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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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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. / Spencer, Benjamin Walter Jack; Gergel, Tania; Hotopf, Matthew; Owen, Gareth.

In: British Journal of Psychiatry, Vol. 213, 08.2018, p. 484-89.

Research output: Contribution to journalArticle

Harvard

Spencer, BWJ, Gergel, T, Hotopf, M & Owen, G 2018, '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.', British Journal of Psychiatry, vol. 213, pp. 484-89. https://doi.org/10.1192/bjp.2018.85

APA

Spencer, B. W. J., Gergel, T., Hotopf, M., & Owen, G. (2018). 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. British Journal of Psychiatry, 213, 484-89. https://doi.org/10.1192/bjp.2018.85

Vancouver

Spencer BWJ, Gergel T, Hotopf M, Owen G. 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. British Journal of Psychiatry. 2018 Aug;213:484-89. https://doi.org/10.1192/bjp.2018.85

Author

Spencer, Benjamin Walter Jack ; Gergel, Tania ; Hotopf, Matthew ; Owen, Gareth. / 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. In: British Journal of Psychiatry. 2018 ; Vol. 213. pp. 484-89.

Bibtex Download

@article{f92f1b9b2abb4ec69079a3fc7101cfa4,
title = "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.",
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. Aims We 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 {\textquoteleft}expert judgement{\textquoteright} 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 {\textquoteleft}no-go area{\textquoteright} and, where appropriate, should recruit in these settings.",
author = "Spencer, {Benjamin Walter Jack} and Tania Gergel and Matthew Hotopf and Gareth Owen",
year = "2018",
month = aug,
doi = "10.1192/bjp.2018.85",
language = "English",
volume = "213",
pages = "484--89",
journal = "British Journal of Psychiatry",
issn = "0007-1250",
publisher = "Cambridge University Press",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Unwell in hospital but not incapable

T2 - cross- sectional study on the dissociation of decision- making capacity for treatment and research in in-patients with schizophrenia and related psychoses.

AU - Spencer, Benjamin Walter Jack

AU - Gergel, Tania

AU - Hotopf, Matthew

AU - Owen, Gareth

PY - 2018/8

Y1 - 2018/8

N2 - 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. Aims We 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.

AB - 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. Aims We 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.

UR - https://www.cambridge.org/core/services/aop-cambridge-core/content/view/7A481580225CC59D09096547FFFC1DCC/S0007125018000855a.pdf/unwell_in_hospital_but_not_incapable_crosssectional_study_on_the_dissociation_of_decisionmaking_capacity_for_treatment_and_research_in_inpatients_with_schizophrenia_and_related_psychoses.pdf

U2 - 10.1192/bjp.2018.85

DO - 10.1192/bjp.2018.85

M3 - Article

VL - 213

SP - 484

EP - 489

JO - British Journal of Psychiatry

JF - British Journal of Psychiatry

SN - 0007-1250

ER -

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