Mentally ill and non-mentally-ill patients' abilities to understand informed consent disclosures for medication

The perormance of two groups of hospitalized mentally ill patients (schizophrenia and major depression) and two groups of non-mentally-ill patients (patients hospitalized for ischemic heart disease and non-ill primary care patients) was compared on a standardized, objective instrument for assessing patients' understanding of information relevant for patient decision making (consent) about treatment with medication. Generally, hospitalized schizophrenic patients manifested significantly poorer understanding of informed consent disclosures about potential medication than did the other groups. Considerable variance, however, was apparent within the schizophrenic group and was related to a number of clinical and demographic variables. The results are interpreted with reference to issues of compatence to consent to or refuse treatment.This research was supported by the Research Network on Mental Health and the Law of the John D. and Catherine T. MacArthur Foundation. We wish to acknowledge Cynthia Wickless, Elizabeth Cote, and Kathryn Cranford for their assistance in this study and to thank several colleagues for helpful comments on an earlier draft: William Gardner, Steven K. Hoge, John Monahan, Stephen Morse, Ed Mulvey, and Henry Steadman.