The recovery of factors associated with decision-making capacity in individuals with psychosis
Open accessAbstract
Background: There is limited data on the recovery of factors associated with decisional capacity in patients with psychosis. Aims: To study the relationship between changes in mental capacity, symptoms and global functioning using structured measures during treatment for psychosis. Method: Fifty-six patients with psychosis were assessed for capacity to consent to treatment on admission and at 6 and 12 weeks following treatment. The MacArthur Competence Assessment Tool – Treatment, the Positive and Negative Symptom Scale and the Global Assessment of Functioning Scale were used to measure mental capacities, symptom severity and global functioning respectively. Treating consultants rated capacity to consent, masked to these measures. Results: Greater impairments on all measures were found in patients assessed as lacking capacity. These improved with treatment over 12 weeks with significant effect sizes (0.5 to 0.6). Stronger correlations between mental capacities, positive symptoms (-0.47) and global functioning (0.56) were noted in the first 6 weeks. Conclusions: Impairments in capacity in acute stages of psychosis are related to symptom severity and functional impairment. They improve during treatment, particularly in the first 6 weeks.
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Individuals exhibiting more severe symptoms are more likely to be perceived as incapable of understanding and therefore of making decisions.
“Considering that individuals exhibiting more severe symptoms are more likely to be perceived as incapable of understanding and therefore of making decisions [175,176]”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [175]
The Results report that hospitalized patients with psychosis whom clinicians judged to lack capacity had more severe symptoms and lower understanding scores. The Clinical implications section also says clinicians may be influenced by deficits in understanding. The claim extends this finding to individuals generally, whereas the study concerns patients with psychosis and capacity to consent to treatment. (LLM, conf=0.82)
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- Authors
- Fernandez, C., Kennedy, H. G., & Kennedy, M.
- Affiliations
- St. Patrick's Hospital (IE)
- Trinity College Dublin (IE)
- Corresponding author
- Kennedy, Harry G.
- ORCID
- Kennedy, Harry G.
- Venue
- BJPsych Open
- Publisher
- Royal College of Psychiatrists
- Published
- 2017-05
- Volume
- 3
- Issue
- 3
- Pages
- 113-119
- ISSN
- 2056-4724 (ISSN-L)
- PMC
- PMC5415675
- OpenAlex
- W2610902548
- Cited by
- 19
- References
- 33
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 1 · 2022: 1 · 2021: 1 · 2020: 6 · 2019: 2 · 2018: 3
- FWCI
- 3.73
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BJPsych Open (publishedVersion)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (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, psychosis, consent to treatment, treatment recovery, positive symptoms, global functioning, functional disability, acute psychosis, antipsychotic drugs
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