Capacity to consent to research among patients with bipolar disorder

Sahana Misra, Linda Ganzini

    Research output: Contribution to journalArticle

    8 Citations (Scopus)

    Abstract

    Experts have debated the influence of mental illness on decision-making capacity. This paper reviews concepts of decision-making capacity and existing research on the influence of mental illness on capacity to consent to research. We propose how bipolar disorder, especially mania, may have an effect on consent capacity. The current conceptualization of capacity utilizes legal standards of 'choice', 'understanding', 'appreciation' and 'rational reasoning', as well as voluntarism, or the assurance that the patient is free to agree or to decline to participate in research. Studies of patients with schizophrenia suggest impaired cognition influences 'understanding' and is more important than severity of psychosis in affecting decision-making abilities. There are no studies of sources and extent of impairment to consent to research among manic patients. Mania may influence a patient's understanding of the research protocol, but also alter the patient's views, values and level of insight, thus impairing decision-making abilities at the 'appreciation' standard even when the patient understands the relevant information. Mania may impact freedom to decide, yet paradoxically, manic patients may be less influenced by others and less vulnerable to coercion, undue influence and undue incentives compared to patients without mental illness. We suggest that in patients with mood disorders, the legal standard of appreciation be thoroughly probed during the consent procedure. Studies of the effect of mania and depression on consent capacity and voluntarism are needed in order to develop processes that increase safeguards in the informed consent process.

    Original languageEnglish (US)
    Pages (from-to)115-123
    Number of pages9
    JournalJournal of Affective Disorders
    Volume80
    Issue number2-3
    DOIs
    StatePublished - Jun 2004

    Fingerprint

    Bipolar Disorder
    Research
    Decision Making
    Aptitude
    Coercion
    Mentally Ill Persons
    Informed Consent
    Mood Disorders
    Psychotic Disorders
    Cognition
    Motivation
    Schizophrenia
    Depression

    Keywords

    • Bipolar disorder
    • Decision-making capacity
    • Research

    ASJC Scopus subject areas

    • Psychiatry and Mental health
    • Behavioral Neuroscience
    • Biological Psychiatry
    • Neurology
    • Psychology(all)

    Cite this

    Capacity to consent to research among patients with bipolar disorder. / Misra, Sahana; Ganzini, Linda.

    In: Journal of Affective Disorders, Vol. 80, No. 2-3, 06.2004, p. 115-123.

    Research output: Contribution to journalArticle

    @article{e4ee1398ee484de29063cde54f800e3c,
    title = "Capacity to consent to research among patients with bipolar disorder",
    abstract = "Experts have debated the influence of mental illness on decision-making capacity. This paper reviews concepts of decision-making capacity and existing research on the influence of mental illness on capacity to consent to research. We propose how bipolar disorder, especially mania, may have an effect on consent capacity. The current conceptualization of capacity utilizes legal standards of 'choice', 'understanding', 'appreciation' and 'rational reasoning', as well as voluntarism, or the assurance that the patient is free to agree or to decline to participate in research. Studies of patients with schizophrenia suggest impaired cognition influences 'understanding' and is more important than severity of psychosis in affecting decision-making abilities. There are no studies of sources and extent of impairment to consent to research among manic patients. Mania may influence a patient's understanding of the research protocol, but also alter the patient's views, values and level of insight, thus impairing decision-making abilities at the 'appreciation' standard even when the patient understands the relevant information. Mania may impact freedom to decide, yet paradoxically, manic patients may be less influenced by others and less vulnerable to coercion, undue influence and undue incentives compared to patients without mental illness. We suggest that in patients with mood disorders, the legal standard of appreciation be thoroughly probed during the consent procedure. Studies of the effect of mania and depression on consent capacity and voluntarism are needed in order to develop processes that increase safeguards in the informed consent process.",
    keywords = "Bipolar disorder, Decision-making capacity, Research",
    author = "Sahana Misra and Linda Ganzini",
    year = "2004",
    month = "6",
    doi = "10.1016/S0165-0327(03)00109-5",
    language = "English (US)",
    volume = "80",
    pages = "115--123",
    journal = "Journal of Affective Disorders",
    issn = "0165-0327",
    publisher = "Elsevier",
    number = "2-3",

    }

    TY - JOUR

    T1 - Capacity to consent to research among patients with bipolar disorder

    AU - Misra, Sahana

    AU - Ganzini, Linda

    PY - 2004/6

    Y1 - 2004/6

    N2 - Experts have debated the influence of mental illness on decision-making capacity. This paper reviews concepts of decision-making capacity and existing research on the influence of mental illness on capacity to consent to research. We propose how bipolar disorder, especially mania, may have an effect on consent capacity. The current conceptualization of capacity utilizes legal standards of 'choice', 'understanding', 'appreciation' and 'rational reasoning', as well as voluntarism, or the assurance that the patient is free to agree or to decline to participate in research. Studies of patients with schizophrenia suggest impaired cognition influences 'understanding' and is more important than severity of psychosis in affecting decision-making abilities. There are no studies of sources and extent of impairment to consent to research among manic patients. Mania may influence a patient's understanding of the research protocol, but also alter the patient's views, values and level of insight, thus impairing decision-making abilities at the 'appreciation' standard even when the patient understands the relevant information. Mania may impact freedom to decide, yet paradoxically, manic patients may be less influenced by others and less vulnerable to coercion, undue influence and undue incentives compared to patients without mental illness. We suggest that in patients with mood disorders, the legal standard of appreciation be thoroughly probed during the consent procedure. Studies of the effect of mania and depression on consent capacity and voluntarism are needed in order to develop processes that increase safeguards in the informed consent process.

    AB - Experts have debated the influence of mental illness on decision-making capacity. This paper reviews concepts of decision-making capacity and existing research on the influence of mental illness on capacity to consent to research. We propose how bipolar disorder, especially mania, may have an effect on consent capacity. The current conceptualization of capacity utilizes legal standards of 'choice', 'understanding', 'appreciation' and 'rational reasoning', as well as voluntarism, or the assurance that the patient is free to agree or to decline to participate in research. Studies of patients with schizophrenia suggest impaired cognition influences 'understanding' and is more important than severity of psychosis in affecting decision-making abilities. There are no studies of sources and extent of impairment to consent to research among manic patients. Mania may influence a patient's understanding of the research protocol, but also alter the patient's views, values and level of insight, thus impairing decision-making abilities at the 'appreciation' standard even when the patient understands the relevant information. Mania may impact freedom to decide, yet paradoxically, manic patients may be less influenced by others and less vulnerable to coercion, undue influence and undue incentives compared to patients without mental illness. We suggest that in patients with mood disorders, the legal standard of appreciation be thoroughly probed during the consent procedure. Studies of the effect of mania and depression on consent capacity and voluntarism are needed in order to develop processes that increase safeguards in the informed consent process.

    KW - Bipolar disorder

    KW - Decision-making capacity

    KW - Research

    UR - http://www.scopus.com/inward/record.url?scp=2342562981&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=2342562981&partnerID=8YFLogxK

    U2 - 10.1016/S0165-0327(03)00109-5

    DO - 10.1016/S0165-0327(03)00109-5

    M3 - Article

    VL - 80

    SP - 115

    EP - 123

    JO - Journal of Affective Disorders

    JF - Journal of Affective Disorders

    SN - 0165-0327

    IS - 2-3

    ER -