Bilanakis N, Peritogiannis V K, Vratsista Aik
Department of Psychiatry, General Hospital of Arta, Arta.
Private Sector Psychiatrist, Ioannina, Greece.
Psychiatriki. 2017 Jan-Mar;28(1):37-45. doi: 10.22365/jpsych.2017.281.37.
In contemporary medical ethics and clinical practice the autonomy of patients and their right to accept or refuse an offered treatment is acknowledged and respected. Prerequisite for the right of a patient to consent to any medical act is the capacity to make valid decisions regarding his/ her treatment. The objective of our study was to assess -for the first time in our country- treatment decision-making capacity of hospitalized patients with schizophrenia; to explore any possible association with demographic and clinical variables; and to compare treatment decision-making capacity of patients with schizophrenia with medical patients' capacity. The sample of patients comprised of 21 patients with schizophrenia who were hospitalized in the psychiatric ward of the General Hospital of Arta, north-west Greece. Those patients' capacity was compared with treatment decision-making capacity of 78 patients hospitalized in the internal medicine ward of the same hospital. All patients' capacity was assessed within 72 hours of admission with the use of the Greek version of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), a valid and reliable tool for capacity assessment. The performance of patients with schizophrenia on the MacCAT-T was significantly worse than medical patients' performance, suggesting that patients with schizophrenia, as a group had poorer decision-making capacity compared to medical patients. Both negative symptomatology (anergia) and positive symptoms (hostility and suspiciousness), as measured with the use of the Brief Psychiatric Rating Scale (BPRS) were associated with poor performance on the MacCAT-T. Although medical patients as a group scored better in the MacCAT-T, there were several cases that lacked decision-making capacity. In conclusion, patients with schizophrenia had higher incapacity rates than medical patients during the first days of hospitalization. Lack of treatment decision-making capacity is not necessarily the rule for patients with schizophrenia, and capacity is not present in all medical patients. The ability of patients to consent to treatment should be re-assessed during hospitalization, and when restored, informed consent should be obtained by clinicians.
在当代医学伦理和临床实践中，患者的自主权以及他们接受或拒绝所提供治疗的权利得到了认可和尊重。患者同意任何医疗行为的权利的前提是有能力就其治疗做出有效的决定。我们研究的目的是——在我国首次——评估住院精神分裂症患者的治疗决策能力；探讨其与人口统计学和临床变量之间的任何可能关联；并比较精神分裂症患者与内科患者的治疗决策能力。患者样本包括21名在希腊西北部阿尔塔综合医院精神科病房住院的精神分裂症患者。将这些患者的能力与同一医院内科病房住院的78名患者的治疗决策能力进行比较。所有患者的能力在入院72小时内使用希腊版的麦克阿瑟治疗能力评估工具（MacCAT-T）进行评估，这是一种有效且可靠的能力评估工具。精神分裂症患者在MacCAT-T上的表现明显比内科患者差，这表明作为一个群体，精神分裂症患者的决策能力比内科患者差。使用简明精神病评定量表（BPRS）测量的阴性症状（无活力）和阳性症状（敌意和猜疑）均与MacCAT-T上的表现不佳有关。虽然内科患者作为一个群体在MacCAT-T上得分更高，但也有几例缺乏决策能力。总之，在住院的头几天，精神分裂症患者的无能力率高于内科患者。缺乏治疗决策能力不一定是精神分裂症患者的普遍情况，而且并非所有内科患者都有决策能力。患者同意治疗的能力在住院期间应重新评估，能力恢复后，临床医生应获得知情同意。
