Mandarelli Gabriele, Parmigiani Giovanna, Tarsitani Lorenzo, Frati Paola, Biondi Massimo, Ferracuti Stefano
Departmentof Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant’Andrea Hospital, via di Grottarossa 1035, 00189 Roma, Italy.
J Empir Res Hum Res Ethics. 2012 Dec;7(5):63-70. doi: 10.1525/jer.2012.7.5.63.
Despite the acknowledged influence of cognition on patients' capacity to consent to treatment, the specific neuropsychological domains involved remain elusive, as does the role of executive functions. We investigated possible associations between executive functions and decisional capacity in a sample of acute psychiatric inpatients. Patients were recruited and evaluated through the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the 24-item Brief Psychiatric Rating Scale (BPRS), the Mini-Mental State Examination (MMSE), and the Wisconsin Card Sorting Test (WCST). Patients with poor executive functioning performed worse in MacCAT understanding, appreciation, and expression of a choice, compared with good performers. These findings point to the importance of cognition in decisional capacity processes. In addition, the strong association found between learning abilities and informed consent decision-making provide empirical evidence indicating possible cognitive enhancement strategies that may improve psychiatric patients' competency.
尽管认知对患者同意治疗的能力的影响已得到公认，但其中涉及的具体神经心理学领域仍不明确，执行功能的作用也同样如此。我们在一组急性精神病住院患者样本中调查了执行功能与决策能力之间可能存在的关联。通过麦克阿瑟治疗能力评估工具（MacCAT-T）、24项简明精神病评定量表（BPRS）、简易精神状态检查表（MMSE）和威斯康星卡片分类测验（WCST）对患者进行招募和评估。与执行功能良好的患者相比，执行功能较差的患者在MacCAT对选择的理解、领会和表达方面表现更差。这些发现表明认知在决策能力过程中的重要性。此外，在学习能力与知情同意决策之间发现的强烈关联提供了经验证据，表明可能存在可改善精神病患者能力的认知增强策略。
