Decision making in a schizophrenic population

Over the past decade, competence to make decisions has become a prominent topic in forensic psychology. We employed a gambling paradigm to measure ability to weigh risks, benefits, and probabilities in an internally consistent manner. Decision-making behavior of chronic, involuntarily committed schizophrenic inpatients was compared to outpatient schizophrenics and first-degree relatives of the patients. We found significant differences between inpatients and non-mentally-ill relatives, and between inpatient and outpatient schizophrenics. When WAIS-R Vocabulary subtest score was statistically controlled,no significant differences between any of the groups remained. Vocabulary x group interactions revealed that Vocabulary subtest predicted decision-making behavior for outpatients and controls, but not inpatients. Severity of psychiatric symptoms and number of prior hospitalizations predicted decision-making behavior for inpatient schizophrenics. Results suggest that competence assessments that rely primarily on verbal abilities may be inadequate to assess competence in acutely ill psychiatric patients.