The capacity of schizophrenia and bipolar disorder individuals to make autonomous decisions about pharmacological treatments for their illness in real life: A scoping review

Abstract

Background and aim Having decision making capacity is central to the exercise of autonomy in mental health care. The objective of this scoping review is to summarize the evidence on the capacity of people with schizophrenia or bipolar disorder to make decisions about their treatment in real life to support medical practice. Methods Systematic search of observational studies on the assessment of capacity of patients with schizophrenia, psychosis, or bipolar disorder to make healthcare and treatment‐related decisions, conducted in any clinical setting published up to January 31, 2020 was performed. Free text searches and medical subject headings in English were combined in PubMed, Scopus, CINAHL, and PsycInfo. Publications were selected as per inclusion and exclusion criteria. The Newcastle‐Ottawa Scale for observational studies was used to assess the quality of publications. Results Thirty publications were reviewed. According to the Newcastle‐Ottawa Scale criteria, the publications reviewed were good quality. Findings showed that more than 70% of schizophrenia and schizoaffective disorder outpatients understood treatment options at the point of making decisions about their illness and healthcare. Patients treated voluntarily had considerably better scores for decisional capacity than those treated involuntarily. The burden of psychiatric symptoms could compromise decisional capacity temporarily. Decision‐making capacity improved over time from admission to discharge from hospital, and with treatment among psychiatry inpatients. Schizophrenia and bipolar disorder patients could be as competent as nonpsychiatric individuals in making decisions about their treatments in everyday life. Conclusions This scoping review provides a body of evidence for healthcare professionals in need of assessing the capacity of schizophrenia and bipolar disorder patients for autonomously decide about their treatments. Decisional capacity judgements should consider variations in capacity over time and be based on the type of decision to be made, the severity of symptoms, and the specific phase of the mental disorder.

Decisional capacity in young people with first episode psychosis, major depressive disorder and no mental disorder

“…These findings are consistent with adult populations showing that most adults with mental disorders retain decisional capacity ( Spencer et al, 2017 ), and that people with psychotic disorders are more likely to experience impaired decisional capacity than individuals with non-psychotic disorders ( Boettger et al, 2015 ; Owen et al, 2009 ). As in the current study, some studies demonstrated no relationship between age and decisional capacity among adults with psychotic disorders ( Palmer and Jeste, 2006 ; Pons et al, 2020 ), yet others have found greater capacity in younger individuals ( Pons et al, 2020 ). Prior research regarding the relationship between symptom severity and decisional capacity among adults with psychotic disorders has yielded inconsistent results.…”

Learning about psychiatric aspects of medical assistance in dying: a pilot survey of self-perceived educational needs among assessors in a Canadian academic hospital

“…In the presence of psychiatric comorbidity, the decisionmaking capacity to consent is rarely affected, but can be in some severe cases (43). Best practices of capacity to consent to treatment include considering variations in capacity over time and depending on the type of decision, the severity of symptoms, and the phase of the mental illness (44). Consequently, although every assessor has to feel competent to assess capacity, any overestimation of that competence could potentially and to some extent result in lack of recognition of individuals without capacity or missed opportunity to ask for a specialized advise, such as to a consultation-liaison psychiatrist when complexity arise from cases (45).…”

What Is the Capacity of Individuals with Schizophrenia and Bipolar Disorder to Make Healthcare Decisions? An Exploratory Study of the Views of Patients, Psychiatrists, and Family Caregivers—A Survey on Decisional Capacity in Mental Health

“…Overall, all participants in this survey agreed that, in general, schizophrenia and bipolar disorder patients living in the community have the capacity to make decisions about their everyday healthcare and on the pharmacological treatment of their disease. Likewise, other authors have reported that psychiatric patients are capable of making treatment-related decisions, even when being admitted into hospital with considerable burden of symptoms [5,6,32]. In a systematic literature review, Hostiuc et al (2018) concluded that even in those circumstances in which schizophrenia patients are considered to have a significantly decreased decision-making capacity compared to non-mentally ill patients, they should be considered competent unless very severe changes are identifiable during clinical examination.…”

“…This is particularly challenging for schizophrenia and bipolar disorder patients, where impaired insight and cognitive performance may further decrease their decision-making capacity [3,4]. In consequence, their decision-making capacity varies over time and with the type of decision to be made [3,5]. Several studies reveal that schizophrenia and bipolar disorder patients retain the capacity to make treatment and other healthcare-related decisions despite impairments at some stages of the illness, and this can be fully recovered after treatment [6].…”