Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-29T00:50:39.887Z Has data issue: false hasContentIssue false
  • English
  • Français

Mental capacity to consent to treatment in anorexia nervosa: explorative study

Published online by Cambridge University Press:  02 January 2018

Isis F.F.M. Elzakkers ,
Unna N. Danner ,
Hans W. Hoek  and
Annemarie A van Elburg
Isis F.F.M. Elzakkers*
Affiliation:
Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands
Unna N. Danner
Affiliation:
Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands Parnassia Bavo Psychiatric Institute, The Hague, The Netherlands Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
Hans W. Hoek
Affiliation:
Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands Department of Social Sciences, Utrecht University, Utrecht, The Netherlands
Annemarie A van Elburg
Affiliation:
Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands
*
Isis F.F.M. Elzakkers, MD, Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Wenshoek 4, 3705 WE, Zeist, The Netherlands. Email: [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background

Mental capacity to consent to treatment in anorexia nervosa is a neglected area in clinical decision-making.

Aims

To examine clinical and neuropsychological parameters associated with diminished mental capacity in anorexia nervosa.

Method

An explorative study was conducted in 70 adult female patients with severe anorexia nervosa. Mental capacity to consent to treatment was assessed by experienced psychiatrists. Further measurements included the MacCAT-T (to assess mental capacity status), a range of clinical measures (body mass index (BMI) and comorbidity) and neuropsychological tests assessing decision-making, central coherence and set-shifting capacity.

Results

Diminished mental capacity occurs in a third of patients with severe anorexia nervosa and is associated with a low BMI, less appreciation of illness and treatment, previous treatment for anorexia nervosa, low social functioning and poor set shifting.

Conclusions

Assessment of diminished mental capacity in anorexia nervosa requires careful evaluation of not only BMI, but also the degree of appreciation of illness and treatment, history and the tendency to have a rigid thinking style.

Type
Research Article
Information
BJPsych Open , Volume 2 , Issue 2 , March 2016 , pp. 147 - 153
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Copyright
Copyright © The Royal College of Psychiatrists 2016

Footnotes

Declaration of interest

None.

References

1 Hoek, HW. Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Curr Opin Psychiatry 2006; 19: 389–94.10.1097/01.yco.0000228759.95237.78Google Scholar
2 Arcelus, J, Mitchell, AJ, Wales, J, Nielsen, S. Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Arch Gen Psychiatry 2011; 68: 724–31.Google Scholar
3 Keel, PK, Brown, TA. Update on course and outcome in eating disorders. Int J Eat Disord 2010; 43: 195–204.Google Scholar
4 Smink, FR. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 2012; 14: 406–14.Google Scholar
5 Strober, M, Freeman, R, Morrell, W. The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10? 15 years in a prospective study. Int J Eat Disord 1997; 22: 339–60.10.1002/(SICI)1098-108X(199712)22:4<339::AID-EAT1>3.0.CO;2-N3.0.CO;2-N>Google Scholar
6 Treasure, J, Claudino, AM, Zucker, N. Eating disorders. Lancet 2010; 375: 583–93.Google Scholar
7 Zipfel, S, Giel, KE, Bulik, CM, Hay, P, Schmidt, U. Anorexia nervosa: aetiology, assessment and treatment. Lancet Psychiatry 2015; 2: 1099–111.Google Scholar
8 Kaye, WH, Wierenga, CE, Bailer, UF, Simmons, AN, Bischoff-Grethe, A. Nothing tastes as good as skinny feels: the neurobiology of anorexia nervosa. Trends Neurosci 2013; 36: 110–20.Google Scholar
9 Walsh, BT. The enigmatic persistence of anorexia nervosa. Am J Psychiatry 2013; 170: 477–84.Google Scholar
10 Lopez, C, Tchanturia, K, Stahl, D, Treasure, J. Central coherence in eating disorders: a systematic review. Psychol Med 2008; 38: 1393–404.Google Scholar
11 Tchanturia, K, Davies, H, Roberts, M, Harrison, A, Nakazato, M, Schmidt, U, et al. Poor cognitive flexibility in eating disorders: examining the evidence using the Wisconsin Card Sorting Task. PLoS One 2012; 7: e28331.Google Scholar
12 Tchanturia, K, Liao, PC, Uher, R, Lawrence, N, Treasure, J, Campbell, IC. An investigation of decision making in anorexia nervosa using the Iowa Gambling Task and skin conductance measurements. J Int Neuropsychol Soc 2007; 13: 635–41.Google Scholar
13 Danner, UN, Sanders, N, Smeets, PAM, van Meer, F, Adan, RAH, Hoek, HW, et al. Neuropsychological weaknesses in anorexia nervosa: set-shifting, central coherence, and decision making in currently ill and recovered women. Int J Eat Disord 2012; 45: 685–94.Google Scholar
14 Galimberti, E, Fadda, E, Cavallini, MC, Martoni, RM, Erzegovesi, S, Bellodi, L. Executive functioning in anorexia nervosa patients and their unaffected relatives. Psychiatry Res 2013; 208: 238–44.Google Scholar
15 Chan, TWS, Ahn, W-Y, Bates, JE, Busemeyer, JR, Guillaume, S, Redgrave, GW, et al. Differential impairments underlying decision making in anorexia nervosa and bulimia nervosa: a cognitive modeling analysis. Int J Eat Disord 2014; 47: 157–67.10.1002/eat.22223Google Scholar
16 Tan, JOA, Hope, T, Stewart, A. Anorexia nervosa and personal identity: the accounts of patients and their parents. Int J Law Psychiatry 2003; 26: 533–48.Google Scholar
17 Grisso, T, Appelbaum, PS. Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals. Oxford University Press, 1998.Google Scholar
18 Okai, D, Owen, G, McGuire, H, Singh, S, Churchill, R, Hotopf, M. Mental capacity in psychiatric patients: systematic review. Br J Psychiatry 2007; 191: 291–7.Google Scholar
19 Tan, J, Hope, T, Stewart, A. Competence to refuse treatment in anorexia nervosa. Int J Law Psychiatry 2003; 26: 697–707.Google Scholar
20 Turrell, SL, Peterson-Badali, M, Katzman, DK. Consent to treatment in adolescents with anorexia nervosa. Int J Eat Disord 2011; 44: 703–7.Google Scholar
21 Breden, TM, Vollmann, J. The cognitive based approach of capacity assessment in psychiatry: a philosophical critique of the MacCAT-T. Health Care Anal 2004; 12: 273–83; discussion 265–72.Google Scholar
22 Owen, GS, Freyenhagen, F, Richardson, G, Hotopf, M. Mental capacity and decisional autonomy: an interdisciplinary challenge. Inquiry 2009; 52: 79–107.Google Scholar
23 Hindmarch, T, Hotopf, M, Owen, G. Depression and decision-making capacity for treatment or research: a systematic review. BMC Med Ethics 2013; 14: 54.10.1186/1472-6939-14-54Google Scholar
24 Vollmann, J. “But I don't feel it”: values and emotions in the assessment of competence in patients with anorexia nervosa. Philos Psychiatr Psychol 2006; 13: 289–91.Google Scholar
25 Charland, LC. Anorexia and the MacCAT-T test for mental competence, validity, value, and emotion. Philos Psychiatr Psychol 2007; 13: 283–7.Google Scholar
26 Tan, J, Stewart, A, Hope, T. Decision-making as a broader concept. Philos Psychiatr Psychol 2009; 16: 345–9.Google Scholar
27 Tan, J, Hope, T, Stewart, A, Fitzpatrick, R. Control and compulsory treatment in anorexia nervosa: the views of patients and parents. Int J Law Psychiatry 2003; 26: 627–45.Google Scholar
28 Grisso, T, Appelbaum, PS. Appreciating anorexia: decisional capacity and the role of values. Philos Psychiatr Psychol 2006; 13: 293–301.Google Scholar
29 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Test ERevision) (DSM-IV-TR). APA, 2000.Google Scholar
30 Cooper, Z, Fairburn, C. The eating disorder examination: a semi-structured interview for the assessment of the specific psychopathology of eating disorders. Int J Eat Disord 1987; 6: 1–8.Google Scholar
31 Grisso, T, Appelbaum, PS, Hill-Fotouhi, C. The MacCAT-T: a clinical tool to assess patients' capacities to make treatment decisions. Psychiatr Serv 1997; 48: 1415–9.Google Scholar
32 First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders. American Psychiatric Press, 1996.Google Scholar
33 Beck, AT, Steer, RA, Brouwn, GK. Manual for the Beck Depression Inventory-II. Psychological Corporation, 1996.Google Scholar
34 Spielberger, CD, Gorsuch, RL, Lushene, R, Vagg, PR, Jacobs, GA. Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press, 1983.Google Scholar
35 Bagby, RM, Parker, JDA, Taylor, GJ. The twenty-item Toronto Alexithymia scale—I. Item selection and cross-validation of the factor structure. J Psychosom Res 1994; 38: 23–32.Google Scholar
36 Bagby, RM, Taylor, GJ, Parker, JDA. The twenty-item Toronto Alexithymia scale—II. Convergent, discriminant, and concurrent validity. J Psychosom Res 1994; 38: 33–40.Google Scholar
37 Bechara, A, Damasio, AR, Damasio, H, Anderson, SW. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 1994; 50: 7–15.10.1016/0010-0277(94)90018-3Google Scholar
38 Osterrieth, PA. Le test de copie d'une figure complexe: contribution àl'é tude de la perception et de la mémoire [The complex figure test: it's contribution in the study of perception and memory]. Delachaux & Niestlé, 1944.Google Scholar
39 Berg, EA. A simple objective technique for measuring flexibility in thinking. J Gen Psychol 1948; 39: 15–22.Google Scholar
40 Stedal, K, Frampton, I, Landrø, NI, Lask, B. An examination of the Ravello profile? A neuropsychological test battery for anorexia nervosa. Eur Eat Disord Rev 2012; 20: 175–81.Google Scholar
41 Lang, K, Lopez, C, Stahl, D, Tchanturia, K, Treasure, J. Central coherence in eating disorders: an updated systematic review and meta-analysis. World J Biol Psychiatry 2014; 15: 586–98.Google Scholar
42 Fowler, L, Blackwell, A, Jaffa, A, Palmer, R, Robbins, TW, Sahakian, BJ, et al. Profile of neurocognitive impairments associated with female in-patients with anorexia nervosa. Psychol Med 2006; 36: 517–27.Google Scholar
43 Tan, JO, Stewart, A, Fitzpatrick, R, Hope, T. Attitudes of patients with anorexia nervosa to compulsory treatment and coercion. Int J Law Psychiatry 2010; 33: 13–9.Google Scholar
44 Owen, GS, Szmukler, G, Richardson, G, David, AS, Raymont, V, Freyenhagen, F, et al. Decision-making capacity for treatment in psychiatric and medical in-patients: cross-sectional, comparative study. Br J Psychiatry 2013; 203: 461–7.Google Scholar
45 Suhr, JA, Tsanadis, J. Affect and personality correlates of the Iowa gambling task. Pers Indiv Differ 2007; 43: 27–36.Google Scholar
46 de Vries, M, Holland, RW, Witteman, CLM. In the winning mood: affect in the Iowa gambling task. Judge Decis Mak 2008; 3: 42–50.Google Scholar
47 Damasio, AR. Descartes' error and the future of human life. Sci Am 1994; 271: 144.10.1038/scientificamerican1094-144Google Scholar
48 Bechara, A, Damasio, H, Damasio, AR. Emotion, decision making and the orbitofrontal cortex. Cereb Cortex 2000; 10: 295–307.10.1093/cercor/10.3.295Google Scholar
49 Stroup, TS, Appelbaum, PS, Gu, H, Hays, S, Swartz, MS, Keefe, RSE, et al. Longitudinal consent-related abilities among research participants with schizophrenia: results from the CATIE study. Schizophr Res 2011; 130: 47–52.Google Scholar
50 Tchanturia, K, Lock, J. Cognitive remediation therapy for eating disorders: development, refinement and future directions. Curr Top Behav Neurosci 2011; 6: 269–87.Google Scholar
51 Danner, UN, Dingemans, AE, Steinglass, J. Cognitive remediation therapy for eating disorders. Curr Opin Psychiatry 2015; 28: 468–72.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.