Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Curr Opin Psychiatry. 2011 Sep;24(5):442-6. doi: 10.1097/YCO.0b013e328349bba5.
The past three decades have seen the emergence of the field of decision-making capacity research. The growth has been such that there are several reviews covering a variety of subtopics within the field. The goal is to briefly summarize the state of research.
Most studies in this field use the MacArthur Competence Assessment Tools for the decisional capacity assessment. Studies in psychiatric patients indicate incapacity is common (20-30%), but the majority are capable of making treatment decisions. Positive symptoms (hallucinations, delusions); negative symptoms (unusual thought content, conceptual disorganization); severity of symptoms; involuntary admission; lack of insight and treatment refusal were the stronger predictors for incapacity in acute and cognitive dysfunction in chronic patients.
Mental capacity has complex relationships with psychopathological variables, and these relationships are different according to diagnostic group. More research is needed to determine the clinical parameters related to the lack of capacity to make treatment decisions in psychiatric patients.
过去三十年见证了决策能力研究领域的出现。该领域的研究呈指数级增长，有多项综述涵盖了该领域的多个子课题。本文旨在简要总结研究现状。
该领域的大多数研究都使用麦克阿瑟决策能力评估工具进行决策能力评估。在精神疾病患者中的研究表明，能力不足较为常见（20-30%），但大多数患者能够做出治疗决策。阳性症状（幻觉、妄想）；阴性症状（异常思维内容、概念混乱）；症状严重程度；非自愿入院；缺乏洞察力和治疗拒绝是急性患者和认知功能障碍慢性患者能力不足的较强预测因子。
心理能力与精神病理学变量之间存在复杂的关系，这些关系因诊断组别而异。需要更多的研究来确定与精神疾病患者缺乏治疗决策能力相关的临床参数。
