RESUMO
BACKGROUND: The adequacy of subjects' informed consent to research is the focus of an important public and professional debate. The potential impairment of decisional capacity in persons with schizophrenia is central to the discussions. This study ascertains the decisional capacity for informed consent in schizophrenic research subjects, to determine if reduced capacity relates to specific aspects of psychopathologic features and to test the hypothesis that reduced capacity can be remediated with an educational informed consent process. METHODS: Decisional capacity was assessed for 30 research subjects with schizophrenia and 24 nonill (normal) comparison subjects. Measures of psychopathologic features and cognition were obtained for the subjects with schizophrenia. Subjects who performed poorly on the decisional capacity measure received an educational intervention designed to improve their ability to provide informed consent and were then retested. RESULTS: The patient group did not perform as well as the controls on initial decisional capacity assessment. Poor performance was modestly related to the extent of symptoms but robustly related to cognitive impairments. Following the educational intervention, the performance of subjects with schizophrenia was equal to that of the nonill comparison group. CONCLUSIONS: Many persons with schizophrenia may be challenged by the cognitive demands of an informed consent process for research participation. In many cases, their reduced capacity can be compensated by a more intensive educational intervention as part of the informed consent process.
Assuntos
Consentimento Livre e Esclarecido , Competência Mental , Seleção de Pacientes , Esquizofrenia/diagnóstico , Adulto , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Estudos de Coortes , Tomada de Decisões , Feminino , Psiquiatria Legal/educação , Humanos , Masculino , Educação de Pacientes como Assunto , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Projetos de Pesquisa/normas , Psicologia do Esquizofrênico , Índice de Gravidade de DoençaRESUMO
Motivation for spinal cord injury rehabilitation is a difficult management task for clinicians. Ventilator-dependent quadriplegics experience conditions which are particularly likely to lead to motivational problems. The following article provides a theoretical model with which to understand patient motivation. The model conceptualizes patient motivation as a patient-rehabilitation environment fit problem and employs concepts from social learning theory to facilitate understanding and intervention with such difficulties. The model is applied to two ventilator-dependent rehabilitation cases. Recommendations for clinical practice are provided.