PDF(Pubmed)
Abstract：
Background: Mental capacity is a fundamental aspect that enables patients to fully participate in various healthcare procedures. To assist healthcare professionals (HCPs) in assessing patients\' capacity, especially in the mental health field, several standardized tools have been developed. These tools include the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), and the Competence Assessment Tool for Psychiatric Advance Directives (CAT-PAD). The core dimensions explored by these tools include Understanding, Appreciation, Reasoning, and Expression of a choice. Objective: This meta-analysis aimed to investigate potential differences in decision-making capacity within the healthcare context among groups of patients with bipolar disorders (BD) and schizophrenia spectrum disorders (SSD). Methods: A systematic search was conducted on Medline/Pubmed, and Scopus. Additionally, Google Scholar was manually inspected, and a manual search of emerging reviews and reference lists of the retrieved papers was performed. Eligible studies were specifically cross-sectional, utilizing standardized assessment tools, and involving patients diagnosed with BD and SSD. Data from the studies were independently extracted and pooled using random-effect models. Hedges\' g was used as a measure for outcomes. Results: Six studies were identified, with three studies using the MacCAT-CR, two studies the MacCAT-T, and one the CAT-PAD. The participants included 189 individuals with BD and 324 individuals with SSD. The meta-analysis revealed that patients with BD performed slightly better compared to patients with SSD, with the difference being statistically significant in the domain of Appreciation (ES = 0.23, 95% CI: 0.01 to 0.04, p = 0.037). There was no statistically significant difference between the two groups for Understanding (ES = 0.09, 95% CI:-0.10 to 0.27, p = 0.352), Reasoning (ES = 0.18, 95% CI: -0.12 to 0.47, p = 0.074), and Expression of a choice (ES = 0.23, 95% CI: -0.01 to 0.48, p = 0.60). In the sensitivity analysis, furthermore, when considering only studies involving patients in symptomatic remission, the difference for Appreciation also resulted in non-significant (ES = 0.21, 95% CI: -0.04 to 0.46, p = 0.102). Conclusions: These findings indicate that there are no significant differences between patients with BD and SSD during remission phases, while differences are minimal during acute phases. The usefulness of standardized assessment of capacity at any stage of the illness should be considered, both for diagnostic-therapeutic phases and for research and advance directives. Further studies are necessary to understand the reasons for the overlap in capacity between the two diagnostic categories compared in this study.
摘要：
背景：心理能力是使患者能够充分参与各种医疗保健程序的基本方面。为了协助医疗保健专业人员(HCP)评估患者的能力，特别是在心理健康领域，已经开发了几种标准化工具。这些工具包括麦克阿瑟能力评估工具（MacCAT-T），麦克阿瑟临床研究能力评估工具(MacCAT-CR)，和精神病学预先指令能力评估工具(CAT-PAD)。这些工具探索的核心维度包括理解，感谢,推理,和选择的表达。目的：这项荟萃分析旨在调查双相情感障碍（BD）和精神分裂症谱系障碍（SSD）患者在医疗保健背景下决策能力的潜在差异。方法：对Medline/Pubmed进行系统搜索，还有Scopus.此外,谷歌学者被手动检查，并对新出现的评论和检索到的论文的参考列表进行了手动搜索。符合条件的研究是专门的横断面研究，利用标准化评估工具，并涉及诊断为BD和SSD的患者。使用随机效应模型独立地提取和汇集来自研究的数据。对冲被用作结果的衡量标准。结果：确定了六项研究，使用MacCAT-CR进行了三项研究，两项研究MacCAT-T，一个是CAT-PAD。参与者包括189名BD患者和324名SSD患者。荟萃分析显示，与SSD患者相比，BD患者的表现略好。在欣赏领域的差异具有统计学意义（ES=0.23，95％CI：0.01至0.04，p=0.037）。两组之间的理解差异无统计学意义（ES=0.09，95％CI：-0.10至0.27，p=0.352），推理(ES=0.18，95%CI：-0.12至0.47，p=0.074)，和选择的表达(ES=0.23,95%CI:-0.01至0.48,p=0.60)。在敏感性分析中，此外，当仅考虑涉及症状缓解患者的研究时，赞赏的差异也导致不显著(ES=0.21，95%CI:-0.04至0.46，p=0.102)。结论：这些结果表明，在缓解期，BD和SSD患者之间没有显着差异。而在急性期差异很小。应考虑在疾病的任何阶段对能力进行标准化评估的有用性，既用于诊断-治疗阶段，也用于研究和提前指令。有必要进行进一步的研究，以了解本研究中比较的两个诊断类别之间能力重叠的原因。
