Abstract
Decision-making processes of psychiatric inpatients were assessed at admission and prior to discharge, and compared to hospital staff members using a paired comparison paradigm in which subjects chose between hypothetical antipsychotic medications. Multidimensional analyses of binary choice matrices revealed that all subjects based decisions on the risks and benefits of medication, and weighted risks and benefits in roughly equal proportions. Hospital staff demonstrated greater internal consistency in their decisions than the inpatient sample at both time points. For newly admitted inpatients, severity of psychiatric symptoms and nonverbal intelligence were related to internal consistency of decision making, and behavioral indices of medication compliance predicted relative weighting of risks and benefits. For predischarge and comparison samples, verbal intelligence and treatment preferences predicted both outcome measures. Reliance on verbal reports of decision making may be misleading when assessing competence in acutely impaired psychiatric patients.
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This research was supported by the Program of Research on Mental Health and the Law of the John D. and Catherine T. MacArthur Foundation. The authors would also like to express their appreciation to Wayne DeSarbo for providing the MDS program used in these analyses, Jim Pisano, for assisting in the development of the paired comparison computer program, Tom Grisso and Paul Appelbaum, for providing their then unpublished measures of decision making (UTD and TRAT), and the staff and patients of Western State Hospital for participating in and assisting in the completion of this research.
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Rosenfeld, B.D., Turkheimer, E.N. Modeling psychiatric patients' treatment decision making. Law Hum Behav 19, 389–405 (1995). https://doi.org/10.1007/BF01499139
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DOI: https://doi.org/10.1007/BF01499139