Masand P S, Bouckoms A J, Fischel S V, Calabrese L V, Stern T A
Department of Psychiatry, SUNY Health Science Center at Syracuse 13210, USA.
Psychosomatics. 1998 Jan-Feb;39(1):55-60. doi: 10.1016/S0033-3182(98)71381-7.
Psychiatric consultation for assessment of competency is common but infrequently studied. Past studies have used chart reviews. The authors prospectively studied 88 consecutive psychiatric consultations at 3 centers. Competency evaluation was performed to determine whether the patient could 1) sign out of the hospital against medical advice (AMA) (N = 16); 2) give informed consent (N = 16); 3) take care of him-/herself (N = 33); 4) refuse medical care (N = 24); or 5) deal with other matters (N = 12). Patients with a favorable risk-benefit ratio were more likely to be seen in consultation compared with those with an unfavorable ratio. Patients in whom there was concordance in the assessment of the psychiatric consultant and the referring physician (N = 61) were more likely to be male, single, to have psychotropics recommended, to sign out AMA, and to be discharged from the hospital. Patients in whom there was disagreement between the consultee and the consultant merits further study.
进行能力评估的精神科会诊很常见，但很少有研究。过去的研究采用病历审查。作者前瞻性地研究了3个中心连续进行的88次精神科会诊。进行能力评估以确定患者是否能够：1）不顾医生建议自行出院（AMA）（n = 16）；2）给予知情同意（n = 16）；3）照顾自己（n = 33）；4）拒绝医疗护理（n = 24）；或5）处理其他事务（n = 12）。与风险效益比不利的患者相比，风险效益比有利的患者更有可能接受会诊。精神科会诊医生和转诊医生评估结果一致的患者（n = 61）更有可能为男性、单身、被推荐使用精神药物、不顾医生建议自行出院并出院。会诊对象与会诊医生之间存在分歧的患者值得进一步研究。
