Functional mental capacity, treatment as usual and time: Magnitude of change in secure hospital patients with major mental illness
Open accessAbstract
BACKGROUND: Decision making ability can change with time, depending on mental or physical health. Little is known about the factors that determine this change and the relationship of capacity to time. As a pilot for studies using functional mental capacities as an outcome measure, we sought to quantify this relationship measuring change over time using competence assessment tools, and rating scales for symptoms and global function. METHODOLOGY: We assessed 37 inpatients in a secure psychiatric hospital. All patients met the diagnostic and statistical manual of mental disorders-fourth edition and International classification of diseases, 10th edition criteria for an Axis 1 mental illness, all with psychosis. Patients were interviewed twice a mean of 323 days apart (median 176 days range 17-1221 days). The MacArthur competence assessment tools for consent to treatment (MacCAT-T) and fitness to plead (MacCAT-FP) were used to quantify functional capacity along with the Positive and Negative Syndrome Scale (PANSS) and global assessment of function (GAF) scale. A comparison was also made between those patients prescribed clozapine in comparison to other antipsychotics. RESULTS: The number judged by treating psychiatrists to lack capacity either to make a treatment choice or to plead in court fell from 35 to 8%. Change was greatest for those admitted within the previous 9 months. The measures of capacity improved between time 1 and time 2 for both consent to treatment and fitness to plead. The measures of capacity improved with positive symptoms within the PANSS and with GAF scores. Those with shorter lengths of stay at baseline had the greatest improvements in the MacCAT-FP scores. Effect sizes were medium or large (0.3-0.7+). As expected, patients prescribed clozapine had larger changes in functional mental capacities and larger effect sizes than those prescribed other psychotropics. The results show a strong relationship between the clinicians' assessment of capacity and structured rating scales. CONCLUSIONS: We have shown that there is an improvement in capacity scores with time. More research is needed to compare the effect of treatment on capacity at fixed time intervals. It would also be helpful to look at a more general patient population.
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Low global functioning predicted incapacity in four studies.
“Finally, low global functioning predicted incapacity in four studies (Dornan et al., 2015;Kennedy et al., 2009;Rutledge et al., 2008;Tor et al., 2020).”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Dornan et al., 2015
The Discussion (Interpretation; no page given) says improvement in global functioning was associated with improvement in all measures of mental capacity. But this study examined changes over time in selected secure-hospital patients; it does not establish that low global functioning predicts incapacity. The other three cited studies are outside this verdict. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAround 25% of patients were unable to express a choice between two medications or no treatment.
“Regarding the ability to decide between two medications or no treatment, around 25% of patients were unable to express a choice (Dornan et al., 2015;Kennedy et al., 2009;Rutledge et al., 2008)”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Dornan et al., 2015
Positive symptoms were found to be associated with incapacity in 8 studies, especially conceptual disorganization, manic symptoms, delusions and unusual thought content.
“Positive symptoms were found to be associated with incapacity in 8 studies (Dornan et al., 2015;Fraguas et al., 2007;Kennedy et al., 2009;Mandarelli et al., 2018b;G. Owen et al., 2009;Skipworth et al., 2013;Spencer et al., 2018), especially conceptual disorganization (G.Owen et al., 2009;Skipworth et al., 2013), manic symptoms (Mandarelli et al., 2014(Mandarelli et al., , 2018b;;Spencer et al., 2”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Dornan et al., 2015
Patients taking clozapine showed greater improvement in capacity, especially appreciation, than those treated with other psychotropics.
“The authors concluded that patients taking clozapine showed greater improvement in capacity, especially appreciation; that is, they had better ability to decide than those treated with other psychotropics (Dornan et al., 2015).”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Dornan et al., 2015
Regular programmed activities and medication in hospital improve patients' ability to make treatment decisions over time, even if the intervention lasts only one month.
“On the other hand, it is important to point out that regular programmed activities and medication in hospital seems to improve patients' ability to make treatment decisions over time (Dornan et al., 2015), even if the intervention lasts only one month (G.Owen et al., 2009).”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Dornan et al., 2015
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Self-citationBuizza, C., Strozza, C., Sbravati, G., de Girolamo, G., Ferrari, C., Iozzino, L., Macis, A., Kennedy, H. G., & Candini, V. (2022) · Figshare · doi:10.6084/m9.figshare.21077619
Self-citation
- Authors
- Dornan, J., Kennedy, M., Garland, J., Rutledge, E., & Kennedy, H. G.
- Affiliations
- Trinity College Dublin (IE)
- Central Mental Hospital (IE)
- Corresponding author
- Kennedy, Harry G.
- ORCID
- Kennedy, Harry G.
- Venue
- BMC Research Notes
- Published
- 2015-10-14
- Volume
- 8
- Issue
- 1
- Pages
- 566-566
- ISSN
- 1756-0500 (ISSN-L)
- PMC
- PMC4606547
- OpenAlex
- W2104806275
- Cited by
- 29
- References
- 27
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 3 · 2022: 7 · 2021: 2 · 2020: 4 · 2019: 3 · 2018: 4 · 2017: 2
- FWCI
- 2.48
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Research Notes (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion, cc-by)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Keywords
- decision-making capacity, secure psychiatric hospitals, psychosis, severe mental illness, fitness to plead, consent to treatment, clozapine, antipsychotic drugs, length of hospital stay, positive symptoms, global functioning, change over time
- MeSH terms
- Adult, Clozapine, Female, Forensic Psychiatry, Hospitalization, Hospitals, Psychiatric, Humans, Informed Consent, Inpatients, Male, Middle Aged, Pilot Projects, Psychiatric Status Rating Scales, Psychotic Disorders, Time Factors, Antipsychotic Agents, Mental Competency
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