title: Clinical assessment of decision-making capacity in acquired brain injury with personality change.
abstract: Assessment of decision-making capacity (DMC) can be difficult in acquired brain injury (ABI) particularly with the syndrome of organic personality disorder (OPD) (the "frontal lobe syndrome"). Clinical neuroscience may help but there are challenges translating its constructs to the decision-making abilities considered relevant by law and ethics. An in-depth interview study of DMC in OPD was undertaken. Six patients were purposefully sampled and rich interview data were acquired for scrutiny using interpretative phenomenological analysis. Interview data revealed that awareness of deficit and thinking about psychological states can be present. However, the awareness of deficit may not be "online" and effectively integrated into decision-making. Without this online awareness of deficit the ability to appreciate or use and weigh information in the process of deciding some matters appeared absent. We argue that the decision-making abilities discussed are: (1) necessary for DMC, (2) threatened by ABI , and (3) assessable at interview. Some advice for practically incorporating these abilities within assessments of DMC in patients with OPD is outlined.
authors.affiliation: a Department of Psychological Medicine, Weston Education Centre , King's College London, Institute of Psychiatry, Psychology and Neuroscience , London , UK.
authors.forename: Gareth S
authors.initials: GS
authors.lastname: Owen
authors.affiliation: b School of Philosophy and Art History , University of Essex , Colchester , UK.
authors.forename: Fabian
authors.initials: F
authors.lastname: Freyenhagen
authors.affiliation: b School of Philosophy and Art History , University of Essex , Colchester , UK.
authors.forename: Wayne
authors.initials: W
authors.lastname: Martin
authors.affiliation: a Department of Psychological Medicine, Weston Education Centre , King's College London, Institute of Psychiatry, Psychology and Neuroscience , London , UK.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: David
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001364:Awareness; D001930:Brain Injuries / Q000523:psychology*; D000070642:Brain Injuries, Traumatic / Q000523:psychology; D003657:Decision Making; D005625:Frontal Lobe; D006801:Humans; D008297:Male; D016743:Mental Competency; D000067489:Metacognition; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010551:Personality; D010554:Personality Disorders / Q000523:psychology*; D019106:Postoperative Hemorrhage / Q000523:psychology; D036301:Qualitative Research; D012649:Self Concept; D020521:Stroke / Q000523:psychology; D013345:Subarachnoid Hemorrhage / Q000523:psychology; D013577:Syndrome
keywords: Acquired brain injury; Decision-making capacity; Frontal lobe syndrome; Mental capacity; Organic personality disorder