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Clinical assessment of decision-making capacity in acquired brain injury with personality change

Research output: Contribution to journalArticle

Gareth Owen, Fabian Freyenhagen, Wayne Martin, Anthony David

Original languageEnglish
Pages (from-to)133-148
Number of pages16
JournalNeuropsychological Rehabilitation
Volume27
Issue number1
Early online date19 Jun 2015
DOIs
Publication statusPublished - 2017

Bibliographical note

© 2015 The Authors. Published by Taylor & Francis.

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Abstract

Assessment of decision-making capacity (DMC) can be difficult in acquired brain injury (ABI) particularly with the syndrome of organic personality disorder (OPD) (the “frontal lobe syndrome”). Clinical neuroscience may help but there are challenges translating its constructs to the decision-making abilities considered relevant by law and ethics. An in-depth interview study of DMC in OPD was undertaken. Six patients were purposefully sampled and rich interview data were acquired for scrutiny using interpretative phenomenological analysis. Interview data revealed that awareness of deficit and thinking about psychological states can be present. However, the awareness of deficit may not be “online” and effectively integrated into decision-making. Without this online awareness of deficit the ability to appreciate or use and weigh information in the process of deciding some matters appeared absent. We argue that the decision-making abilities discussed are: (1) necessary for DMC, (2) threatened by ABI , and (3) assessable at interview. Some advice for practically incorporating these abilities within assessments of DMC in patients with OPD is outlined.

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