Capacity to Consent to Research on Bipolar Disorder

描述（由申请人提供）：显然需要对双相情感障碍进行持续的临床研究，以确定更有效的治疗方法。然而，主要的情感症状，以及往往与这种情况相关的洞察力和认知功能的缺陷，可能会对一些患者同意参加此类研究的能力产生不利影响。除了我们的初步数据，从一个小的限制性样本的中年和老年双相情感障碍患者，还没有发表的研究能力，同意在双相情感障碍患者的研究。拟议的纵向研究的目标是确定与同意研究的能力的水平和稳定性的相关因素，在临床和人口统计学异质性样本的172人与双相I型或II型障碍，以及在118名健康的对照组（HC）。我们还将评估通过互动披露过程可以提高对披露信息的理解程度。在基线、6周、12周和26周访视时，将使用标准指标系统评价决策能力、精神病理学严重程度、自知力缺陷和神经心理功能。我们假设，双相情感障碍患者将显示出显着的缺陷，在决策能力相对于HC，但将有相当大的组内异质性;人与人之间的差异，在决策能力将更强烈地与认知缺陷的水平比严重程度的精神病理或洞察力缺陷。然而，随着时间的推移，人内的变异性将是精神病理学和洞察力变化的函数。我们还假设，以前的情感发作的数量将与决策能力差，但这种关系将介导的有害影响，多个情感发作的认知功能和所有参与者之间的理解水平将通过迭代的披露过程中提高。这项研究将具有很高的公共卫生和生物伦理学意义，因为双相情感障碍的临床研究仍有明显的需求，但缺乏经验数据来指导政策和研究人员在确保有效的初始和持续知情同意方面对此类参与者进行伦理招募。

DESCRIPTION (provided by applicant): There is a clear need for ongoing clinical research on bipolar disorder to identify more effective treatments. However, the primary affective symptoms, and deficits in insight and cognitive functioning that are often associated with this condition, may adversely affect the capacity of some patients to consent to participate in such research. With the exception of our preliminary data from a small circumscribed sample of middle-aged and older bipolar patients, there have been no published studies of capacity to consent to research among bipolar patients. The goals of the proposed longitudinal study are to identify the factors associated with the level and stability of capacity to consent to research among a clinically and demographically heterogeneous sample of 172 people with bipolar I or II disorder, as well as among 118 healthy comparison subjects (HCs). We will also evaluate the degree to which understanding of disclosed information can be improved through an interactive disclosure process. Using standard measures, decisional capacity, severity of psychopathology, insight deficits, and neuropsychological functioning will be systematically evaluated at baseline, 6-, 12-, and 26- week visits. We hypothesize that bipolar patients will show significant deficits in decisional capacity relative to HCs, but there will be considerable within-group heterogeneity; between person differences in decisional capacity will be more strongly related to level of cognitive deficits than to severity of psychopathology or insight deficits. However, within-person variability over time will be a function of changes in psychopathology and insight. We also hypothesize that the number of prior affective episodes will be related to worse decisional capacity, but that this relationship will be mediated by the deleterious effects of multiple affective episodes on cognitive functioning and that levels of understanding among all participants will improve through an iterative disclosure process. This study will have high public health and bioethical significance, as there remains a clear need for clinical research in bipolar disorder, but there is a lack of empirical data to guide policy and researchers regarding the ethical enrollment of such participants in terms of ensuring valid initial and continuing informed consent.