Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, Western Education Centre, London, UK.
Psychol Med. 2011 Jan;41(1):119-28. doi: 10.1017/S0033291710000383. Epub 2010 Mar 29.
Mental capacity is an emerging ethical legal concept in psychiatric settings but its relation to clinical parameters remains uncertain. We sought to investigate the associations of regaining capacity to make treatment decisions following approximately 1 month of in-patient psychiatric treatment.
We followed up 115 consecutive patients admitted to a psychiatric hospital who were judged to lack capacity to make treatment decisions at the point of hospitalization. We were primarily interested in whether the diagnosis of schizophrenia and schizoaffective disorder associated with reduced chances of regaining capacity compared with other diagnoses and whether affective symptoms on admission associated with increased chances of regaining capacity. In addition, we examined how change in insight was associated with regaining capacity in schizophrenia, bipolar affective disorder (BPAD)-mania, and depression.
We found evidence that the category of 'schizophrenia or schizoaffective disorder' associated with not regaining capacity at 1 month compared with BPAD-mania [odds ratio (OR) 3.62, 95% confidence intervals (CI) 1.13-11.6] and depression (OR 5.35, 95% CI 1.47-9.55) and that affective symptoms on admission associated with regaining capacity (OR 1.23, 95% CI 1.02-1.48). In addition, using an interaction model, we found some evidence that gain in insight may not be a good indicator of regaining capacity in patients with depression compared with patients with schizophrenia and BPAD-mania.
We suggest that clinico-ethical studies using mental capacity provide a way of assessing the validity of nosological and other clinical concepts in psychiatry.
精神能力是精神病学领域新兴的伦理法律概念，但它与临床参数的关系尚不确定。我们试图调查在大约 1 个月的住院精神病治疗后，恢复做出治疗决策能力的关联。
我们对 115 名连续住院的精神病患者进行了随访，这些患者在入院时被判断为缺乏做出治疗决策的能力。我们主要关注的是，与其他诊断相比，精神分裂症和分裂情感障碍的诊断是否与恢复能力的机会降低有关，以及入院时的情感症状是否与恢复能力的机会增加有关。此外，我们还研究了精神分裂症、双相情感障碍（BPAD）-躁狂症和抑郁症患者的洞察力变化与恢复能力之间的关系。
我们发现有证据表明，与 BPAD-躁狂症（优势比 [OR] 3.62，95%置信区间 [CI] 1.13-11.6）和抑郁症（OR 5.35，95% CI 1.47-9.55）相比，“精神分裂症或分裂情感障碍”类别与 1 个月时无法恢复能力有关，并且入院时的情感症状与恢复能力有关（OR 1.23，95% CI 1.02-1.48）。此外，使用交互模型，我们发现一些证据表明，与精神分裂症和 BPAD-躁狂症患者相比，洞察力的增加可能不是抑郁症患者恢复能力的良好指标。
我们建议使用精神能力的临床伦理研究为评估精神病学中的分类学和其他临床概念的有效性提供了一种方法。
