title: Treatment decision-making capacity in non-consensual psychiatric treatment: a multicentre study.
abstract: To evaluate treatment decision-making capacity (DMC) to consent to psychiatric treatment in involuntarily committed patients and to further investigate possible associations with clinical and socio-demographic characteristics of patients.
  
  
  
  131 involuntarily hospitalised patients were recruited in three university hospitals. Mental capacity to consent to treatment was measured with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T); psychiatric symptoms severity (Brief Psychiatric Rating Scale, BPRS-E) and cognitive functioning (Mini Mental State Examination, MMSE) were also assessed.
  
  
  
  Mental capacity ratings for the 131 involuntarily hospitalised patients showed that patients affected by bipolar disorders (BD) scored generally better than those affected by schizophrenia spectrum disorders (SSD) in MacCAT-T appreciation (p < 0.05) and reasoning (p < 0.01). Positive symptoms were associated with poorer capacity to appreciate (r = -0.24; p < 0.01) and reason (r = -0.27; p < 0.01) about one's own treatment. Negative symptoms were associated with poorer understanding of treatment (r = -0.23; p < 0.01). Poorer cognitive functioning, as measured by MMSE, negatively affected MacCAT-T understanding in patients affected by SSD, but not in those affected by BD (SSD r = 0.37; p < 0.01; BD r = -0.01; p = 0.9). Poorer MacCAT-T reasoning was associated with more manic symptoms in the BD group of patients but not in the SSD group (BD r = -0.32; p < 0.05; SSD r = 0.03; p = 0.8). Twenty-two per cent (n = 29) of the 131 recruited patients showed high treatment DMC as defined by having scored higher than 75% of understanding, appreciating and reasoning MacCAT-T subscales maximum sores and 2 at expressing a choice. The remaining involuntarily hospitalised patients where considered to have low treatment DMC. Chi-squared disclosed that 32% of BD patients had high treatment DMC compared with 9% of SSD patients (p < 0.001).
  
  
  
  Treatment DMC can be routinely assessed in non-consensual psychiatric settings by the MacCAT-T, as is the case of other clinical variables. Such approach can lead to the identification of patients with high treatment DMC, thus drawing attention to possible dichotomy between legal and clinical status.
authors.affiliation: Department of Neurology and Psychiatry,University of Rome 'Sapienza',viale dell'Università 30,00185 Rome,Italy.
authors.forename: G
authors.identifier: 0000-0003-4887-5108
authors.initials: G
authors.lastname: Mandarelli
authors.affiliation: Section of Criminology and Forensic Psychiatry,University of Bari 'Aldo Moro',Piazza Giulio Cesare,70124,Bari,Italy.
authors.forename: F
authors.initials: F
authors.lastname: Carabellese
authors.affiliation: Department of Neurology and Psychiatry,University of Rome 'Sapienza',viale dell'Università 30,00185 Rome,Italy.
authors.forename: G
authors.initials: G
authors.lastname: Parmigiani
authors.affiliation: School of Psychiatry,University of Perugia,06156 Perugia,Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bernardini
authors.affiliation: School of Psychiatry,University of Perugia,06156 Perugia,Italy.
authors.forename: L
authors.identifier: 0000-0001-7680-5532
authors.initials: L
authors.lastname: Pauselli
authors.affiliation: School of Psychiatry,University of Perugia,06156 Perugia,Italy.
authors.forename: R
authors.initials: R
authors.lastname: Quartesan
authors.affiliation: Section of Criminology and Forensic Psychiatry,University of Bari 'Aldo Moro',Piazza Giulio Cesare,70124,Bari,Italy.
authors.forename: R
authors.initials: R
authors.lastname: Catanesi
authors.affiliation: Department of Neurology and Psychiatry,University of Rome 'Sapienza',viale dell'Università 30,00185 Rome,Italy.
authors.forename: S
authors.initials: S
authors.lastname: Ferracuti
mesh_terms: D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders; D003657:Decision Making; D005260:Female; D006760:Hospitalization; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D007297:Inpatients / Q000523:psychology*; D007558:Italy; D008297:Male; D016743:Mental Competency; D010358:Patient Participation / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index
keywords: Informed consent; involuntary hospitalisation; mental capacity; severe mental illness