Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 6
  • Cited by
    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.


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:
  • Published online: 29 March 2010

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.


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.


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.


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

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:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

LB Alloy , LY Abramson (1979). Judgment of contingency in depressed and nondepressed students: sadder but wiser? Journal of Experimental Psychology General 108, 441485.

PS Appelbaum (2003). Law & psychiatry: dangerous persons, moral panic, and the uses of psychiatry. Psychiatric Servives 54, 441442.

PS Appelbaum (2007). Assessment of patient's competence to consent to treatment. The New England Journal of Medicine 357, 18341840.

PS Appelbaum , T Grisso (1995). The MacArthur Treatment Competence Study. I: mental illness and competence to consent to treatment. Law & Human Behavior 19, 105126.

R Cairns , C Maddock , AS David , P Hayward , G Richardson , G Szmukler , M Hotopf (2005). Prevalence and predictors of mental incapacity in psychiatric in-patients. The British Journal of Psychiatry 187, 379385.

P Fennell (1996). Treatment without Consent: Law, Psychiatry and the Treatment of Mentally Disordered People since 1845. Routledge: London.

SN Ghaemi (2007). Feeling and time: the phenomenology of mood disorders, depressive realism, and existential psychotherapy. Schizophernia Bulletin 33, 122130.

R Jacob , ICH Clare , A Holland , PC Watson , C Maimaris , M. Gunn 2005. Self harm capacity and refusal of treatment: implications for emergency practice. A prospective observational study. Emergency Medicine Journal 22, 799802.

DV Jeste , BW Palmer , S Golshan , LT Eyler , LB Dunn , T Meeks , D Glorioso , I Fellows , H Kraemer , PS Appelbaum (2009). Multimedia consent for research in people with schizophrenia and normal subjects: a randomized controlled trial. Schizophrenia Bulletin 35, 719729.

JB Kirkbride , P Fearon , C Morgan , P Dazzan , K Morgan , J Tarrant , T Lloyd , J Holloway , G Hutchinson , JP Leff , RM Mallett , GL Harrison , RM Murray , PB Jones (2006). Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study. Archives of General Psychiatry 63, 250258.

D Okai , G Owen , H McGuire , S Singh , R Churchill , M Hotopf (2007). Mental capacity in psychiatric patients: Systematic review. British Journal of Psychiatry 191, 291297.

GS Owen , G Richardson , A David , G Szmuker , P Hayward , M Hotopf (2008). Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: a cross sectional study. British Medical Journal 337, 448.

S Pini , GB Cassano , L Dell'Osso , XF Amador (2001). Insight into illness in schizophrenia, schizoaffective disorder, and mood disorders with psychotic features. American Journal of Psychiatry 158, 122125.

G Richardson (2005). The European Convention and mental health law in England and Wales: moving beyond process. International Journal of Law and Psychiatry 28, 127139.

G Richardson (2007). Balancing autonomy and risk: a failure of nerve in England and Wales? International Journal of Law and Psychiatry 30, 7180.

DB Rubin (1976). Inference and missing data (with discussion). Biometrika 63, 581592.

M Sanz , G Constable , I Lopez-Ibor , R Kemp , AS David (1998). A comparative study of insight scales and their relationship to psychopathological and clinical variables. Psychological Medicine 28, 437446.

SP Singh , N Greenwood , S White , R Churchill (2007). Ethnicity and the Mental Health Act 1983. British Journal of Psychiatry 191, 99–105.

JG Wong , ICH Clare , AJ Holland , PC Watson , M Gunn (2000). The capacity of people with a ‘mental disability’ to make a health care decision. Psychological Medicine 30, 295306.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *