Clinical assessment of decision-making capacity in acquired brain injury with personality change. Issue 1 (2nd January 2017)

• Record Type: Journal Article
• Authors: Owen, Gareth S.; Freyenhagen, Fabian; Martin, Wayne; David, Anthony S.
• Is Part Of: Neuropsychological rehabilitation. Volume 27:Issue 1(2017)
• Page Start: 133
• Page End: 148
• Publication Date: 2017-01-02
• Subjects: Mental capacity -- Decision-making capacity -- Acquired brain injury -- Frontal lobe syndrome -- Organic personality disorder; Brain damage -- Patients -- Rehabilitation -- Periodicals; Clinical neuropsychology -- Periodicals; 617.4810443
• DOI: 10.1080/09602011.2015.1053948
• Languages: English
• ISSNs: 0960-2011

Abstract

Abstract : Assessment of decision-making capacity (DMC) can be difficult in acquired brain injury (ABI) particularly with the syndrome of organic personality disorder (OPD) (the "frontal lobe syndrome"). Clinical neuroscience may help but there are challenges translating its constructs to the decision-making abilities considered relevant by law and ethics. An in-depth interview study of DMC in OPD was undertaken. Six patients were purposefully sampled and rich interview data were acquired for scrutiny using interpretative phenomenological analysis. Interview data revealed that awareness of deficit and thinking about psychological states can be present. However, the awareness of deficit may not be "online" and effectively integrated into decision-making. Without this online awareness of deficit the ability to appreciate or use and weigh information in the process of deciding some matters appeared absent. We argue that the decision-making abilities discussed are: (1) necessary for DMC, (2) threatened by ABI, and (3) assessable at interview. Some advice for practically incorporating these abilities within assessments of DMC in patients with OPD is outlined.