Functional mental capacity, treatment as usual and time: magnitude of change in secure hospital patients with major mental illness

Hdl Handle:
http://hdl.handle.net/10147/579720
Title:
Functional mental capacity, treatment as usual and time: magnitude of change in secure hospital patients with major mental illness
Authors:
Dornan, Julieanne; Kennedy, Miriam; Garland, Jackie; Rutledge, Emer; Kennedy, Harry G
Affiliation:
1 National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. 2 St Patricks Hospital, Dublin, Ireland. 3 Department of Psychiatry, Trinity College Dublin, Dublin, Ireland.
Citation:
BMC Research Notes. 2015 Oct 14;8(1):566
Publisher:
BioMed Central
Issue Date:
14-Oct-2015
URI:
http://dx.doi.org/10.1186/s13104-015-1547-4; http://hdl.handle.net/10147/579720
Abstract:
Abstract Background Decision making ability can change with time, depending on mental or physical health. Little is known about the factors that determine this change and the relationship of capacity to time. As a pilot for studies using functional mental capacities as an outcome measure, we sought to quantify this relationship measuring change over time using competence assessment tools, and rating scales for symptoms and global function. Methodology We assessed 37 inpatients in a secure psychiatric hospital. All patients met the diagnostic and statistical manual of mental disorders-fourth edition and International classification of diseases, 10th edition criteria for an Axis 1 mental illness, all with psychosis. Patients were interviewed twice a mean of 323 days apart (median 176 days range 17–1221 days). The MacArthur competence assessment tools for consent to treatment (MacCAT-T) and fitness to plead (MacCAT-FP) were used to quantify functional capacity along with the Positive and Negative Syndrome Scale (PANSS) and global assessment of function (GAF) scale. A comparison was also made between those patients prescribed clozapine in comparison to other antipsychotics. Results The number judged by treating psychiatrists to lack capacity either to make a treatment choice or to plead in court fell from 35 to 8 %. Change was greatest for those admitted within the previous 9 months. The measures of capacity improved between time 1 and time 2 for both consent to treatment and fitness to plead. The measures of capacity improved with positive symptoms within the PANSS and with GAF scores. Those with shorter lengths of stay at baseline had the greatest improvements in the MacCAT-FP scores. Effect sizes were medium or large (0.3–0.7+). As expected, patients prescribed clozapine had larger changes in functional mental capacities and larger effect sizes than those prescribed other psychotropics. The results show a strong relationship between the clinicians’ assessment of capacity and structured rating scales. Conclusions We have shown that there is an improvement in capacity scores with time. More research is needed to compare the effect of treatment on capacity at fixed time intervals. It would also be helpful to look at a more general patient population.
Item Type:
Article
Language:
en
Description:
Background: Decision making ability can change with time, depending on mental or physical health. Little is known about the factors that determine this change and the relationship of capacity to time. As a pilot for studies using func- tional mental capacities as an outcome measure, we sought to quantify this relationship measuring change over time using competence assessment tools, and rating scales for symptoms and global function. Methodology: We assessed 37 inpatients in a secure psychiatric hospital. All patients met the diagnostic and statisti- cal manual of mental disorders-fourth edition and International classification of diseases, 10th edition criteria for an Axis 1 mental illness, all with psychosis. Patients were interviewed twice a mean of 323 days apart (median 176 days range 17–1221 days). The MacArthur competence assessment tools for consent to treatment (MacCAT-T ) and fitness to plead (MacCAT-FP) were used to quantify functional capacity along with the Positive and Negative Syndrome Scale (PANSS) and global assessment of function (GAF) scale. A comparison was also made between those patients pre - scribed clozapine in comparison to other antipsychotics. Results: The number judged by treating psychiatrists to lack capacity either to make a treatment choice or to plead in court fell from 35 to 8 %. Change was greatest for those admitted within the previous 9 months. The measures of capacity improved between time 1 and time 2 for both consent to treatment and fitness to plead. The measures of capacity improved with positive symptoms within the PANSS and with GAF scores. Those with shorter lengths of stay at baseline had the greatest improvements in the MacCAT-FP scores. Effect sizes were medium or large (0.3–0.7 + ). As expected, patients prescribed clozapine had larger changes in functional mental capacities and larger effect sizes than those prescribed other psychotropics. The results show a strong relationship between the clinicians’ assessment of capacity and structured rating scales. Conclusions: We have shown that there is an improvement in capacity scores with time. More research is needed to compare the effect of treatment on capacity at fixed time intervals. It would also be helpful to look at a more general patient population.
Keywords:
PSYCHIATRIC CARE; INPATIENT; MENTAL HEALTH
Local subject classification:
FUNCTIONAL MENTAL CAPACITY

Full metadata record

DC FieldValue Language
dc.contributor.authorDornan, Julieanneen
dc.contributor.authorKennedy, Miriamen
dc.contributor.authorGarland, Jackieen
dc.contributor.authorRutledge, Emeren
dc.contributor.authorKennedy, Harry Gen
dc.date.accessioned2015-10-15T11:03:37Zen
dc.date.available2015-10-15T11:03:37Zen
dc.date.issued2015-10-14en
dc.identifier.citationBMC Research Notes. 2015 Oct 14;8(1):566en
dc.identifier.urihttp://dx.doi.org/10.1186/s13104-015-1547-4en
dc.identifier.urihttp://hdl.handle.net/10147/579720en
dc.descriptionBackground: Decision making ability can change with time, depending on mental or physical health. Little is known about the factors that determine this change and the relationship of capacity to time. As a pilot for studies using func- tional mental capacities as an outcome measure, we sought to quantify this relationship measuring change over time using competence assessment tools, and rating scales for symptoms and global function. Methodology: We assessed 37 inpatients in a secure psychiatric hospital. All patients met the diagnostic and statisti- cal manual of mental disorders-fourth edition and International classification of diseases, 10th edition criteria for an Axis 1 mental illness, all with psychosis. Patients were interviewed twice a mean of 323 days apart (median 176 days range 17–1221 days). The MacArthur competence assessment tools for consent to treatment (MacCAT-T ) and fitness to plead (MacCAT-FP) were used to quantify functional capacity along with the Positive and Negative Syndrome Scale (PANSS) and global assessment of function (GAF) scale. A comparison was also made between those patients pre - scribed clozapine in comparison to other antipsychotics. Results: The number judged by treating psychiatrists to lack capacity either to make a treatment choice or to plead in court fell from 35 to 8 %. Change was greatest for those admitted within the previous 9 months. The measures of capacity improved between time 1 and time 2 for both consent to treatment and fitness to plead. The measures of capacity improved with positive symptoms within the PANSS and with GAF scores. Those with shorter lengths of stay at baseline had the greatest improvements in the MacCAT-FP scores. Effect sizes were medium or large (0.3–0.7 + ). As expected, patients prescribed clozapine had larger changes in functional mental capacities and larger effect sizes than those prescribed other psychotropics. The results show a strong relationship between the clinicians’ assessment of capacity and structured rating scales. Conclusions: We have shown that there is an improvement in capacity scores with time. More research is needed to compare the effect of treatment on capacity at fixed time intervals. It would also be helpful to look at a more general patient population.en
dc.description.abstractAbstract Background Decision making ability can change with time, depending on mental or physical health. Little is known about the factors that determine this change and the relationship of capacity to time. As a pilot for studies using functional mental capacities as an outcome measure, we sought to quantify this relationship measuring change over time using competence assessment tools, and rating scales for symptoms and global function. Methodology We assessed 37 inpatients in a secure psychiatric hospital. All patients met the diagnostic and statistical manual of mental disorders-fourth edition and International classification of diseases, 10th edition criteria for an Axis 1 mental illness, all with psychosis. Patients were interviewed twice a mean of 323 days apart (median 176 days range 17–1221 days). The MacArthur competence assessment tools for consent to treatment (MacCAT-T) and fitness to plead (MacCAT-FP) were used to quantify functional capacity along with the Positive and Negative Syndrome Scale (PANSS) and global assessment of function (GAF) scale. A comparison was also made between those patients prescribed clozapine in comparison to other antipsychotics. Results The number judged by treating psychiatrists to lack capacity either to make a treatment choice or to plead in court fell from 35 to 8 %. Change was greatest for those admitted within the previous 9 months. The measures of capacity improved between time 1 and time 2 for both consent to treatment and fitness to plead. The measures of capacity improved with positive symptoms within the PANSS and with GAF scores. Those with shorter lengths of stay at baseline had the greatest improvements in the MacCAT-FP scores. Effect sizes were medium or large (0.3–0.7+). As expected, patients prescribed clozapine had larger changes in functional mental capacities and larger effect sizes than those prescribed other psychotropics. The results show a strong relationship between the clinicians’ assessment of capacity and structured rating scales. Conclusions We have shown that there is an improvement in capacity scores with time. More research is needed to compare the effect of treatment on capacity at fixed time intervals. It would also be helpful to look at a more general patient population.en
dc.language.isoenen
dc.publisherBioMed Centralen
dc.subjectPSYCHIATRIC CAREen
dc.subjectINPATIENTen
dc.subjectMENTAL HEALTHen
dc.subject.otherFUNCTIONAL MENTAL CAPACITYen
dc.titleFunctional mental capacity, treatment as usual and time: magnitude of change in secure hospital patients with major mental illnessen
dc.typeArticleen
dc.contributor.department1 National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. 2 St Patricks Hospital, Dublin, Ireland. 3 Department of Psychiatry, Trinity College Dublin, Dublin, Ireland.en
dc.language.rfc3066enen
dc.rights.holderDornan et al.en
dc.date.updated2015-10-14T16:04:29Zen
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