Regaining mental capacity for treatment decisions following psychiatric admission: A clinico-ethical study
Open accessAbstract
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.
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Black patients were significantly less likely to regain capacity for treatment decisions, compared to White patients (OR = 0.29, 95% CI [0.11 -0.74]).
“Black patients were significantly less likely to regain capacity for treatment decisions, compared to White patients (OR = 0.29, 95% CI [0.11 -0.74]).”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as G. S. Owen et al., 2011
The Results (Descriptive data; page unavailable) report that a greater percentage of Black patients did not regain capacity, supporting the direction of the claim. The paper calls this an apparent difference and says the numbers were too small for further analysis; our copy does not support the asserted statistical significance, odds ratio, or confidence interval. (LLM, conf=0.88)
Experimental — accuracy not yet measuredTwo studies found that Black ethnicity was associated with poorer capacity, compared to White European ethnicity.
“Regarding ethnicity, two studies found that Black ethnicity was associated with poorer capacity, compared to White European ethnicity (G. S. Owen et al., 2008Owen et al., , 2011)).”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as G. S. Owen et al., 2011
The Results (Descriptive data; page unavailable) report that a greater percentage of Black patients did not regain capacity, but call the difference only apparent: potential confounders were numerous and the numbers too small for further analysis. The passage does not specify White European patients as the comparator. This paper therefore supports a cautious observation about regaining capacity, not the claim's unqualified association with poorer capacity. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn general, the included studies suggest that psychiatric symptoms are associated with incapacity.
“In general, the included studies suggest that psychiatric symptoms are also associated with incapacity (G. S. Owen et al., 2011).”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as G. S. Owen et al., 2011
The Results (Univariate analysis) find an association between affective symptoms on admission and regaining capacity, which supports a link between some psychiatric symptoms and capacity. They find no association for psychotic symptom scores, however, and the study examines regaining capacity among patients initially judged to lack it—not a general association between psychiatric symptoms and incapacity. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAcross inpatients, poor insight was a consistent and strong predictor of incapacity.
“Across inpatients, poor insight was also a consistent and strong predictor of incapacity (G.Owen et al., 2009;G. S. Owen et al., 2011;Seo et al., 2011;Skipworth et al., 2013;Spencer et al., 2018)”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as G. S. Owen et al., 2011
The Discussion says insight is closely associated with capacity in general psychiatric inpatient studies, and the Results report an association between change in insight and regaining capacity. But the Discussion explicitly says insight is not a good indicator of capacity for patients with depression, so the source does not support calling poor insight a consistent, strong predictor across all inpatients. Page numbers were not provided in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBlack African and Black Caribbean patients were significantly less likely to have capacity to make treatment decisions.
“More specifically, Black African (OR = 0.14, 95% CI [0.05 -0.37]) and Black Caribbean (OR = 0.32, 95% CI [0.13 -0.78]) patients were significantly less likely to have capacity to make treatment decisions.”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as G. S. Owen et al., 2011
The Results (Descriptive data; page unavailable) report an apparent difference: a greater percentage of patients with black ethnicity did not regain capacity after admission. The paper does not distinguish Black African from Black Caribbean patients or report the cited odds ratios; it says the numbers were too small for further analysis. Its outcome is regaining capacity, not simply having capacity to make treatment decisions. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Psychiatric symptoms, especially positive symptoms, have been associated with incapacity.
“Although diagnosis alone is therefore an insufficient guide to capacity, psychiatric symptoms have been associated with incapacity (G. S. Owen et al., 2011), especially positive symptoms.”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as G. S. Owen et al., 2011
The Results (Univariate analysis; page unavailable) associate affective symptoms on admission with regaining capacity, supporting a relationship between some psychiatric symptoms and capacity. But they find no association between psychotic symptom scores and regaining capacity, and the Discussion says psychotic symptoms at admission were not associated with maintained incapacity at follow-up. The paper therefore does not support the emphasis on positive symptoms; its findings also concern recovery of capacity in patients who initially lacked it, rather than incapacity generally. (LLM, conf=0.87)
Experimental — accuracy not yet measured
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Cites
RUBIN, D. B. (1976) · Biometrika · doi:10.1093/biomet/63.3.581 · Cited by 9,925 · see citing works
Multiple Imputation of Missing Values
Royston, P. (2004) · The Stata Journal: Promoting communications on statistics and Stata · doi:10.1177/1536867x0400400301 · Cited by 2,340 · cited 1× · see citing works
“Multiple imputation methods using ice family commands (Rubin, 1976 ; Royston, 2004 ; 2005a, b) in Stata 10.1 (StataCorp, USA) have been used to deal with the missing capacity evaluations at the follow-up (about 18”
MethodInfluentialJudgment of contingency in depressed and nondepressed students: sadder but wiser?
Alloy, L., & Abramson, L. (1979) · Journal of experimental psychology. General · doi:10.1037//0096-3445.108.4.441 · Cited by 1,733 · see citing works
Judgment of contingency in depressed and nondepressed students: Sadder but wiser?
Alloy, L. B., & Abramson, L. Y. (1979) · Journal of Experimental Psychology: General · doi:10.1037/0096-3445.108.4.441 · Cited by 1,692 · see citing works
Multiple Imputation of Missing Values: Update
Royston, P. (2005) · The Stata Journal Promoting communications on statistics and Stata · doi:10.1177/1536867x0500500204 · Cited by 1,683 · see citing works
Assessment of Patients' Competence to Consent to Treatment
Appelbaum, P. S. (2007) · New England Journal of Medicine · doi:10.1056/nejmcp074045 · Cited by 1,427 · see citing works
Multiple Imputation of Missing Values: Update of Ice
Royston, P. J. (2005) · The Stata Journal Promoting communications on statistics and Stata · doi:10.1177/1536867x0500500404 · Cited by 1,038 · see citing works
Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Prefessionals
Grisso, T., & Appelbaum, P. S. (1998) · doi:10.1093/oso/9780195103724.001.0001 · Cited by 823 · see citing works
Training and quality assurance with the Brief Psychiatric Rating Scale: "The drift busters."
Ventura, J., Green, M. F., Shaner, A. L., & Liberman, R. P. (1993) · International Journal of Methods in Psychiatric Research · Cited by 748 · see citing works
Grisso, T., & Appelbaum, P. S. (1995) · Law and Human Behavior · doi:10.1007/bf01499323 · Cited by 595 · see citing works
Heterogeneity in Incidence Rates of Schizophrenia and Other Psychotic Syndromes
Kirkbride, J. B., Fearon, P., Morgan, C., Dazzan, P., Morgan, K. D., Tarrant, J., Lloyd, T., Holloway, J. D., Hutchinson, G. A., Leff, J., et al. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.3.250 · Cited by 520 · see citing works
The MacArthur Treatment Competence Study. I: Mental illness and competence to consent to treatment.
Appelbaum, P. S., & Grisso, T. (1995) · Law and Human Behavior · doi:10.1007/bf01499321 · Cited by 424 · see citing works
Sanz, M. A. G., CONSTABLE, G., Lopez-Ibor, I., KEMP, R., & David, A. S. (1998) · Psychological Medicine · doi:10.1017/s0033291797006296 · Cited by 264 · see citing works
Self-citationMental capacity in psychiatric patients: Systematic review
Okai, D., Owen, G., McGuire, H., Singh, S., Churchill, R., & Hotopf, M. (2007) · British Journal of Psychiatry · doi:10.1192/bjp.bp.106.035162 · Cited by 262 · see citing works
Self-citationComparison of standards for assessing patients' capacities to make treatment decisions
Grisso, T., & Appelbaum, P. S. (1995) · American Journal of Psychiatry · doi:10.1176/ajp.152.7.1033 · Cited by 250 · see citing works
(2004) · Oxford University Press eBooks · doi:10.1093/med/9780198525684.001.0001 · Cited by 229 · see citing works
Pini, S., Cassano, G. B., Dell’Osso, L., & AMADOR, X. F. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.1.122 · Cited by 228 · see citing works
Owen, G. S., Richardson, G., David, A. S., Szmukler, G., Hayward, P., & Hotopf, M. (2008) · BMJ · doi:10.1136/bmj.39580.546597.be · Cited by 172 · see citing works
Self-citationAlmost a Revolution: Mental Health Law and the Limits of Change
Appelbaum, P. S. (1994) · DigitalGeorgetown (Georgetown University Library) · Cited by 169 · see citing works
Prevalence and predictors of mental incapacity in psychiatric in-patients
Cairns, R., Maddock, C., Buchanan, A. W., David, A. S., Hayward, P., Richardson, G., SZMUKLER, G. I., & Hotopf, M. H. (2005) · The British Journal of Psychiatry · doi:10.1192/bjp.187.4.379 · Cited by 165 · see citing works
Self-citationAssessing Competence to Consent to Treatment
Hoffman, B. F. (1980) · The Canadian Journal of Psychiatry · doi:10.1177/070674378002500427 · Cited by 165 · see citing works
The capacity of people with a ‘mental disability’ to make a health care decision
Wong, J., Clare, I. C. H., Holland, A. J., Watson, P., & GUNN, M. (2000) · Psychological Medicine · doi:10.1017/s0033291700001768 · Cited by 162 · see citing works
Competence of mentally ill patients: a comparative empirical study
VOLLMANN, J., BAUER, A., DANKER-HOPFE, H., & HELMCHEN, H. (2003) · Psychological Medicine · doi:10.1017/s0033291703008389 · Cited by 159 · see citing works
Stevens, A., & Price, J. (2015) · Routledge eBooks · doi:10.4324/9781315740577-14 · Cited by 143 · see citing works
X. F. Amador, A. S. D. (1999) · Nordic Journal of Psychiatry · doi:10.1080/080394899427737 · Cited by 122 · see citing works
Ethnicity and the Mental Health Act 1983
Singh, S. P., Greenwood, N., White, S. J., & Churchill, R. C. (2007) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.106.030346 · Cited by 119 · see citing works
Ghaemi, S. N. (2006) · Schizophrenia Bulletin · doi:10.1093/schbul/sbl061 · Cited by 107 · see citing works
Mental capacity, diagnosis and insight in psychiatric in-patients: A cross-sectional study
Owen, G. S., David, A. S., Richardson, G., Szmukler, G., Hayward, P., & Hotopf, M. (2009) · Psychological Medicine · doi:10.1017/s0033291708004637 · Cited by 99 · see citing works
Self-citationCutting, J. (1997) · doi:10.1093/oso/9780192622402.001.0001 · Cited by 86 · see citing works
Jeste, D. V., Palmer, B. W., Golshan, S., Eyler, L. T., Dunn, L. B., Meeks, T. W., Glorioso, D., Fellows, I. E., KRAEMER, H. C., & Appelbaum, P. S. (2008) · Schizophrenia Bulletin · doi:10.1093/schbul/sbm148 · Cited by 82 · see citing works
Fennell, P. (2002) · Routledge eBooks · doi:10.4324/9780203417898 · Cited by 37 · see citing works
Jacob, R., Clare, I. C. H., Holland, A., Watson, P. C., Maimaris, C., & Gunn, M. (2005) · Emergency Medicine Journal · doi:10.1136/emj.2004.018671 · Cited by 36 · see citing works
Almost a Revolution: Mental Health Law and the Limits of Change
Janofsky, J. S. (1995) · Psychiatric Services · doi:10.1176/ps.46.8.839 · Cited by 34 · see citing works
Balancing autonomy and risk: A failure of nerve in England and Wales?
Richardson, G. (2006) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2005.08.013 · Cited by 31 · see citing works
Self-citationThe European convention and mental health law in England and Wales: Moving beyond process?
Richardson, G. (2005) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2005.03.005 · Cited by 24 · see citing works
Self-citationLaw & Psychiatry: Dangerous Persons, Moral Panic, and the Uses of Psychiatry
Appelbaum, P. S. (2003) · Psychiatric Services · doi:10.1176/appi.ps.54.4.441 · Cited by 13 · see citing works
McKenna, P. J. (2003) · Cited by 9 · see citing works
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Research works printed but not linked: 2
- Owen GS David AS Richardson G Szmuker G Hayward P Hotopf M Mental capacity, diagnosis and insight Psychological Medicine 2009 39 1389 1398 18940026 PMC7611628
- PsychCorp Wechsler Abbreviated Scale of Intelligence - Manual PsychCorp Oxford, UK 1999
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Hindmarch, T., Hotopf, M., & Owen, G. S. (2013) · BMC Medical Ethics · doi:10.1186/1472-6939-14-54 · Cited by 178 · see citing works
Self-citationSpencer, B. W. J., Shields, G., Gergel, T., Hotopf, M., & Owen, G. S. (2017) · Psychological Medicine · doi:10.1017/s0033291717000502 · Cited by 43 · see citing works
Self-citationPons, E. V., Salvador‐Carulla, L., Calcedo‐Barba, A., Paz, S., Messer, T., Pacciardi, B., & Zeller, S. L. (2020) · Health Science Reports · doi:10.1002/hsr2.179 · Cited by 23 · see citing works
Marcó-García, S., Ariyo, K., Owen, G. S., & David, A. S. (2024) · Psychological Medicine · doi:10.1017/s0033291724000242 · Cited by 18 · see citing works
Self-citationBilanakis, N., Vratsista, A., Kalampokis, G., Papamichael, G., & Peritogiannis, V. (2013) · Annals of General Psychiatry · doi:10.1186/1744-859x-12-10 · Cited by 12 · see citing works
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Olié, E., Catanzaro, T., Malestroit, M., Guija, J. A., Giner, L., & Courtet, P. (2023) · Annals of General Psychiatry · doi:10.1186/s12991-023-00459-w · Cited by 9 · see citing works
- Authors
- Owen, G. S., Ster, I. C., David, A. S., Szmukler, G., Hayward, P., Richardson, G., & Hotopf, M.
- Affiliations
- King's College London (GB)
- Corresponding author
- Owen, G. S.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2010-03-29
- Volume
- 41
- Issue
- 1
- Pages
- 119-128
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC7611689
- OpenAlex
- W2133963804
- Cited by
- 24
- References
- 37
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2020: 3 · 2019: 4 · 2018: 2 · 2017: 5 · 2016: 1 · 2015: 1 · 2013: 2
- FWCI
- 1.40
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Research Portal (King's College London) (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion)
- Funders
- London School of Hygiene and Tropical Medicine
- Wellcome Trust
- National Institute for Health and Care Research (MAUBRC-2012-1, NF-SI-0507-10088)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- decision-making capacity, treatment decision-making, psychiatric inpatients, schizophrenia, schizoaffective disorder, bipolar disorder, depression, insight, affective symptoms, psychiatric ethics, disease classification
- MeSH terms
- Adult, Mental Disorders, Bipolar Disorder, Major Depressive Disorder, Female, Humans, Inpatients, Male, Psychiatric Department, Hospital, Psychiatric Status Rating Scales, Psychotic Disorders, Remission Induction, Schizophrenia, Schizophrenic Psychology, Time Factors, Confidence Intervals, Logistic Models, Odds Ratio, Mental Competency
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