Mental capacity to consent to treatment in anorexia nervosa: explorative study
Isis F.F.M. Elzakkers,
Unna N. Danner,
Hans W. Hoek,
Annemarie A van Elburg
Affiliations
Isis F.F.M. Elzakkers
Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands
Unna N. Danner
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
Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands Department of Social Sciences, Utrecht University, Utrecht, The Netherlands
Annemarie A van Elburg
Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands
BackgroundMental capacity to consent to treatment in anorexia nervosa is a neglected area in clinical decision-making.AimsTo examine clinical and neuropsychological parameters associated with diminished mental capacity in anorexia nervosa.MethodAn 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.ResultsDiminished 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.ConclusionsAssessment 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.
