【摘要】 目的:初步调查新入院精神分裂症患者知情同意能力状况以及相关因素。方法:对53名连续入院的符合疾病和有关健康问题的国际统计分类第10版精神分裂症诊断的患者在住院72 h内完成评估。采用麦克阿瑟知情同意能力评估工具临床用版本(Mac CAT-T)评估知情同意能力,同时记录一般情况、用自知力与治疗态度问卷(ITAQ)评估自知力,用简明精神病量表(BPRS)评估病情严重程度,以及分析其与知情同意能力的关系。结果:45人(84.9%)知情同意能力不同程度受损,以理解(1.58±1.85)和鉴别维度(2.40±1.47)受损明显。相关性分析显示Mac CAT-T总分与自知力水平呈正相关(r=0.73,P<0.01),与年龄、受教育程度、病程、BPRS总分相关无统计学意义。Logistic回归分析提示自知力(OR=0.69)为知情同意能力的保护因素而思维障碍(OR=1.39)为危险因素。对非自愿入院的患者进行分析发现34.1%的患者保留知情同意能力。结论:新入院精神分裂症患者知情同意能力受损可能是常见的,以理解和鉴别能力最为明显。知情同意能力与自知力和思维障碍相关,是否自愿入院并不能完全代表知情同意能力水平。更多还原

【Abstract】 Objective: To investigate the competency of informed consent in new admitted schizophrenia patients. Methods: Fifty-three patients w ho w ere consecutively admitted to the hospital and diagnosed as schizophrenia according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision( ICD-10) w ere recruited and assessed in seventy-tw o hours. The competence of informed consent w as assessed by the Mac Arthur Competence Assessment Tool-Treatment( Mac CAT-T). The insight w as assessed by the Insight and Treatment Attitude Questionnaire. The severity of illness w as assessed by the Brief Psychiatric Rating Scale( BPRS). Correlations betw een the competence of informed consent and the factors mentioned above w ere discussed. Results: Forty-five( 84. 9%) patients had low er Mac CAT-T scores,especially the scores of understanding dimension( 1. 58 ± 1. 85) and appreciation dimension( 2. 40 ± 1. 47). The competence of informed consent w as significantly correlated w ith insight( r = 0. 73,P < 0. 01) but not correlated w ith age,education,duration of illness and BPRS scores. Logistic regression demonstrated that insight( OR = 0. 69) w as a protective factor of competence of informed consent w hile thought disturbance( OR = 1. 39) w as a risk factor. As to the involuntary admitted patients,34. 1% of them had competence of informed consent. Conclusion: The competence of informed consent in new admitted schizophrenia patients is w idely impaired especially in understanding and appreciation dimension. The competence of informed consent is correlated w ith insight and thought disturbance. Voluntary or involuntary hospitalization does not reflect the level of competence of informed consent.更多还原