range of sociodemographic and clinical variables, including insight score on the Expanded Schedule for the Assessment of Insight (SAI-E). The same variables were compared in an analysis stratified according to diagnostic group: psychotic disorders/bipolar affective disorder (BPAD)/non-psychotic disorders.

Results

Psychotic disorders and manic episodes of BPAD are most strongly associated with incapacity. In such patients, insight is the best discriminator of capacity status. In patients with non-psychotic disorders, insight is less strongly associated with capacity; in this group depressed mood discriminates capacity status whereas it does not in psychotic disorders. Cognitive performance does not discriminate capacity status in patients with psychotic disorders.

Conclusions

Mental capacity has complex relationships with psychopathological variables, and these relationships are different according to diagnostic group. Insight is the best discriminator of capacity status in psychotic disorders and BPAD but not in non-psychotic disorders.

Keywords

Insightmedical ethicsmental capacitymental health law
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 8 , August 2009 , pp. 1389 - 1398
Copyright
Copyright © 2008 Cambridge University Press

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