精神分裂症患者知情同意能力的相关因素

Informed consent competency and related factors in patients with schizophrenia

目的:分析精神分裂症患者知情同意能力的相关因素。方法:选取符合精神障碍诊断与统计手册第4版诊断标准的100例社区康复、门诊/住院的精神分裂症患者(精神分裂症组)和28例正常对照(对照组),使用简体中文版麦克阿瑟临床研究知情同意能力评估工具(Mac CAT-CR)、阳性和阴性症状量表(PANSS)、韦氏智力量表简式(WASI)、临床总体印象-严重程度量表(CGI-S)分别评估受试者知情同意能力、精神症状、智商和疾病严重程度。使用logistic回归分析模型拟合分析精神分裂症患者知情同意能力的危险因素。结果:精神分裂症组知情同意能力缺失、受损、完整的比率分别为26.0%、47.0%和27.0%,正常对照组分别为3.6%,57.1%和39.3%,精神分裂症组知情同意能力缺失的比率高于正常对照组(26.0%vs.3.6%,P<0.01),受损与完整的比率两组差异无统计学意义(均P>0.05)。Logistic回归分析发现,高PANSS阳性症状分量表总分(OR=1.15)、高PANSS阴性症状分量表总分(OR=1.23)和高CGI-S评分(OR=1.57)的精神分裂症患者知情同意能力受损的风险增加;高受教育年限(OR=0.73)和高智商(OR=0.92)的精神分裂症患者知情同意能力不容易受损。结论:精神分裂症患者知情同意能力比对照差,精神分裂症患者的阳性、阴性症状重、疾病严重程度高可能增加精神分裂症患者知情同意能力受损的风险;高受教育年限与高智商可能降低精神分裂症患者知情同意能力受损的风险。

Objective： To analyze related factors to the informed consent competency of patients with schizophrenia. Methods： Subjects were divided into two groups, namely one group including 100 patients with schizophrenia and the other group including 28 heathy controls. Patients with schizophrenia were administrated from community rehabilitation units and The Sixth Hospital of Peking University, diagnosed with the Diagnostic and Statistical Manual of mental disorder, Fourth Edition （DSM-IV）. Informed consent competency of subjects were evaluated with the Chinese Mandarin Version of MacArthur Competence Assessment Tool for Clinical Research. Psychiatric symptoms, intelligence quotient and severity of disease were accessed individually with the Positive and Negative Symptom Scale （PANSS）, Wechsler Abbreviated Scale of Intelligence （WASI） and Clinical General Impression- Severity Scale （CGI-S）. Logistic regression analysis model was used to analyze the risk factors of impaired informed consent competency in schizophrenia. Results： The rates of absent, impaired and adequate informed consent competency were 26.0% （26/100）, 47.0% （47/100） and 27.0% （27/100） in schizophrenia group, and 3.6% （1/28）, 57. 1% （16/28） and 39. 3% （11/28） in control group. Rate of absent informed consent competency was higher in schizophrenia group than that in control group （26. 0% vs. 3.6%, P 〈0. 01）. There were no statistic significant differences in rates of impaired and adequate informed consent competency between two groups （both P 〉 0. 05）. Results of logistic regression analysis showed that schizophrenic patients with higher scores of positive subscale （OR = 1.15）, negative subscale （OR = 1.23） and CGI-S （OR = 1.57） had more tendency to impaired capaci- ty. Higher education level （OR = 0. 73） and higher scores of IQ （ OR = 0. 92） had less risks for that. Conclusion： Competency of informed consent in schizophrenia may be worse than that in health control. Patients with schizophrenia with impaired informed consent competency may have more serious of positive, negative psychiatric symptoms and higher severity of disease. Higher level of education and IQ scores may reduce the risk of impaired informed consent competency.