The evaluation of consent capacity and decision making support for older patients with schizophrenia - The evaluation of consent capacity and decision making support for older patients with schizophrenia

OBJECTIVE: To clarify the difference between the consent capacity to antipsychotic treatment and hyperlipemic treatment, and the effect of the decision aid, the visual teaching material, on consent capacity. METHODS: We recruited older institutionalized patients with chronic schizophrenia under treatment or treatment plan of hyperlipidemia(n=7). Baseline measures included the neurocognitive tests and brief psychiatric rating scale and the MacArthur Competence Assessment Tool for Treatment(MacCAT-T). The order of capacity assessment was randomly assigned to remove an order effect. We readministered the MacCAT-T with the decision aid one month later. The differences of the score in the MacCAT-T between treatments and improvement of the score of the MacCAT-T by using the decision aid were analyzed using t test. The study was approved by the Ethics Committee of Kyoto Prefectural University of Medicine. RESULTS: "Reasoning" and "Comparison of the result" scores in the MacCAT-T were significantly higher in antipsychotic treatment than hyperlipemic treatment. Furthermore, "Understanding of the disease" and "Understanding of the substitute treatment" score in antipsychotic treatment, and "Understanding", "Understanding of the treatment", "Benefits and disadvantages of the treatment", "Understanding of the substitute treatment" and "Recognition of the treatment" scores in hyperlipemic treatment were significantly improved by using the decision aid. CONCLUSION: Better reasoning in antipsychotic treatment may reflect that the treatment effect is easy to recognize in the antipsychotic treatment than hyperlipemic treatment. The decision aid may help their understanding of the treatment and the substitute treatment through the compensation of working memory deterioration.