Okai David, Owen Gareth, McGuire Hugh, Singh Swaran, Churchill Rachel, Hotopf Matthew
Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK.
Br J Psychiatry. 2007 Oct;191:291-7. doi: 10.1192/bjp.bp.106.035162.
Mental capacity is central to legal and ethical debates on the use of compulsion in psychiatry.
To describe the clinical epidemiology of mental incapacity in patients with psychiatric disorders, including interrater reliability of assessments, frequency in the psychiatric population and associations of mental incapacity.
Cross-sectional studies of capacity to consent to treatment for psychiatric patients were systematically reviewed from Medline, EMBASE and PsycInfo databases. Information on the reliability of assessments, frequency and associations of mental incapacity was extracted.
Out of 37 papers reviewed, 29 different capacity assessment tools were identified. Studies were highly heterogeneous in their measurement and definitions of capacity. Interrater reliabilities between tools were high. Studies indicate incapacity is common (median 29%) but the majority of psychiatric in-patients are capable of making treatment decisions. Psychosis, severity of symptoms, involuntary admission and treatment refusal were the strongest risk factors for incapacity.
Mental capacity can be reliably assessed. The majority of psychiatric in-patients have capacity, and socio-demographic variables do not have a major impact but clinical ones do.
心理能力是精神病学中关于强制治疗使用的法律和伦理辩论的核心。
描述精神疾病患者心理无行为能力的临床流行病学，包括评估者间信度、在精神科人群中的发生率以及心理无行为能力的相关因素。
从Medline、EMBASE和PsycInfo数据库系统回顾了关于精神科患者同意治疗能力的横断面研究。提取了关于评估信度、心理无行为能力的发生率及相关因素的信息。
在37篇被审查的论文中，识别出29种不同的能力评估工具。这些研究在能力的测量和定义方面高度异质性。工具间的评估者间信度较高。研究表明无行为能力很常见（中位数为29%），但大多数精神科住院患者有能力做出治疗决定。精神病、症状严重程度、非自愿住院和拒绝治疗是无行为能力的最强危险因素。
心理能力可以得到可靠评估。大多数精神科住院患者有行为能力，社会人口统计学变量没有重大影响，但临床变量有影响。
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