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Psychiatric Evaluation of Mental Capacity in the General Hospital: A Significant Teaching Opportunity
Donald S. Kornfeld, M.D.; Philip R. Muskin, M.D.; Fatimah A. Tahil, M.D.
FOCUS 2013;11:594-599. doi:10.1176/appi.focus.11.4.594

Background  Requests for evaluation of mental capacity in general hospitals have increased in frequency.

Objective  The authors sought to determine the interventions required to respond adequately and assess the initiating circumstances.

Method  Questionnaires completed by psychiatric consultants were analyzed, and chart reviews were completed.

Results  Capacity evaluation alone resolved 32% of the requests; 31% required an evaluation plus additional interventions; 37% did not require a capacity evaluation. Patients threatening to leave against advice, and/or refusing treatments or procedures represented 64% of requests. Consultants successfully resolved 88% of such cases.

Conclusion  A mental capacity evaluation alone was insufficient to resolve two-thirds of problems eliciting requests. Consultation–liaison psychiatrists can use these evaluations as teaching opportunities.
(Reprinted with permission from Psychosomatics 2009; 50:468–473) 

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TABLE 1.Sample Characteristics
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TABLE 2.Reason for Capacity-Consultation Request (N = 96)
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TABLE 3.Psychiatric Consultants’ Interventions
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TABLE 4.Patients Threatening to Sign Out AMA or Refusing Procedure/Treatment (N = 62)
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TABLE 5.Concordance in Assessment of Capacity Between Referring Physician and Psychiatric Consultant (N = 75)


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