On measuring incapacity.

PURPOSE OF REVIEW: We review the relevant literature published in the last year on assessing the capacity of mental patients to make decisions in different areas of their lives. We have analyzed the research relating to the development of capacity assessment instruments. RECENT FINDINGS: We examine recent studies focusing on the capacity of mental patients with mild to moderate dementia. Also we investigate how brief interventions affect patients' understanding of the implications of being enrolled in a particular research project. A new area of research has emerged in the field trying to elucidate which neuropsychological and clinical factors can help to predict present or future incapacity. There is still debate on the construct validity of capacity since different theoretical approaches can be used. SUMMARY: Unfortunately there is controversy regarding the utility of neuropsychological and clinical data as predictors of incapacity. It is still necessary, therefore, to use different capacity instruments to ascertain whether patients have sufficient capacity for a specific task or decision.

Do psychiatric patients improve their competency to consent to hospitalization after admission? A prospective study in an acute inpatient ward.

OBJECTIVES: Competency to consent to hospitalization has important clinical and ethical implications. However, there are no follow-up studies that evaluate improvement in competency during psychiatric hospitalization. The authors sought to determine whether patients admitted to a psychiatric ward as incompetent to consent to hospitalization improve their competency during hospitalization. METHOD: A total of 160 consecutively admitted patients were administered the Competency Questionnaire (CQ), a structured scale designed to assess competency to consent to psychiatric hospitalization. The CQ was administered both upon admission and at discharge. Severity and acuity of the psychiatric disorder were assessed with the Severity of Psychiatric Illness Scale and the Acuity of Psychiatric Illness Scale. RESULTS: Of the 160 assessed patients, 70 (43.8%) were rated incompetent. Forty-five of these 70 incompetent patients completed the admission-to-discharge follow-up. Twenty-one of these 45 patients (46.6%) remained incompetent at discharge. Participation in the treatment process was the only variable that predicted improvement on competency during hospitalization. Severity of psychiatric illness at admission did not predict improvement on competency. CONCLUSIONS: Nearly half of the patients who upon admission were incompetent remained incompetent at discharge.