Decision-making capacity for research participation among individuals in the CATIE schizophrenia trial.
Decision-making capacity for research participation among individuals in the CATIE schizophrenia trial.
复制标题
CATIE 精神分裂症试验中个体参与研究的决策能力。
DOI：
10.1016/j.schres.2005.08.007
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发表时间：
2005
影响因子：
4.5
通讯作者：
Lieberman,Jeffrey
中科院分区：
文献类型：
--
作者：
Stroup,Scott;Appelbaum,Paul;Swartz,Marvin;Patel,Mukesh;Davis,Sonia;Jeste,Dilip;Kim,Scott;Keefe,Richard;Manschreck,Theo;McEvoy,Joseph;Lieberman,Jeffrey
精神分裂症患者可能缺乏决策能力的程度以及能力的预测因素可能导致我们在进入临床试验时检查大样本精神分裂症患者中精神病理学、神经认知功能和决策能力之间的关系。一项由国家精神卫生研究所赞助的临床试验，旨在比较抗精神病药物的有效性，受试者接受了麦克阿瑟能力评估工具-临床研究（MacCAT-CR），并在随机化之前必须证明有足够的决策能力。MacCAT-CR，阳性和阴性症状量表（PANSS），和广泛的神经认知电池完成了1447名研究参与者。神经认知综合评分和所有5个神经认知分项评分（文字记忆，警惕，处理速度，推理，和工作记忆）的MacCAT-CR的理解，欣赏，推理量表在基线呈正相关。较高水平的阴性症状，但不是阳性症状，与这三个MacCAT-CR量表呈负相关。所有三个MacCAT-CR量表的线性回归模型确定工作记忆作为预测因子;阴性症状的理解和赞赏scores. CONCLUSIONSSnegative症状和方面的神经认知功能与决策能力在这个大样本的中度患病的精神分裂症患者。在MacCAT-CR量表的多元回归模型预测性能，工作记忆是唯一一致的预测决策能力的组成部分。患有精神分裂症的人有突出的认知功能障碍，特别是记忆障碍，在参与研究时可能需要特别关注。
OBJECTIVEUncertainty regarding the degree to which persons with schizophrenia may lack decision-making capacity, and what the predictors of capacity may be led us to examine the relationship between psychopathology, neurocognitive functioning, and decision-making capacity in a large sample of persons with schizophrenia at entry into a clinical trial.METHODIn the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial, a clinical trial sponsored by the National Institute of Mental Health designed to compare the effectiveness of antipsychotic drugs, subjects were administered the MacArthur Competence Assessment Tool-Clinical Research (MacCAT-CR) and had to demonstrate adequate decision-making capacity before randomization. The MacCAT-CR, the Positive and Negative Syndrome Scale (PANSS), and an extensive neurocognitive battery were completed for 1447 study participants.RESULTSThe neurocognitive composite score and all 5 neurocognitive subscores (verbal memory, vigilance, processing speed, reasoning, and working memory) were positive correlates of the MacCAT-CR understanding, appreciation, and reasoning scales at baseline. Higher levels of negative symptoms, but not positive symptoms, were inversely correlated with these three MacCAT-CR scales. Linear regression models of all three MacCAT-CR scales identified working memory as a predictor; negative symptoms made a small contribution to the understanding and appreciation scores.CONCLUSIONSNegative symptoms and aspects of neurocognitive functioning were correlated with decision-making capacity in this large sample of moderately ill subjects with schizophrenia. In multiple regression models predicting performance on the MacCAT-CR scales, working memory was the only consistent predictor of the components of decision-making capacity. Individuals with schizophrenia who have prominent cognitive dysfunction, especially memory impairment, may warrant particular attention when participating in research.