title: Impact of decisional capacity on the use of leverage to encourage treatment adherence.
abstract: Leverage is often applied to persons with mental illnesses who live in the community to encourage them to adhere to treatment. Given the underlying assumption that the targets of such leverage are unable to make good decisions about treatment on their own, one might expect that decisional incapacity regarding treatment would correlate with the use of leverage. As part of a multi-site study of leverage in community treatment, 120 subjects at two sites reported on their leverage experiences and completed a decisional capacity assessment with the MacCAT-T. No strong or consistent associations were found between capacity and use of leverage, raising questions about the basis on which decisions to employ leverage are being made.
authors.affiliation: Division of Psychiatry, Law and Ethics, New York State Psychiatric Institute, New York, NY 10032, USA. psa21@columbia.edu
authors.forename: Paul S
authors.initials: PS
authors.lastname: Appelbaum
authors.forename: Allison
authors.initials: A
authors.lastname: Redlich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D003156:Community Mental Health Services; D003657:Decision Making; D003865:Major Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008404:Massachusetts; D016743:Mental Competency; D008875:Middle Aged; D009657:North Carolina; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D011594:Psychometrics; D012559:Schizophrenia / Q000188:drug therapy*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D017367:Selective Serotonin Reuptake Inhibitors