Dornan Julieanne, Kennedy Miriam, Garland Jackie, Rutledge Emer, Kennedy Harry G
National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland.
Department of Psychiatry, Trinity College Dublin, Dublin, Ireland.
BMC Res Notes. 2015 Oct 14;8:566. doi: 10.1186/s13104-015-1547-4.
Decision making ability can change with time, depending on mental or physical health. Little is known about the factors that determine this change and the relationship of capacity to time. As a pilot for studies using functional mental capacities as an outcome measure, we sought to quantify this relationship measuring change over time using competence assessment tools, and rating scales for symptoms and global function.
We assessed 37 inpatients in a secure psychiatric hospital. All patients met the diagnostic and statistical manual of mental disorders-fourth edition and International classification of diseases, 10th edition criteria for an Axis 1 mental illness, all with psychosis. Patients were interviewed twice a mean of 323 days apart (median 176 days range 17-1221 days). The MacArthur competence assessment tools for consent to treatment (MacCAT-T) and fitness to plead (MacCAT-FP) were used to quantify functional capacity along with the Positive and Negative Syndrome Scale (PANSS) and global assessment of function (GAF) scale. A comparison was also made between those patients prescribed clozapine in comparison to other antipsychotics.
The number judged by treating psychiatrists to lack capacity either to make a treatment choice or to plead in court fell from 35 to 8%. Change was greatest for those admitted within the previous 9 months. The measures of capacity improved between time 1 and time 2 for both consent to treatment and fitness to plead. The measures of capacity improved with positive symptoms within the PANSS and with GAF scores. Those with shorter lengths of stay at baseline had the greatest improvements in the MacCAT-FP scores. Effect sizes were medium or large (0.3-0.7+). As expected, patients prescribed clozapine had larger changes in functional mental capacities and larger effect sizes than those prescribed other psychotropics. The results show a strong relationship between the clinicians' assessment of capacity and structured rating scales.
We have shown that there is an improvement in capacity scores with time. More research is needed to compare the effect of treatment on capacity at fixed time intervals. It would also be helpful to look at a more general patient population.
决策能力会随时间变化，这取决于精神或身体健康状况。对于决定这种变化的因素以及能力与时间的关系，我们知之甚少。作为一项以功能性心理能力作为结果指标的研究的先导，我们试图通过使用能力评估工具以及症状和整体功能评定量表来量化这种随时间变化的关系。
我们评估了一家安全精神病医院的37名住院患者。所有患者均符合《精神障碍诊断与统计手册》第四版和《国际疾病分类》第十版中关于轴I精神疾病的标准，均患有精神病。患者平均每隔323天接受两次访谈（中位数为176天，范围为17 - 1221天）。使用麦克阿瑟治疗同意能力评估工具（MacCAT - T）和答辩能力评估工具（MacCAT - FP）来量化功能能力，同时使用阳性和阴性症状量表（PANSS）以及整体功能评估（GAF）量表。还对服用氯氮平的患者与服用其他抗精神病药物的患者进行了比较。
被主治精神科医生判定缺乏做出治疗选择或在法庭上答辩能力的人数从35%降至8%。对于那些在过去9个月内入院的患者，变化最为显著。在治疗同意能力和答辩能力方面，从时间1到时间2，能力指标均有所改善。能力指标随着PANSS中的阳性症状以及GAF评分而改善。基线住院时间较短的患者在MacCAT - FP评分方面改善最大。效应大小为中等或较大（0.3 - 0.7 +）。正如预期的那样，与服用其他精神药物的患者相比，服用氯氮平的患者在功能性心理能力方面有更大的变化和更大的效应大小。结果表明临床医生对能力的评估与结构化评定量表之间存在密切关系。
我们已经表明能力得分会随时间提高。需要更多研究来比较在固定时间间隔内治疗对能力的影响。研究更广泛的患者群体也会有所帮助。
