Abstract
Clinicians routinely assess patients’ mental capacity on a daily basis, but a more thorough assessment may be needed in complex cases. We aimed to identify the characteristics of inpatients in a general hospital, who were referred to a liaison psychiatry service for mental capacity assessment, reasons for the referrals, and the factors associated with their mental capacity. A 6-year retrospective study (2008–2013) was conducted using data collected routinely (e.g., age, gender, diagnosis, Thai Mental State Examination score, reasons for the referral, and the outcome of capacity assessment) on referrals for mental capacity assessment to a Consultation-liaison Psychiatry Unit at a university hospital in Thailand. Among 6194 consecutive referrals to the liaison-psychiatry services, only 0.6 % [n = 37, mean age (SD), 59.83 (20.42)] were referred for capacity assessment, 43.24 % of which lacked mental capacity. The most common requests from referring physicians were for assessment of testamentary capacity (15 assessed, 53.33 % lacking capacity), financial management capacity (14 assessed, 50 % lacking capacity), and capacity to consent to treatment (9 assessed, 22.22 % lacking capacity). Delirium, rather than dementia or other mental disorders, was associated with mental incapacity (p < 0.001) and being more dependent during the admission (p = 0.048). There were no significant differences for mean age (p = 0.257) or Thai Mental State Examination score (p = 0.206). The main request from referring clinicians was to assess testamentary capacity. Delirium and being more dependent during the admission were associated with lack of mental capacity, whereas age and dementia were not.
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Abbreviations
- TMSE:
-
Thai Mental State Examination
- GAF:
-
Global assessment of functioning
- SD:
-
Standard deviation
- df:
-
Degree of freedom
- IQR:
-
Interquartile range
- χ2 :
-
Chi square test
- U:
-
Mann–Whitney U test
- F:
-
Fisher-Exact test
References
Banner NF: Unreasonable reasons: normative judgements in the assessment of mental capacity. Journal of Evaluation in Clinical Practice 18(5):1038–1044, 2012.
Okai D, Owen G, Mcguire H, Singh S, Churchill R, Hotopf M: Mental capacity in psychiatric patients: Systematic review. The British Journal of Psychiatry 191(4):291–297, 2007.
Cairns R, Maddock C, Buchanan A, David AS, Hayward P, Richardson G, Szmukler G, Hotopf M: Reliability of mental capacity assessments in psychiatric in-patients. The British Journal of Psychiatry 187(4):372–378, 2005.
Palmer BW, Savla GN, Roesch SC, Jeste DV: Changes in capacity to consent over time in patients involved in psychiatric research. The British Journal of Psychiatry 202(6):454–458, 2013.
Mujic F, Von Heising M, Stewart RJ, Prince MJ: Mental capacity assessments among general hospital inpatients referred to a specialist liaison psychiatry service for older people. International Psychogeriatrics 21(4):729–737, 2009.
Thai Medical Council: Thai Physicians by Subspecialty. Bangkok, 2014.
National Statistical Office: Key Statistics of Thailand 2012. Bangkok, 2012.
Thai Medical Council: Medical Competency Assessment Criteria for National License 2012. Bangkok 94, 2012.
Tsoh J, Peisah C, Narumoto J, Wongpakaran N, Wongpakaran T, O’Neill N, Jiang T, Ogano S, Mimura M, Kato Y et al: Comparisons of guardianship laws and surrogate decision-making practices in China, Japan, Thailand and Australia: a review by the Asia Consortium, International Psychogeriatric Association (IPA) capacity taskforce. International psychogeriatrics 27(6):1029–1037, 2015.
Raymont V, Bingley W, Buchanan A, David AS, Hayward P, Wessely S, Hotopf M: Prevalence of mental incapacity in medical inpatients and associated risk factors: Cross-sectional study. Lancet 364(9443):1421–1427, 2004.
Merel SE, Murray SB: Decisional capacity. Hospital Medicine Clinics 2(2):263–273, 2013.
Whelan PJ, Oleszek J, Macdonald A, Gaughran F: The utility of the Mini-Mental State Examination in guiding assessment of capacity to consent to research. International Psychogeriatrics 21(2):338–344, 2009.
Luke L, Redley M, Clare I, Holland A: Hospital clinicians’ attitudes towards a statutory advocacy service for patients lacking mental capacity: implications for implementation. Journal of health services research & policy 13(2):73–78, 2008.
Ramsay H, Roche E, O’Donoghue B: Five years after implementation: A review of the Irish Mental Health Act 2001. International journal of law and psychiatry 36(1):83–91, 2013.
Pariwatcharakul P: Psychiatric Consultation at Siriraj Hospital in 2005. Bangkok, Mahidol University, 2007.
Paholpak S: Psychiatric consultation at Srinagarind Hospital: A report on 271 cases. Journal of Medical Association of Thailand 74(8):329–336, 1991.
Maneeton B, Khemawichanurat W, Maneeton N: Consultation-liaison psychiatry in Maharaj Nakorn Chiang Mai Hospital. ASEAN Journal of Psychiatry 8(2):124–130, 2007.
Sangkul J, Pitanupong J: Psychiatric consultation at Songklanagarind Hospital. Songklanagarind Medical Journal 18(1):57–63, 2000.
Train The Brain Forum Committee: Thai Mental State Examination (TMSE). Siriraj Hospital Gazette 45:359–374, 1993.
Pariwatcharakul P, Chantarat W, Singhakant S, Jantarak L, Suriyachaiwattana T, Sakulisariyaporn C, Sitdhiraksa N, Chantakarn S, Ketumarn P, Yantadilok S: Antipsychotic prescribing pattern for geriatric patients with delirium in Thailand. Clinical Psychopharmacology and Neuroscience 8(3):144–148, 2010.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington, DC, American Psychiatric Association, 2000.
Owen GS, Szmukler G, Richardson G, David AS, Raymont V, Freyenhagen F, Martin W, Hotopf M: Decision-making capacity for treatment in psychiatric and medical in-patients: Cross-sectional, comparative study. The British Journal of Psychiatry 203(6):461–467, 2013.
Seyfried L, Ryan KA, Kim SY: Assessment of decision-making capacity: Views and experiences of consultation psychiatrists. Psychosomatics 54(2):115–123, 2013.
Lepping P: Overestimating patients’ capacity. The British Journal of Psychiatry 199(5):355–356, 2011.
Acknowledgments
Both of the authors are supported by “Chalermphrakiat” Grant, Faculty of Medicine Siriraj Hospital, Mahidol University. The authors are thankful to Dr. Woraphat Ratta-apha, Ms. Aree Singlamphong, Ms. Reelawadee Tumsatan and Ms. Boonploy Srimana for their help and comments. This research has been presented in the Royal College of Psychiatrists International Congress 2014, London, UK and the Siriraj International Conference in Medicine and Public Health 2014, Bangkok, Thailand.
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This study was approved by the Siriraj Institutional Review Board (Certificate of Approval number Si 285/2014).
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Pariwatcharakul, P., Singhakant, S. Mental Capacity Assessments Among Inpatients Referred to the Consultation-Liaison Psychiatry Unit at a University Hospital in Bangkok, Thailand. Psychiatr Q 88, 65–73 (2017). https://doi.org/10.1007/s11126-016-9439-x
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DOI: https://doi.org/10.1007/s11126-016-9439-x