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.     

THE GROWING IMPACT OF GLOBALIZATION UPON CITY POLICIES1

The increasing pace of globalization is impacting numerous cities across the United States. The imperatives of complex interdependence and the progressive internationalization of production have been particularly important stimuli. Moreover, the increasing professionalization of local governments makes them better equipped to handle an active international role. As the forces of globalization penetrate deeper into communities, local leaders find themselves resorting to symbolic or “conscious‐raising” measures designed to heighten international sensitivities and awareness. Economic interests are also pivotal in forging bilateral foreign contacts and accords initiated at the local level. Of particular significance is the horizontal restructuring of private‐public sector relationships. Finally, a case study of Charlotte illustrates both the variety of forces pushing cities to respond to globalization and the considerable constraints that still exist upon such efforts.