The Relationship Between Executive Functions and Capacity to Consent to Treatment in Acute Psychiatric Hospitalization

Mandarelli, Gabriele; Parmigiani, Giovanna; Tarsitani, Lorenzo; Frati, Paola; Biondi, Massimo; Ferracuti, Stefano

doi:10.1525/jer.2012.7.5.63

Cited by 34 publications

(28 citation statements)

References 41 publications

(42 reference statements)

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“…In the regression analysis, we found no association between cognitive measures and voluntariness of hospitalization and treatment. This result is not in line with another study of our group , which showed a strong association between cognitive functions and competence to consent to treatment. A possible explanation is that the cognitive measures we used (MMSE, Raven's CPM) give little information about those neuropsychological aspects known to be important for competence decision‐making, such as executive functions or metacognition .…”

Section: Discussioncontrasting

confidence: 99%

“…Such results represent an essential background to guide studies aimed at investigating mental capacity also in coercive psychiatric clinical settings. Several lines of evidence pointed out that a significant association exists between cognitive functioning and mental capacity, and patients with cognitive dysfunctions could be at higher risk of incapacity . In those psychiatric patients presenting with severe psychiatric symptoms, as do patients hospitalized for acute treatment, symptoms also appear to be negatively associated with decisional capacity .…”

mentioning

confidence: 99%

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Mental Capacity in Patients Involuntarily or Voluntarily Receiving Psychiatric Treatment for an Acute Mental Disorder

Mandarelli

Tarsitani

Parmigiani

et al. 2014

Journal of Forensic Sciences

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Despite the growing amount of data, much information is needed on patients' mental capacity to consent to psychiatric treatment for acute mental disorders. The present study was undertaken to compare differences in capacity to consent to psychiatric treatment in patients treated voluntarily and involuntarily and to investigate the role of psychiatric symptoms, competency, and cognitive functioning in determining voluntariness of hospital admission. Involuntary patients were interviewed with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the 24-item Brief Psychiatric Rating Scale (BPRS), the Mini Mental State Examination (MMSE) and the Raven's Colored Progressive Matrices, and their data were compared with those for age- and sex-matched voluntary patients. Involuntary patients performed worse in all MacCAT-T subscales. Capacity to consent to treatment varied widely within each group. Overall, involuntary patients have worse consent-related mental capacity than those treated voluntarily, despite capacity to consent to treatment showing a significant variability in both groups.

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Section: Discussioncontrasting

confidence: 99%

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confidence: 99%

Mental Capacity in Patients Involuntarily or Voluntarily Receiving Psychiatric Treatment for an Acute Mental Disorder

Mandarelli

Tarsitani

Parmigiani

et al. 2014

Journal of Forensic Sciences

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“…Factors associated with the capacity to consent, such as executive functions, need to be assessed (Mandarelli, Parmigiani, Tarsitani, et al, 2013). We still do not have a validated approach to enhance decisional capacity in individuals with IDD (Cleaver et al, 2010).…”

Section: Best Practicesmentioning

confidence: 99%

Parent Ratings of Ability to Consent for Clinical Trials in Fragile X Syndrome

Bailey

Raspa

Wheeler

et al. 2014

Journal of Empirical Research on Human Research Ethics

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Advances in understanding neurobiology and intellectual disabilities have led to clinical trials testing new medications. This study assessed parents’ perceptions of the ability of their son or daughter with fragile X syndrome (FXS), an inherited form of intellectual disability, to participate in the consent process for clinical trials. Four hundred and twenty-two families participated in a survey that included six items assessing various aspects of the ability to provide consent. A rank ordering of decisional tasks was found. The easiest task was to understand that the medication was different from his or her medical treatment; the most difficult was the ability to understand and weigh the potential benefits and risks of study participation. Factor analysis suggested that despite the range in difficulty, the six items were best summarized by a single decisional ability score. Parents of 29% of males reported that their son was not at all capable of participating, but the remainder exhibited a range of decisional skills. Factors associated with this variability include age, and parents’ willingness to enroll their child in clinical trials. We conclude that many individuals with FXS appear to be able to participate at some level in the consent or assent process, but will likely need individualized support to maximize effective participation.

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“…[37] Ghormley ve arkadaşları depresyonda olan ve yatarak tedavi gören 31 hasta ile 16 normal katılımcıyı karşılaştırdıkları çalışmaların-da, nöropsikolojik bozulmanın (özellikle yeni bilgiyi öğrenme) onam formunda paylaşı-lan bilgilerin anlaşılması üzerinde etkisi olduğunu, aynı zamanda verilen bilgiyi anlamayan katılımcılara tanıma belleklerini güçlendirecek ipuçları verildiğinde, anlama becerilerinin arttığını gözlemişlerdir. [39] Raffard ve arkadaşları [40] ile Mandarelli ve arkadaşları [41] gibi araştırmacılar ise şizofrenide onam verme kapasitesini yürütücü işlev-lerdeki bozulmalar bağlamında ele almışlar ve anlama, kavrama ve seçimini belirtme alanlarındaki performansın yürütücü işlevlerdeki bozulmayla ilişkili olduğunu bulmuş-lardır. Stroup ve arkadaşları şizofreni hastalarındaki onam vermeyle ilişkili becerilerini uzunlamasına bir araştırma deseniyle inceledikleri çalışmalarında 1.158 katılımcının %96'sında bu becerilerin uzun dönemde sabit kaldığı veya daha geliştiğini gözlenmiştir.…”

Section: Bilişsel Süreçlerunclassified

“…[40,50] Roberts genel anlamda psikiyatrik belirtilerin onam verme kapasitesine olumsuz etkisinden söz ederken, [14] bazı araştırmacılar [33] pozitif belirtilerin daha belirleyici olduğunu belirtmiş, bazıları ise [37,51]negatif belirtilerin olumsuz etkisine dikkat çek-mişlerdir. Yakın dönemli çalışmaların bir kısmı onam verme kapasitesi ile nörobilişsel işlevler arasındaki ilişkiyi incelerken, [39,41] bir kısmı da içgörünün yordayıcılığını araştırmışlardır. [48,49] Son olarak, bazı araştırmacılar ise bilişsel işlevselliği desteklemeye yönelik psikoeğitimsel müdahalelerin olumlu sonuçlar verdiğini bulmuşlar-dır.…”

Section: Bilişsel Süreçlerunclassified

Informed Consent and Capacity to Give Consent in Mental Disorders

Maçkalı¹

2014

Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychia

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ÖzetSağlık alanında etik davranışları belirleyen dört temel ilke (özerkliğe saygı, faydalı olma, zarar vermeme ve adalet) içinde en çok 'özerkliğe saygı' prensibiyle ilişkili olan bilgilendirilmiş onam aynı zamanda danışanın karar verme hakkı ve hastaya/danışana ve özerkliğine verilen değeri de yansıtır. Bilgilendirilmiş onam, bireyin pek çok farklı seçenek içinden kendisi için en uygun yöntemi seçmek üzere mantıklı bir karar almasını ve klinisyen ile etkileşimi de kapsayan bilgi paylaşım sürecidir. Bu kavram gizliliğin sınırlarına, yetkinliğe, uygun ve yeterli bilgi paylaşımına, gönüllülüğe dair ölçütle-rin neler olduğuna ilişkin klinisyenlere ışık tutmaktadır. Bir kuramsal derleme olan bu çalışmada bilgilendirilmiş onam kavramının tanımları ve içeriği paylaşıldıktan sonra, psikoterapistlerin psikoterapi sürecinde kullanacakları onam formunun neleri kapsaması, bilgilendirilmiş onam bileşenleri irdelenmiştir. Ardından yukarıda belirtilen tanı grupları kapsamında ruhsal bozukluklar ve onam verme kapasitesi ilişkisi incelenmiştir. AbstractAmong four basic principles (respect for autonomy, beneficence, non-malfeasance, and justice) which determine ethical behaviors in healthcare, informed consent is mostly related to 'respect for autonomy'. Also, it reflects patient/client's right for decision and the value given for the client and his/her autonomy. Informed consent is an information sharing process including both rational decision-making about the most appropriate method among many different options and the interaction between the clinician and the client. This concept sheds light on criteria regarding the limits of confidentiality, competency, appropriate and sufficient information sharing and voluntariness. In this theoretical review, the definitions and the content of informed consent were shared, and then a section regarding the required content of informed consent for psychotherapy process was provided. Then, the components of informed consent were discussed and the relationship between capacity to consent and mental disorders in terms of aforementioned diagnostic groups was examined.

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The Relationship Between Executive Functions and Capacity to Consent to Treatment in Acute Psychiatric Hospitalization

Cited by 34 publications

References 41 publications

Mental Capacity in Patients Involuntarily or Voluntarily Receiving Psychiatric Treatment for an Acute Mental Disorder

Mental Capacity in Patients Involuntarily or Voluntarily Receiving Psychiatric Treatment for an Acute Mental Disorder

Parent Ratings of Ability to Consent for Clinical Trials in Fragile X Syndrome

Informed Consent and Capacity to Give Consent in Mental Disorders

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