PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Mental Competency”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed1979

Brief form of the Competency Screening Test for mental competence to stand trial.

Investigated a brief 5-item version of the Competency Screening Test (a sentence completion test of mental competence to stand trial) for its relationship to the complete 22-item test, and for its power to predict the mental competency findings of a comprehensive Clinical Psychiatric Evaluation conducted by a forensic psychiatrist. Ss were 21 female patients serially examined in a forensic psychiatric service for mental competence to stand trial. Tests were individually administered. The brief version of Competency Screening Test was highly correlated, with the full test Rho = .92. It classified 17 (of 21) patients in direct agreement with the results of the Clinical Psychiatric Evaluation. It showed a theoretical, but small relationship with verbal intelligence for this group. The 5-item form seems applicable for preliminary competency screening evaluation.

Adult↗
PubMed1988

Clinical determination of mental competence. A theory and a retrospective study.

In an attempt to establish a method for determination of mental competence, a two-part investigation was undertaken. First, a model for mental competence was devised that would be applicable across a broad range of neurologic disorders; this model was based on a patient's ability to make complex decisions. Second, a retrospective analysis of competence in 92 inpatients on a neurobehavioral service was carried out. The model was a useful way to view competence, at least in this population. Competence could be classified as operational, limited to a single cognitive domain, or as general, cutting across all domains in a way for which no compensation could be devised. The results suggest that a model of competence based on analysis of individual cognitive operations will provide a sound clinical approach to a common problem that is presently not well characterized.

Adult↗
PubMed1991

Can compulsory removal ever be justified for adults who are mentally competent?

Section 47 of the National Assistance Act is controversial in that it makes provision for the compulsory removal and care of mentally competent adults in certain limited circumstances. A case is described in which it is argued that compulsory management could be justified. This is because the diversity and potentially conflicting nature of the relevant considerations involved in this and a restricted range of other cases, defies their being captured in any wholly rational moral scheme. It follows that if the law is to be both sensitive and just it cannot always provide definitive guidance as to how the community doctor, as the designated decision-maker, should act. The acceptance of his or her judgement is therefore necessary and depends for its proper working on trust, which can only be gained through compassion and respect for the patients concerned.

Aged↗
PubMed1989

Evaluation of mental competency.

The assessment of competency is a legal and judicial one, often resting heavily on a medical evaluation. According to one set of criteria, the primary elements of mental competency are based on an individual's awareness of the nature of the present situation, factual understanding of the issues at hand and ability to manipulate information rationally to reach a decision. Family physicians can play pivotal roles in the process of competency determination.

Activities of Daily Living↗
PubMed1992

The do-not-resuscitate order in a nursing home: patient's choice or staff's decision.

An 86-year-old woman in a residential health care facility suffered a massive stroke; immediate intubation was performed, she was transferred to a nearby hospital where she died two months later. Within 48 hours of this event, three mentally competent residents and one family member on the unit requested a do-not-resuscitate order. They, along with the seven other mentally competent and non-terminal residents on the unit, participated in a questionnaire survey, the purpose of which was to elicit information on DNR attitudes. Only one respondent requested cardiopulmonary resuscitation. All insisted that do-not-resuscitate decisions were theirs alone to make. A staff questionnaire was given to 81 employees having many years of health care experience. Most had witnessed death and cardiopulmonary resuscitation and knew of its poor outcome. However, 51% were very willing to participate in cardiopulmonary resuscitation, and 65% thought cardiopulmonary resuscitation was worthwhile in residential health care facilities. Furthermore, 56.8% thought that families should participate in the decision. The dichotomy between residents' wishes and staff perceptions merits recognition and further study.

Aged↗
PubMed1979

Development of articulatory competence in mentally retarded children.

Mentally retarded children participated in a verbal stimulation program developed at the Institute for Psychophysiological and Speech Disorders, Belgrade, Yugoslavia. Intensive home therapy was associated with an increase in articulatory competence in both moderately and profoundly retarded children. The development of articulation differed between retardate groups as well as with the sequence of normal phonological production. The results suggest that the order in which wounds are introduced into the therapeutic program may be a critical factor in the over-all development of competent articulation.

Child↗
PubMed1977

False belief and the refusal of medical treatment.

May a doctor treat a patient, despite that patient's refusal, when in his professional opinion treatment is necessary? This is the dilemma which must from time to time confront most physicians. An examination of the validity of such a refusal is provided by the present authors who use the case history of a patient refusing treatment, for cancer as well as for a fractured hip, to evaluate the grounds for intervention in such circumstances. In such a situation the patient is said to have a 'false belief' and it is the doctor's duty to try to change that belief in the patient's interest. The false belief is considered here in terms of the liberty principle, the patient's mental competence and on what is called the 'harm principle' (harm to other individuals or to society). Finally the concept of paternalism is examined. The authors conclude that the doctor must attempt to change a false belief, and if this fails he must examine the patient's mental competence to make the decision to refuse treatment. But in the last analysis the doctor may be under an obligation to respect the patient's refusal. Readers might like to look at (or read again) the papers on 'Liberty' and 'Conscience' published in this Journal under the heading Analysis.

Attitude to Health↗
PubMed1992

[A project on eating disorders. Increasing of competence within mental health services in treating severe eating disorders].

We describe a two-year education programme for health workers treating patients with eating disorders. The intention of the programme was partly to increase the knowledge and ability of the participants themselves, and partly to spread this knowledge to other health workers not directly involved in the programme. The programme attracted 66 participants. It was composed of theoretical lectures, group supervision, clinical work with patients with eating disorders and individual supervision as needed. Evaluation at the end of the programme showed a greater feeling of competence and more positive attitudes towards treating these particular patients. More than 80% of the participants had supervised other health workers outside the programme, and nearly 50% had held lectures on the treatment of eating disorders.

Clinical Competence↗
PubMedDate not supplied

Not for resuscitative treatment.

The nurse is accountable for her actions. A defence of 'obeying orders' will not always be acceptable. Decisions made by mentally competent adults prevail. A living will is not recognized in the English legal system. Relatives do not have the legal power to make treatment decisions on behalf of a mentally incapacitated adult but their views should be sought. The practitioner must act in the patients' best interests but this does not mean that life should be preserved regardless of quality.

Communication Barriers↗
PubMed1992

Cognitive performance on Piagetian tasks by Alzheimer's disease patients.

The purpose of this study was to examine cognitive abilities in Alzheimer's disease (AD) patients using Piaget's child developmental theory. Thirty elderly AD patients and 30 elderly control subjects were given two traditional Piagetian measures, the Infant Psychological Development Scale and the Concrete Operations Test. Half of the AD subjects (15) were in Piaget's sensorimotor or preoperational stages, while the remaining half of the AD subjects and all elderly control subjects were in Piaget's concrete operational stage, chi 2 [1, N = 60] = 17.42, p less than .001. If subsequent studies confirm that AD patients' cognitive characteristics are similar to Piaget's theoretical model, nursing care might be individualized based on mental competence, thus minimizing the commonly observed caregiver overestimation and underestimation of the AD patient's ability to understand and cooperate.

Aged↗
PubMed1988

The psychiatrist's role in determining competency to consent in the general hospital.

In the general hospital, consultation-liaison psychiatrists are frequently consulted regarding issues of competency to consent to medical and surgical procedures and treatments. It is necessary that psychiatrists practicing in this setting have a thorough awareness of both the legal aspects of competency and consent and the clinical situations which can arise. In this paper we discuss the legal basis for consent and various definitions proposed for mental competency to consent to treatment. We describe a number of typical situations which lead to psychiatric consultation and suggest an appropriate approach to their resolution.

Forensic Psychiatry↗
PubMed1992

Do-not-resuscitate orders for depressed psychiatric inpatients.

Many patients, especially those who are elderly and who have chronic medical illnesses, choose to forgo cardiopulmonary resuscitation (CPR) in case of cardiac arrest. The right of mentally competent patients to refuse CPR is supported by ethicists, the courts, and medical associations. Psychiatrists are increasingly presented with dilemmas about resuscitation preferences of elderly psychiatric inpatients whose decision-making capacity may be impaired because of mental illness such as depression. The authors discuss justifications for patients' refusing resuscitation, the role of advance directives in communicating patients' preferences, and the use of do-not-resuscitate orders for depressed psychiatric inpatients. Survival rates after CPR among elderly patients with chronic medical illnesses are low. Patients and their families need accurate information about the risks and benefits of CPR and about the consequences of refusing the procedure.

Aged↗
PubMed1989

Life-sustaining treatment for patients with AIDS.

Physicians increasingly are being called upon to make difficult decisions about intensive care for patients with the acquired immunodeficiency syndrome (AIDS). AIDS patients who require intensive care have a poor prognosis; the in-hospital mortality rate of those receiving mechanical ventilation for P carinii pneumonia is 86-100 percent in most studies. However, in the past year, two studies documenting improved outcome have been published. Physicians should understand these outcome data and use well-established ethical principles to allow informed competent patients with AIDS to express their preferences regarding intensive care. Patients should be encouraged to provide advanced directives regarding life-sustaining treatments or to designate surrogate decision-makers to be consulted should they lose mental competence. The health care system should provide alternatives to the ICU for compassionate terminal care. However, arbitrary policies denying intensive care to AIDS patients for whom it is medically indicated and desired are not warranted.

Acquired Immunodeficiency Syndrome↗
PubMed1992

[Evaluation of the thyroid function in healthy aged patients residing in 2 geriatric institutions].

Thyroid function assessment in elderly inpatients. It is not well known whether normal ageing might lead to an impairment of thyroid function. We evaluated 297 elderly inmates in two geriatric institutions. After having excluded from the study those who were affected by chronic hepatic or renal disease, were under pharmacologic treatment or had suffered from acute ailments during the previous two months, we assessed thyroid function by determining circulating T4, T3, rT3, FT4, FT3 and TSH in 130 apparently healthy subjects. They could be divided into three groups composed of patients mentally competent, affected by either vascular or senile dementia, or affected by chronic psychosis. Results were also assessed with reference to three different age ranges (65-74, 75-84 and over 85 years). Two patients had subnormal thyroid hormone levels with elevated basal thyrotropin, while other two demonstrated only elevated thyrotropin levels, qualifying respectively for a diagnosis of primary hypothyroidism and subclinical hypothyroidism. In the remaining 126 patients thyroid function was normal, and no differences in thyroid hormone levels could be noticed among the various groups of patients, divided for sex, age range and mental condition. The results of our study confirm the presence of a high percentage of subclinical thyroid dysfunction in old age. They also suggest that in healthy aged subjects thyroid function parameters are not significantly different in reference to sex, age range and mental condition.

Age Factors↗
PubMedDate not supplied

Discussing cardiopulmonary resuscitation: a study of elderly outpatients.

Decisions about when to perform cardiopulmonary resuscitation (CPR) are frequently made without knowing the wishes of the patient. To evaluate the feasibility of outpatient discussions about CPR, the authors surveyed 22 male and 53 female, mentally competent, ambulatory patients 65 years of age and older. Only 7% of those interviewed had an accurate understanding of what CPR meant before hearing a standardized description. Eighty-seven per cent thought discussions about CPR should take place routinely, but only 3% had previously discussed this issue with their physicians. Seventy per cent felt such discussions should take place during periods of health, and 84% felt their views should be part of the medical record. When asked about three terminal illnesses, a minority of patients wanted CPR: 25% felt CPR was indicated in the presence of irreversible coma, 28% for terminal cancer, and 41% for irreversible heart failure. More patients felt they would request CPR if they had irreversible heart failure than if in a coma (p less than 0.002) or for terminal cancer (p = 0.002). The majority of elderly outpatients have clearly defined opinions about the application of CPR and wish to discuss them with their physicians.

Aged↗
PubMed1990

Ethics in cardiovascular medicine. Task Force II: The relation of cardiovascular specialists to patients, other physicians and physician-owned organizations.

1. The American College of Cardiology acknowledges the continuum of changing societal, medical and economic perspectives affecting traditional medical ethics. Primacy of patient responsibility remains paramount to the cardiovascular specialist who at the same time should participate in the development of broader societal programs. 2. Medical decisions should be freely and jointly formulated by the patient and the cardiovascular specialist with appropriate sensitivity to such matters as mental competence, pertinent medical information and standards of care, sufficient time for contemplation, informed consent, patient right of refusal, physician right to refuse to provide inappropriate care and the right of patient, physician or third party payer to seek consultation or additional opinions. 3. The cardiovascular specialist should make a special effort to clarify and document patient preferences regarding end-of-life treatment through some form of advance directive. 4. The cardiovascular specialist bears a moral obligation to provide medical care to any patient who is HIV positive or has AIDS. 5. A conflict of interest occurs when a cardiovascular specialist places personal or financial interest ahead of the welfare and health of a patient. Professional accountability should be established through local or regional peer review. 6. The American College of Cardiology encourages and supports a renewed dedication to the principles of medical ethics, particularly in the field of cardiovascular disease. Cardiovascular specialists are encouraged to participate in the promulgation of medical ethics by teaching and by example, individually and with others.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Day hospital as an alternative to inpatient care for cancer patients: a random assignment trial.

A stratified, random-assignment trial of 442 cancer patients was conducted to evaluate medical, psychosocial, and financial outcomes of day hospital treatment as an alternative to inpatient care for certain cancer patients. Eligible patients required: a 4- to 8-hour treatment plan, including chemotherapy and other long-term intravenous (i.v.) treatment; a stable cardiovascular status; mental competence; no skilled overnight nursing; and a helper to assist with home care. Patients were ineligible if standard outpatient treatment was possible. No statistically significant (p less than 0.05) differences were found between the Adult Day Hospital (ADH) and Inpatient care in medical or psychosocial outcomes over the 60-day study period. The major difference was in medical costs--approximately one-third lower for ADH patients (p less than 0.001) than for the Inpatient group. The study demonstrates that day hospital care of medical oncology patients is clinically equivalent to Inpatient care, causes no negative psychosocial effects, and costs less than Inpatient care. Findings support the trend toward dehospitalization of medical treatment.

Adult↗