title: A systematic review of the literature about competence and poor insight.
abstract: OBJECTIVE
  Formally, incompetence implies that a patient cannot meet the legal requirements for informed consent. Our aim was to review the scientific literature on the relationship between competence and insight in patients with psychiatric disorders, how competence and insight are connected in these patients and whether there are differences in competence and insight among patients with different disorders.
  
  
  METHODS
  A search in PubMed/Medline was performed. Articles were assessed on relevance criteria by two independent reviewers. Study design, population, variables, and outcomes were extracted.
  
  
  RESULTS
  Seven articles were included on studies of psychiatric inpatients and outpatients and of psychotic and non-psychotic patients. All studies used the MacArthur Competence Assessment Tool (MacCAT). All studies but one found a strong correlation between poor insight and incompetence. Psychotic patients with poor insight are very likely to be incompetent, and psychotic patients with adequate insight are generally competent. One well-executed study showed that in non-psychotic disorders, however, another relationship emerges; competence and insight do not completely overlap in these patients.
  
  
  CONCLUSIONS
  Most incompetent psychotic patients have poor insight, but non-psychotic patients with adequate insight were incompetent in a substantial number of cases. In sum: non-psychotic patients with adequate insight can be incompetent.
authors: VU University Medical Centre, Medical Humanities, EMGO+ Institute for Health and Care Research, Amsterdam, the Netherlands. a.ruissen@vumc.nl
authors: A M
authors: AM
authors: Ruissen
authors: G A M
authors: GA
authors: Widdershoven
authors: G
authors: G
authors: Meynen
authors: T A
authors: TA
authors: Abma
authors: A J L M
authors: AJ
authors: van Balkom
mesh_terms: D001364:Awareness; D003657:Decision Making; D007258:Informed Consent / Q000523:psychology*; D016743:Mental Competency / Q000523:psychology*; D001523:Mental Disorders / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000523:psychology*; D016312:Treatment Refusal