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Cited by 28Healthcare Decision-Making and RestraintsEthics in Clinical ResearchSchizophrenia research and treatment

Unwell in hospital but not incapable: Cross-sectional study on the dissociation of decision-making capacity for treatment and research in in-patients with schizophrenia and related psychoses

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Spencer, Benjamin Walter Jack, Gergel, Tania, Hotopf, Matthew, Owen, Gareth S.·2018·The British Journal of Psychiatry
DOI 10.1192/bjp.2018.85PMC PMC6054873
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Abstract

BACKGROUND: Consent to research with decision-making capacity for research (DMC-R) is normally a requirement for study participation. Although the symptoms of schizophrenia and related psychoses are known to affect decision-making capacity for treatment (DMC-T), we know little about their effect on DMC-R.AimsWe aimed to determine if DMC-R differs from DMC-T in proportion and associated symptoms in an in-patient sample of people with schizophrenia and related psychoses. METHOD: Cross-sectional study of psychiatric in-patients admitted for assessment and/or treatment of schizophrenia and related psychoses. We measured DMC-R and DMC-T using 'expert judgement' clinical assessment guided by the MacArthur Competence Assessment Tool for Clinical Research, the MacArthur Competence Assessment Tool for Treatment and the legal framework of the Mental Capacity Act (2005), in addition to symptoms of psychosis. RESULTS: There were 84 participants in the study. Half the participants had DMC-R (51%, 95% CI 40-62%) and a third had DMC-T (31%, 95% CI 21-43%) and this difference was statistically significant (P < 0.01). Thought disorder was most associated with lacking DMC-R (odds ratio 5.72, 95% CI 2.01-16.31, P = 0.001), whereas lack of insight was most associated with lacking DMC-T (odds ratio 26.34, 95% CI 3.60-192.66, P = 0.001). With the exception of improved education status and better DMC-R, there was no effect of sociodemographic variables on either DMC-R or DMC-T. CONCLUSIONS: We have shown that even when severely unwell, people with schizophrenia and related psychoses in in-patient settings commonly retain DMC-R despite lacking DMC-T. Furthermore, different symptoms have different effects on decision-making abilities for different decisions. We should not view in-patient psychiatric settings as a research 'no-go area' and, where appropriate, should recruit in these settings.Declaration of interestNone.

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  • The proportion of psychiatric patients with capacity to decide on hospitalization might reduce between 5% to 27% if decision-making about treatment is part of the same assessment.

    “but this number might reduce between 5% to 27% if decision-making about treatment is part of the same assessment (Spencer et al., 2018).”

    From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Spencer et al., 2018

    The Results section (“Measures of DMC-R and DMC-T”; page unavailable) reports that 51% of in-patients had capacity to decide about research, versus 31% for treatment. This supports a lower proportion for treatment decisions, but the paper does not assess capacity to decide on hospitalization or report a 5%–27% reduction. (LLM, conf=0.82)

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  • Impairments in short-term memory were associated with poorer capacity.

    “Impairments in short-term memory were also associated with poorer capacity (Spencer et al., 2018).”

    From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Spencer et al., 2018

    The Results (Associations with DMC-R and DMC-T) associate worse Logical Memory 1 performance, the study’s short-term memory measure, with lacking decision-making capacity for research (DMC-R). They do not find this association for treatment capacity (DMC-T), so the unqualified reference to poorer capacity is broader than the finding. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Hallucinations were correlated with capacity in non-psychotic disorders, but not in psychotic disorders.

    “Hallucinations were correlated with capacity in non-psychotic disorders (G.Owen et al., 2009), but not in psychotic disorders (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 Spencer et al., 2018

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Authors
Spencer, B. W. J., Gergel, T., Hotopf, M., & Owen, G. S.
Affiliations
  • National Health Service (GB)
  • King's College London (GB)
Corresponding author
Spencer, Benjamin Walter Jack
ORCID
Venue
The British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2018-06-18
Volume
213
Issue
2
Pages
484-489
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.2018.85
PMC
PMC6054873
OpenAlex
W2808969407
Cited by
28
References
33
Citations by year
2026: 1 · 2025: 3 · 2024: 4 · 2023: 3 · 2022: 1 · 2021: 5 · 2020: 5 · 2019: 5 · 2018: 1
FWCI
4.69
Type
journal article
Language
en
Open access
Licence
Locations
  • The British Journal of Psychiatry (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion, cc-by)
Funders
National Institute for Health and Care Research (NF-SI-0515-10102, DRF-2014-07-035)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics in Clinical Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
decision-making capacity, research consent, treatment decision-making, schizophrenia, thought disorder, lack of insight, Mental Capacity Act 2005, research recruitment
MeSH terms
Adult, Cross-Sectional Studies, Decision Making, Female, Hospitalization, Humans, London, Male, Middle Aged, Psychiatric Status Rating Scales, Psychotic Disorders, Schizophrenia, Mental Competency

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