Mental Health, Ethics and Law Research Group,Department of Psychological Medicine,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley National Health Service Foundation Trust,Maudsley Hospital,UK.
Mental Health,Ethics and Law Research Group,Department of Psychological Medicine,Institute of Psychiatry, Psychology and Neuroscience, King's College London,UK.
Br J Psychiatry. 2018 Aug;213(2):484-489. doi: 10.1192/bjp.2018.85. Epub 2018 Jun 18.
Consent to research with decision-making capacity for research (DMC-R) is normally a requirement for study participation. Although the symptoms of schizophrenia and related psychoses are known to affect decision-making capacity for treatment (DMC-T), we know little about their effect on DMC-R.AimsWe aimed to determine if DMC-R differs from DMC-T in proportion and associated symptoms in an in-patient sample of people with schizophrenia and related psychoses.
Cross-sectional study of psychiatric in-patients admitted for assessment and/or treatment of schizophrenia and related psychoses. We measured DMC-R and DMC-T using 'expert judgement' clinical assessment guided by the MacArthur Competence Assessment Tool for Clinical Research, the MacArthur Competence Assessment Tool for Treatment and the legal framework of the Mental Capacity Act (2005), in addition to symptoms of psychosis.
There were 84 participants in the study. Half the participants had DMC-R (51%, 95% CI 40-62%) and a third had DMC-T (31%, 95% CI 21-43%) and this difference was statistically significant (P < 0.01). Thought disorder was most associated with lacking DMC-R (odds ratio 5.72, 95% CI 2.01-16.31, P = 0.001), whereas lack of insight was most associated with lacking DMC-T (odds ratio 26.34, 95% CI 3.60-192.66, P = 0.001). With the exception of improved education status and better DMC-R, there was no effect of sociodemographic variables on either DMC-R or DMC-T.
We have shown that even when severely unwell, people with schizophrenia and related psychoses in in-patient settings commonly retain DMC-R despite lacking DMC-T. Furthermore, different symptoms have different effects on decision-making abilities for different decisions. We should not view in-patient psychiatric settings as a research 'no-go area' and, where appropriate, should recruit in these settings.Declaration of interestNone.
对于有研究决策能力的人，同意进行研究（DMC-R）通常是参与研究的要求。尽管精神分裂症和相关精神病的症状已知会影响治疗决策能力（DMC-T），但我们对其对 DMC-R 的影响知之甚少。
我们旨在确定在精神分裂症和相关精神病的住院患者样本中，DMC-R 是否与 DMC-T 在比例和相关症状上存在差异。
对因评估和/或治疗精神分裂症和相关精神病而住院的精神科患者进行横断面研究。我们使用由麦克阿瑟临床研究能力评估工具、麦克阿瑟治疗能力评估工具和精神能力法案（2005 年）的法律框架指导的“专家判断”临床评估来测量 DMC-R 和 DMC-T，此外还测量了精神病症状。
本研究共有 84 名参与者。一半的参与者有 DMC-R（51%，95%置信区间 40-62%），三分之一的参与者有 DMC-T（31%，95%置信区间 21-43%），差异具有统计学意义（P < 0.01）。思维障碍与缺乏 DMC-R 最相关（优势比 5.72，95%置信区间 2.01-16.31，P = 0.001），而缺乏洞察力与缺乏 DMC-T 最相关（优势比 26.34，95%置信区间 3.60-192.66，P = 0.001）。除了受教育程度提高和 DMC-R 更好之外，社会人口学变量对 DMC-R 或 DMC-T 均无影响。
我们已经表明，即使在病情严重的情况下，住院的精神分裂症和相关精神病患者通常仍保留 DMC-R，尽管缺乏 DMC-T。此外，不同的症状对不同的决策有不同的决策能力影响。我们不应该将住院精神科环境视为研究的“禁区”，在适当的情况下，应该在这些环境中招募参与者。
无。
