Competence to Consent and Its Relationship With Cognitive Function in Patients With Schizophrenia.

Norio Sugawara,Tomiki Sumiyoshi,Norio Yasui-Furukori

doi:10.3389/fpsyt.2019.00195

Norio Sugawara, Tomiki Sumiyoshi + Show 1 more

Open Access

https://doi.org/10.3389/fpsyt.2019.00195

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Abstract

Decisional capacity to consent is an emerging ethical and legal concept, and is closely related to self-determination of patients facing important medical decisions or research participations. Recently, the MacArthur Competence Assessment Tool (MacCAT), a semi-structured interview consisting of four dimensions (Understanding, Appreciation, Reasoning, and Expression of a Choice), was developed to assess the decisional capacity. Decision-making capacity in a group of patients with schizophrenia, as measured by the MacCAT, has been shown to be impaired in comparison with healthy control people. However, this does not necessarily mean the presence of impaired decisional capacity in all cases. Considering the real-world practice of obtaining informed consent from patients with schizophrenia, it is important to evaluate the relationship between psychopathological features and decisional capacity of the illness. Negative symptoms of schizophrenia have been demonstrated to be related to the ability to understand information relevant to the decision, reason rationally, and appreciate a situation and its consequences. On the other hand, positive symptoms, such as delusions and hallucinations have been an inconsistent correlate of poor capacity. Furthermore, some studies indicate that impairment of cognitive function, a core symptom of schizophrenia, could be more largely associated with decisional capacity than positive and negative symptoms. Therefore, it is reasonable to assume cognitive enhancement would enlarge the capacity to consent and promote autonomy in medical treatment and research participation in patients with schizophrenia. Further studies are warranted to elucidate this and related issues.

Highlights

Competence to consent for individuals with psychiatric symptoms or impaired cognitive functioning has become central to the debate on the informed consent in clinical care and research settings
In terms of Decisional Capacity in Schizophrenic Patients clinical research, some patients with incapacity might have participated in clinical trials with their own consent
These are the key elements of the MacArthur Competence Assessment Tool (MacCAT) [6] (Figure 1), which has been widely used for competence assessment [7]

Summary

INTRODUCTION

Competence to consent for individuals with psychiatric symptoms or impaired cognitive functioning has become central to the debate on the informed consent in clinical care and research settings. Palmer et al showed the relationship of learning composite scores with three subscales of MacCAT (understanding, appreciation, and reasoning) [24] They demonstrated that auditory and visual learning abilities could affect the competence to consent [17]. Working memory is a complex and multifaced construct to store and simultaneously manipulate a limited amount of information during short intervals This capacity facilitates further cognitive processing, such as response selection relevant for a specific context. Working memory performance showed considerable bivariate relationships with the understanding, appreciation, and reasoning subscale scores from the MacCAT-CR. Cognitive remediation may improve competence to consent [37], providing ethically adequate care, as well as clinical improvement

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