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    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Hindmarch, Thomas Hotopf, Matthew and Owen, Gareth S 2013. Depression and decision-making capacity for treatment or research: a systematic review. BMC Medical Ethics, Vol. 14, Issue. 1,


    Ostermeyer, Britta Flores, Araceli Dukes, Charles and Shah, Asim A. 2016. Medical Decision-Making Capacity in Depression. Psychiatric Annals, Vol. 46, Issue. 4, p. 247.


    Buckley, P. Citrome, L. Nichita, C. and Vitacco, M. 2011. Psychopharmacology of Aggression in Schizophrenia. Schizophrenia Bulletin, Vol. 37, Issue. 5, p. 930.


    Bilanakis, Nikolaos Vratsista, Aikaterini Kalampokis, Georgios Papamichael, Georgios and Peritogiannis, Vaios 2013. The Greek version of the MacArthur competence assessment tool for treatment: reliability and validity. Evaluation of capacity for treatment decisions in Greek psychiatric patients. Annals of General Psychiatry, Vol. 12, Issue. 1, p. 10.


    Gergel, Tania and Owen, Gareth S. 2015. Fluctuating capacity and advance decision-making in Bipolar Affective Disorder — Self-binding directives and self-determination. International Journal of Law and Psychiatry, Vol. 40, p. 92.


    Ruissen, A. M. Widdershoven, G. A. M. Meynen, G. Abma, T. A. and van Balkom, A. J. L. M. 2012. A systematic review of the literature about competence and poor insight. Acta Psychiatrica Scandinavica, Vol. 125, Issue. 2, p. 103.


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Regaining mental capacity for treatment decisions following psychiatric admission: a clinico-ethical study

  • G. S. Owen (a1), I. Chis. Ster (a2) (a3), A. S. David (a1), G. Szmukler (a4), P. Hayward (a5), G. Richardson (a6) and M. Hotopf (a1)
  • DOI: http://dx.doi.org/10.1017/S0033291710000383
  • Published online: 29 March 2010
Abstract
Background

Mental capacity is an emerging ethical legal concept in psychiatric settings but its relation to clinical parameters remains uncertain. We sought to investigate the associations of regaining capacity to make treatment decisions following approximately 1 month of in-patient psychiatric treatment.

Method

We followed up 115 consecutive patients admitted to a psychiatric hospital who were judged to lack capacity to make treatment decisions at the point of hospitalization. We were primarily interested in whether the diagnosis of schizophrenia and schizoaffective disorder associated with reduced chances of regaining capacity compared with other diagnoses and whether affective symptoms on admission associated with increased chances of regaining capacity. In addition, we examined how change in insight was associated with regaining capacity in schizophrenia, bipolar affective disorder (BPAD)-mania, and depression.

Results

We found evidence that the category of ‘schizophrenia or schizoaffective disorder’ associated with not regaining capacity at 1 month compared with BPAD-mania [odds ratio (OR) 3.62, 95% confidence intervals (CI) 1.13–11.6] and depression (OR 5.35, 95% CI 1.47–9.55) and that affective symptoms on admission associated with regaining capacity (OR 1.23, 95% CI 1.02–1.48). In addition, using an interaction model, we found some evidence that gain in insight may not be a good indicator of regaining capacity in patients with depression compared with patients with schizophrenia and BPAD-mania.

Conclusions

We suggest that clinico-ethical studies using mental capacity provide a way of assessing the validity of nosological and other clinical concepts in psychiatry.

Copyright
Corresponding author
*Address for correspondence: Dr G. S. Owen, Wellcome Trust Clinical Fellow, Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, Western Education Centre, Cutcombe Road, LondonSE5 9RJ, UK. (Email: Gareth.1.Owen@kcl.ac.uk)
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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