Mental capacity and consent to treatment in psychiatric patients: the state of the research

Abstract

Purpose of review: The past three decades have seen the emergence of the field of decision-making capacity research. The growth has been such that there are several reviews covering a variety of subtopics within the field. The goal is to briefly summarize the state of research.

Recent findings: Most studies in this field use the MacArthur Competence Assessment Tools for the decisional capacity assessment. Studies in psychiatric patients indicate incapacity is common (20-30%), but the majority are capable of making treatment decisions. Positive symptoms (hallucinations, delusions); negative symptoms (unusual thought content, conceptual disorganization); severity of symptoms; involuntary admission; lack of insight and treatment refusal were the stronger predictors for incapacity in acute and cognitive dysfunction in chronic patients.

Summary: Mental capacity has complex relationships with psychopathological variables, and these relationships are different according to diagnostic group. More research is needed to determine the clinical parameters related to the lack of capacity to make treatment decisions in psychiatric patients.