Evaluation of the capacity to consent to treatment among patients with bipolar disorder: Comparison between the acute psychopathological episode and the stable mood phase

Abstract

• Treatment decision-making capacity (TDMC) is assessed with the MacCAT-T. • TDMC is different according to inpatient / outpatient status. • Inpatients are acutely ill, while outpatients are euthymic. • Outpatients score higher on MacCAT-T than inpatients. • Outpatients are more able to express consent for an alternative treatment. Treatment decision-making capacity (TDMC) is basic to therapeutic processes and can be measured with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). TDMC may fluctuate in bipolar disorder (BD). We used the MacCAT-T to compare BD inpatients with an acute manic or depressive episode with euthymic BD outpatients on their TDMC. We used the MacCAT-T to cross-sectionally assessed from May 2018 through October 2019 the TDCM of adult BD patients with a Mini Mental State Examination score ≥18, a group of acutely ill hospitalized patients for a manic/hypomanic episode and another of euthymic outpatients during their regular visits at our outpatient clinic. Patients were assessed with other specific psychiatric rating scales. We also tested their TDCM to an alternative treatment. The inpatient group consisted of 53 patients and the outpatient of 47. Inpatients scored worse than outpatients on the MacCAT-T understanding, reasoning and expressing a choice subscale, but not on the appreciating scale. Outpatients were more capable in understanding the characteristics of an alternative advance treatment. MacCAT-T subscales correlated directly with mental state scores, and inversely with mania and psychopathology scores, while only the appreciating subscale correlated inversely with depression scores. The limitations include small sample size and cross-sectional design. TDCM is higher in BD patients at their euthymic state, hence this is the right time to obtain consent from a BD patient in view of possibly depositing psychiatric advance directives.