Insight et capacité à consentir au soin et à la recherche : étude exploratoire et points de vue éthiques

Abstract

In recent years, there has been a growing awareness that the process of obtaining informed consent is central to ethical research and clinical practice. Many studies have focused on the ability to consent for patients suffering from severe mental disorders such as schizophrenia. Several studies have focused on the association between impaired capacity to consent (to treatment or research) and diagnosis or symptoms. But one of the most important features of schizophrenia, the lack of insight has not been extensively studied in relation to capacity to consent. The aim of this study was to explore the relationship existing between the competence to consent and the level of insight in patients suffering from schizophrenia in a cross-sectional study. Participants included 60 outpatients with DSM-IV schizophrenia. Measures included the MacArthur Competence Assessment tool for Treatment (MacCAT-T), the Scale to Assess Unawareness of Mental Disorder (SUMD) and psychopathology rating scales including the Positive and Negative Syndrome Scale (PANSS). Our results showed that “understanding” dimension of MacCAT-T is not correlated to insight. However, a systematic negative correlation was observed between the MacCAT-T “Appreciation” and “Reasoning” dimensions and the five SUMD dimensions. We hypothesise that this strong correlation could be mediated by cognitive disorders in schizophrenia. After such results, prospective studies should be developped evaluating the courses of insight and capacity to consent during the illness and the links with cognitive deficits.