Extra information about treatment is too much for the patient with psychosis

BackgroundCase law across jurisdictions requires ever more complete disclosure of material facts when obtaining consent to treatment.AimsTo determine whether giving extra information impairs the mental capacity to make decisions about treatment.MethodThe MacCAT-T, MacCAT-FP, PANSS and GAF were administered to 88 detained forensic patients with psychosis. Two positive and two negative facts were given about each of two anti-psychotic drugs, and no treatment (twelve items). A choice was elicited. The criterion for incompetence was inability to express a choice. Two extra positive and two extra negative facts about each of the three options were given (twelve extra items) and a choice was again elicited, while repeating the MacCAT-T.ResultsGiving extra information led to a decline in the total score on the MacCAT-T. Twenty one were initially unable to make a choice (24%). After additional information, 33 were incapable (37.5%, Chi-squared p < 0.001). Those initially incapable had the lowest scores on all measures of functional capacity and GAF, with highest scores for symptoms. Those able to choose a treatment option had the highest levels of function and least symptoms. Those who became incapable had intermediate scores.ConclusionsGiving extra information made an extra 15% unable to choose. Clinical judgement must be exercised concerning the amount of information disclosed. Deciding what is material to the individual is arbitrary when so few items of information can be processed. Greater use of guardianship and independent second opinions is recommended.     

Performance Appraisal or Performance Development? a Tale of Two Schemes

After reviewing some of the literature on performance appraisal, this evaluation presents a case study of the introduction of two related schemes in a single Australian government agency. The reasons one was successful and the other less so included the ownership by the agency of the successful scheme; its rapid implementation; and its focus on development rather than appraisal     

Enabling Citizenship: Gender,disability and citizenship in Australia

This paper queries the absence of disabled voices in contemporary citizenship literature. It argues that the language and imagery of the citizen is imbued with hegemonic normalcy and as such excludes disability. Feminist perspectives, such as those which argue for a form of maternal citizenship, largely fail to acknowledge disability experiences. Exclusionary practices are charted and links are made between gender, race and disability in this process. A citizenship which acknowledges disability is fundamental to re-imaging local, national and international collectivities.     

Adolescents' Commitment to Developing Talent: The Role of Peers in Continuing Motivation for Sports and the Arts

The role of peer relationships in supporting or hindering adolescents' talent development has received little research attention, despite the importance of peers in adolescents' lives. We conducted semi-structured in-depth interviews with 41 adolescents talented in sports or the arts, and their parents, to investigate (a) the role of peer relationships in adolescents' continued involvement in their talent activities, (b) possible differences in this role by activity domain, and (c) possible gender differences. Thematic analysis indicated that peers typically played a positive function in supporting the continued involvement of talented adolescents in their talent activities. There were differences in opportunities for peer relationships and social satisfaction between in-school and out-of school activities, but not between activity domains. Both males and females mentioned equally social benefits of such involvement. However, females mentioned receiving negative peer attention more frequently than males, and more often cited social dissatisfaction as a significant contributor to decreased involvement or quitting.