EPA-1721 – Prospective cohort study of capacity to consent to treatment in psychosis

Abstract

In mental illness, the ability to make choices can be affected by impaired capacity. This study aims to assess the capacity to consent to treatment of patients with a psychosis on initial assessment and during on-going care using validated structured instruments. To determine the prevalence of incapacity to give consent to treatment in patients admitted with a psychosis using a validated structured assessment tool, the MacArthur Competence Assessment Tool For Treatment (MacCAT –T) on admission and to determine the rate of recovery of capacity with treatment. All patients who met the ICD-10 criteria and DSM-IV-TR criteria for a psychotic disorder were assessed using the MacCAT –T, PANNS and GAF within 48 hours of admission and again at 6 weeks and 12 weeks after treatment with an antipsychotic. Out of a total of 56 patients, a siginificant majority showed an improvement in their abilities to give valid consent by 6 weeks following treatment and then again at 12 weeks based on the MacCAT-T. The rate of recovery of capacity was greater in the first 6 weeks than in the weeks after up to 12 weeks. Decreases in PANSS Scales and GAF scores were observed at 6 weeks and again at 12 weeks. Based on these findings, the writers would advocate for early treatment of patients with psychosis where capacity is impaired as this is in keeping with protecting their rights to treatment during a period of illness and thus restoring their autonomy sooner.