新入院精神分裂症患者知情同意能力的相关因素

Related factors to the competence of informed consent in new admitted patients with schizophrenia

目的:初步调查新入院精神分裂症患者知情同意能力状况以及相关因素。方法:对53名连续入院的符合疾病和有关健康问题的国际统计分类第10版精神分裂症诊断的患者在住院72 h内完成评估。采用麦克阿瑟知情同意能力评估工具临床用版本(Mac CAT-T)评估知情同意能力,同时记录一般情况、用自知力与治疗态度问卷(ITAQ)评估自知力,用简明精神病量表(BPRS)评估病情严重程度,以及分析其与知情同意能力的关系。结果:45人(84.9%)知情同意能力不同程度受损,以理解(1.58±1.85)和鉴别维度(2.40±1.47)受损明显。相关性分析显示Mac CAT-T总分与自知力水平呈正相关(r=0.73,P<0.01),与年龄、受教育程度、病程、BPRS总分相关无统计学意义。Logistic回归分析提示自知力(OR=0.69)为知情同意能力的保护因素而思维障碍(OR=1.39)为危险因素。对非自愿入院的患者进行分析发现34.1%的患者保留知情同意能力。结论:新入院精神分裂症患者知情同意能力受损可能是常见的,以理解和鉴别能力最为明显。知情同意能力与自知力和思维障碍相关,是否自愿入院并不能完全代表知情同意能力水平。

Objective： To investigate the competency of informed consent in new admitted schizophrenia pa- tients. Methods： Fifty-three patients who were consecutively admitted to the hospital and diagnosed as schizophrenia according to the Internationa/ Statistical Classification of Diseases and Related Health Problems, Tenth Revision （ICD-10） were recruited and assessed in seventy-two hours. The competence of informed consent was assessed by the MacArthur Competence Assessment Tool-Treatment （MacCAT-T）. The insight was assessed by the Insight and Treatment Attitude Questionnaire. The severity of illness was assessed by the Brief Psychiatric Rating Scale （BPRS）. Correlations between the competence of informed consent and the factors mentioned above were discussed. Results： Forty-five （84. 9% ） patients had lower MacCAT-T scores, especially the scores of understanding dimension （ 1.58 ± 1.85） and appreciation dimension （2.40 ± 1.47）. The competence of informed consent was significantly correlated with insight （r =0. 73, P 〈0. 01） but not correlated with age, education, duration of illness and BPRS scores. Logistic regression demonstrated that insight （OR = 0. 69） was a orotective factor of competence of informed consent while thought disturbance （ OR = 1.39） was a risk factor. As to the involuntary admitted patients, 34. 1% of them had competence of informed consent. Conclusion： The competence of informed consent in new admitted schizophrenia patients is widely impaired especially in understanding and appreciation dimension The competence of informed consent is correlated with insight and thought disturbance. Voluntary or involuntary hospitalization does not reflect the level of competence of informed consent.