Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00185 Rome, Italy.
Medicina (Kaunas). 2024 May 5;60(5):764. doi: 10.3390/medicina60050764.
: Mental capacity is a fundamental aspect that enables patients to fully participate in various healthcare procedures. To assist healthcare professionals (HCPs) in assessing patients' capacity, especially in the mental health field, several standardized tools have been developed. These tools include the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), and the Competence Assessment Tool for Psychiatric Advance Directives (CAT-PAD). The core dimensions explored by these tools include Understanding, Appreciation, Reasoning, and Expression of a choice. : This meta-analysis aimed to investigate potential differences in decision-making capacity within the healthcare context among groups of patients with bipolar disorders (BD) and schizophrenia spectrum disorders (SSD). : A systematic search was conducted on Medline/Pubmed, and Scopus. Additionally, Google Scholar was manually inspected, and a manual search of emerging reviews and reference lists of the retrieved papers was performed. Eligible studies were specifically cross-sectional, utilizing standardized assessment tools, and involving patients diagnosed with BD and SSD. Data from the studies were independently extracted and pooled using random-effect models. Hedges' was used as a measure for outcomes. : Six studies were identified, with three studies using the MacCAT-CR, two studies the MacCAT-T, and one the CAT-PAD. The participants included 189 individuals with BD and 324 individuals with SSD. The meta-analysis revealed that patients with BD performed slightly better compared to patients with SSD, with the difference being statistically significant in the domain of Appreciation (ES = 0.23, 95% CI: 0.01 to 0.04, = 0.037). There was no statistically significant difference between the two groups for Understanding (ES = 0.09, 95% CI:-0.10 to 0.27, = 0.352), Reasoning (ES = 0.18, 95% CI: -0.12 to 0.47, = 0.074), and Expression of a choice (ES = 0.23, 95% CI: -0.01 to 0.48, = 0.60). In the sensitivity analysis, furthermore, when considering only studies involving patients in symptomatic remission, the difference for Appreciation also resulted in non-significant (ES = 0.21, 95% CI: -0.04 to 0.46, = 0.102). : These findings indicate that there are no significant differences between patients with BD and SSD during remission phases, while differences are minimal during acute phases. The usefulness of standardized assessment of capacity at any stage of the illness should be considered, both for diagnostic-therapeutic phases and for research and advance directives. Further studies are necessary to understand the reasons for the overlap in capacity between the two diagnostic categories compared in this study.
: 心智能力是使患者能够充分参与各种医疗程序的基本方面。为了帮助医疗保健专业人员（HCPs）评估患者的能力，特别是在心理健康领域，已经开发了几种标准化工具。这些工具包括治疗用麦克阿瑟能力评估工具（MacCAT-T）、临床研究用麦克阿瑟能力评估工具（MacCAT-CR）和精神科预嘱能力评估工具（CAT-PAD）。这些工具探索的核心维度包括理解、欣赏、推理和表达选择。 : 本荟萃分析旨在研究双相情感障碍（BD）和精神分裂症谱系障碍（SSD）患者群体在医疗保健环境中决策能力的潜在差异。 : 对 Medline/Pubmed 和 Scopus 进行了系统搜索。此外，还手动检查了 Google Scholar，并对检索论文的新兴综述和参考文献列表进行了手动搜索。合格的研究是专门的横断面研究，使用标准化评估工具，并涉及诊断为 BD 和 SSD 的患者。使用随机效应模型独立提取和汇总研究数据。使用 Hedges' 作为结果的衡量标准。 : 确定了六项研究，其中三项研究使用了 MacCAT-CR，两项研究使用了 MacCAT-T，一项研究使用了 CAT-PAD。参与者包括 189 名 BD 患者和 324 名 SSD 患者。荟萃分析显示，BD 患者的表现略优于 SSD 患者，在欣赏领域的差异具有统计学意义（ES=0.23，95%CI：0.01 至 0.04， =0.037）。两组在理解（ES=0.09，95%CI：-0.10 至 0.27， =0.352）、推理（ES=0.18，95%CI：-0.12 至 0.47， =0.074）和选择表达（ES=0.23，95%CI：-0.01 至 0.48， =0.60）方面无统计学差异。此外，在敏感性分析中，当仅考虑涉及症状缓解患者的研究时，欣赏方面的差异也不显著（ES=0.21，95%CI：-0.04 至 0.46， =0.102）。 : 这些发现表明，在缓解期，BD 患者和 SSD 患者之间没有显著差异，而在急性期差异很小。应考虑在疾病的任何阶段使用能力的标准化评估，无论是在诊断-治疗阶段还是在研究和预嘱阶段。需要进一步的研究来了解本研究中比较的两个诊断类别之间能力重叠的原因。
