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Background : Mental capacity is a fundamental aspect that enables patients to fully participate in various healthcare procedures. To assist healthcare professionals (HCPs) in assessing patients' capacity, especially in the mental health field, several standardized tools have been developed. These tools include the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), and the Competence Assessment Tool for Psychiatric Advance Directives (CAT-PAD). The core dimensions explored by these tools include Understanding, Appreciation, Reasoning, and Expression of a choice. Objective : This meta-analysis aimed to investigate potential differences in decision-making capacity within the healthcare context among groups of patients with bipolar disorders (BD) and schizophrenia spectrum disorders (SSD). Methods : A systematic search was conducted on Medline/Pubmed, and Scopus. Additionally, Google Scholar was manually inspected, and a manual search of emerging reviews and reference lists of the retrieved papers was performed. Eligible studies were specifically cross-sectional, utilizing standardized assessment tools, and involving patients diagnosed with BD and SSD. Data from the studies were independently extracted and pooled using random-effect models. Hedges' g was used as a measure for outcomes. Results : Six studies were identified, with three studies using the MacCAT-CR, two studies the MacCAT-T, and one the CAT-PAD. The participants included 189 individuals with BD and 324 individuals with SSD. The meta-analysis revealed that patients with BD performed slightly better compared to patients with SSD, with the difference being statistically significant in the domain of Appreciation (ES = 0.23, 95% CI: 0.01 to 0.04, p = 0.037). There was no statistically significant difference between the two groups for Understanding (ES = 0.09, 95% CI:-0.10 to 0.27, p = 0.352), Reasoning (ES = 0.18, 95% CI: -0.12 to 0.47, p = 0.074), and Expression of a choice (ES = 0.23, 95% CI: -0.01 to 0.48, p = 0.60). In the sensitivity analysis, furthermore, when considering only studies involving patients in symptomatic remission, the difference for Appreciation also resulted in non-significant (ES = 0.21, 95% CI: -0.04 to 0.46, p = 0.102). Conclusions : These findings indicate that there are no significant differences between patients with BD and SSD during remission phases, while differences are minimal during acute phases. The usefulness of standardized assessment of capacity at any stage of the illness should be considered, both for diagnostic-therapeutic phases and for research and advance directives. Further studies are necessary to understand the reasons for the overlap in capacity between the two diagnostic categories compared in this study.

Objective: Cognitive contributions to decisional capacity are complex and not well understood. Capacity to consent for research has been linked to executive function, but executive function assessment tools are imperfect. In this study, we examine the relationship between decisional capacity and a newly developed executive function composite score and determine whether cognitive performance can predict impaired decisional capacity., Methods: This is a cross sectional study of participants at the National Institutes of Health with frontotemporal dementia-amyotrophic lateral sclerosis spectrum disorders enrolled between 2017 and 2022. A structured interview tool was used to ascertain research decisional capacity. Study participant Uniform Data Set (v3.0) executive function (UDS3-EF) composite score, Clinical Dementia Rating Scale©, and Neuropsychiatric Inventory was determined., Results: A decrease in UDS3-EF composite score significantly increased the odds of impaired decisional capacity (OR = 2.92, 95% CI [1.66-5.13], p = 0.0002). Executive function was most impaired in frontotemporal dementia (-2.86, SD = 1.26) and least impaired in amyotrophic lateral sclerosis (-0.52, SD = 1.25) participants. The UDS3-EF composite score was also strongly correlated to the Clinical Dementia Rating Scale©., Interpretation: Decisional capacity is intrinsically related to executive function in neurodegenerative disorders, and executive dysfunction may predict a lack of decisional capacity alerting investigators of the need for additional scrutiny during the informed consent process., (Published 2023. This article is a U.S. Government work and is in the public domain in the USA. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)

Objectives: Cognitive impairment affects older adults' capacity to live independently and make lifestyle decisions (lifestyle decision-making capacity; LS-DMC). Cognitive screens and clinical interviews are often used to assess people's need for living-supports prior to conducting comprehensive LS-DMC assessments in busy clinical settings. This study investigated whether the QuickSort - a brief new cognitive screen - provides efficient and accurate information regarding patients' LS-DMC when initially interviewed., Methods: This is an observational and diagnostic accuracy study of older inpatients (≥60 years) consecutively referred for neuropsychological assessment of LS-DMC ( n = 124). The resources required by inpatients with questionable LS-DMC were quantified (length of hospital stay, living-supports). QuickSort scores, patient background information, and two common cognitive screens were used to differentiate between older inpatients ( n = 124) who lacked (64%)/did not-lack (36%) LS-DMC., Results: Hospitalizations averaged 49 days, with 62% of inpatients being readmitted within one year. The QuickSort differentiated between those lacking/not-lacking LS-DMC better than two common cognitive screens and patient information. The likelihood that inpatients lacked LS-DMC increased by a factor of 65.26 for QuickSort scores <2 and reduced by a factor of 0.32 for scores ≥13. Modeling revealed that the post-test likelihood of lacking LS-DMC increased to 99% (scores <2) and reduced to 30% (scores ≥ 13) in settings where many inpatients lack LS-DMC., Conclusions: Older adult inpatients with questionable LS-DMC have a high risk of extended hospitalization and readmission. The QuickSort provides time-efficient and sensitive information regarding patients' LS-DMC, making it a viable alternative to longer cognitive screens that are used at the initial interview stage.

Objectives: To assess the cognitive capacity of early, middle, and late adolescents and their parents or guardians to provide informed consent to a population-based cohort study., Study Design: Adolescent-parent/guardian dyads including 40 early (n = 80; 10-14 years), 20 middle (15-17 years), and 20 late (18-19 years) adolescents were recruited from the Rakai Community Cohort Study, an open demographic cohort in Uganda. Participants were administered the MacArthur Competence Assessment Tool for Clinical Research, a structured open-ended assessment; interviews were recorded and transcribed. Twenty transcripts were scored independently by two coders; the intraclass correlation coefficient was 0.89. The remaining interviews were scored individually. We compared mean scores for early and middle/late adolescents using a one-sided t test and score differences between parent/guardian and adolescent dyads using two-sided paired t tests., Results: Early adolescents (mean score, 28.8; 95% CI, 27.1-30.5) scored significantly lower (P < .01) than middle/late adolescents (32.4; 31.6-33.1). In paired dyad comparisons, we observed no statistically significant difference in scores between parents/guardians and middle/late adolescents (difference, -0.2; 95% CI, -1.0-0.6). We found a statistically significant difference in scores between parents/guardians and early adolescents (difference, 3.0; 95% CI, 1.2-4.8)., Conclusions: The capacity of adolescents-of different ages and in diverse settings-to comprehend risks, benefits, and other elements of informed consent is a critical but understudied area in research ethics. Our findings support the practice of having middle and late adolescents provide independent informed consent for sexual and reproductive health studies. Early adolescents may benefit from supported decision-making approaches., (Copyright © 2022. Published by Elsevier Inc.)

The capacity to designate a surrogate (CDS) is not simply another kind of medical decision-making capacity (DMC). A patient with DMC can express a preference, understand information relevant to that choice, appreciate the significance of that information for their clinical condition, and reason about their choice in light of their goals and values. In contrast, a patient can possess the CDS even if they cannot appreciate their condition or reason about the relative risks and benefits of their options. Patients who lack DMC for many or most kinds of medical choices may nonetheless possess the CDS, particularly since the complex means-ends reasoning required by DMC is one of the first capacities to be lost in progressive cognitive diseases (eg, Alzheimer's disease). That is, patients with significant cognitive decline or mental illness may still understand what a surrogate does, express a preference about a potential surrogate, and be able to provide some kind of justification for that selection. Moreover, there are many legitimate and relevant rationales for surrogate selection that are inconsistent with the reasoning criterion of DMC. Unfortunately, many patients are prevented from designating a surrogate if they are judged to lack DMC. When such patients possess the CDS, this practice is ethically wrong, legally dubious and imposes avoidable burdens on healthcare institutions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Mental health competence (MHC) involves psychosocial capabilities such as regulating emotions, interacting well with peers and caring for others, and predicts a range of health and social outcomes. This study examines the course of MHC from childhood to adolescence and patterning by gender and disadvantage, in Australian and UK contexts., Methods: Data: Longitudinal Study of Australian Children (n=4983) and the Millennium Cohort Study (n=18 296). Measures: A measure capturing key aspects of MHC was derived summing items from the parent-reported Strengths and Difficulties Questionnaire, assessed at 4-5 years, 6-7 years, 10-11 years and 14-15 years. Analysis: Proportions of children with high MHC (scores ≥23 of range 8-24) were estimated by age and country. Random-effects models were used to define MHC trajectories according to baseline MHC and change over time. Sociodemographic patterns were described., Results: The prevalence of high MHC steadily increased from 4 years to 15 years (from 13.6% to 15.8% and 20.6% to 26.2% in Australia and the UK, respectively). Examination of trajectories revealed that pathways of some children diverge from this normative MHC progression. For example, 7% and 9% of children in Australia and the UK, respectively, had a low starting point and decreased further in MHC by mid-adolescence. At all ages, and over time, MHC was lower for boys compared with girls and for children from disadvantaged compared with advantaged family backgrounds., Conclusions: Approaches to promoting MHC require a sustained focus from the early years through to adolescence, with more intensive approaches likely needed to support disadvantaged groups and boys., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Euthanasia laws do not mention as an obstacle brain diseases other than dementia that damage circuits involved in decision-making., Development: Narrative review of the stages of the decision to request euthanasia and the brain areas involved. The amygdala, the cingulate and insular cortex, and different parts of the prefrontal lobes are activated during decisions with similarities to that of requesting euthanasia., Conclusions: When an injury or malfunction of any of the structures involved in making decisions is known, a specific evaluation should be made of the influence it may have on the competence of the patient to request euthanasia.

Background: According to international transgender care guidelines, an important prerequisite for puberty suppression (PS) is transgender adolescents' competence to give informed consent (IC). In society, there is doubt whether transgender adolescents are capable of this, which in some countries has even led to limited access to this intervention. Therefore, this study examined transgender adolescents' medical decision-making competence (MDC) to give IC for starting PS in a structured, replicable way. Additionally, potential associated variables on MDC, such as age, intelligence, sex, psychological functioning, were investigated., Methods: A cross-sectional semistructured interview study with 74 transgender adolescents (aged 10-18 years; 16 birth-assigned boys, 58 birth-assigned girls) within two Dutch specialized gender-identity clinics was performed. To assess MDC, judgements based on the reference standard (clinical assessment) and the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), a validated semistructured interview, were used., Results: Of the transgender adolescents, 93.2% (reference standard judgements; 69 of 74) and 89.2% (MacCAT-T judgements; 66 of 74) were assessed competent to consent. Intermethod agreement was 87.8% (65 of 74). Interrater agreements of the reference standard and MacCAT-T-based judgements were 89.2% (198 of 222) and 86.5% (192 of 222), respectively. IQ and sex were both significantly related to MacCAT-T total score, whereas age, level of emotional and behavioral challenges, and diagnostic trajectories duration were not., Conclusions: By using the MacCAT-T and clinicians' assessments, 93.2% and 89.2%, respectively, of the transgender adolescents in this study were assessed competent to consent for starting PS., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Despite the vast body of studies within self-determination theory, the impact of factors which influence performance in experimental paradigm is still underresearched. The aim of the two studies presented in this paper was to investigate the impact of basic psychological needs on performance with the simultaneous presence of external incentives. Study 1 tested whether the satisfaction of competence and relatedness during task performance (while external incentives were present) can impact individual's performance. Study 2, on the other hand, investigated whether the basic psychological needs and provision of external incentives can impact an individual's performance. Moreover, in both studies the mechanisms behind the need-performance relationship was checked. Our results showed that out of the three basic needs, competence had the strongest positive impact on performance, which was partially mediated by the subjective evaluation of the levels of difficulty and intrinsic motivation. The weak relationship between relatedness and task performance was fully mediated by the level of intrinsic motivation., Competing Interests: The authors have declared that no competing interests exist.

Numerosity estimation performance (e.g., how accurate, consistent, or proportionally spaced (linear) numerosity-numeral mappings are) has previously been associated with math competence. However, the specific mechanisms that underlie such a relation is unknown. One possible mechanism is the mapping process between numerical sets and symbolic numbers (e.g., Arabic numerals). The current study examined two hypothesized mechanisms of numerosity-numeral mappings (item-based "associative" and holistic "structural" mapping) and their roles in the estimation-and-math relation. Specifically, mappings for small numbers (e.g., 1-10) are thought to be associative and resistant to calibration (e.g., feedback on accuracy of estimates), whereas holistic "structural" mapping for larger numbers (e.g., beyond 10) may be supported by flexibly aligning a numeral "response grid" (akin to a ruler) to an analog "mental number line" upon calibration. In 57 adults, we used pre- and post-calibration estimates to measure the range of continuous associative mappings among small numbers (e.g., a base range of associative mappings from 1 to 10), and obtained measures of math competence and delayed multiple-choice strategy reports. Consistent with previous research, uncalibrated estimation performance correlated with calculation competence, controlling for reading fluency and working memory. However, having a higher base range of associative mappings was not related to estimation performance or any math competence measures. Critically, discontinuity in calibration effects was typical at the individual level, which calls into question the nature of "holistic structural mapping". A parsimonious explanation to integrate previous and current findings is that estimation performance is likely optimized by dynamically constructing numerosity-numeral mappings through the use of multiple strategies from trial to trial.

Objectives: Metacomprehension monitoring accuracy in older age may be underestimated because of how it has been measured. Metacomprehension in the present study was uniquely measured by comparing summary quality to summary quality judgments. The effect of age on this accuracy was assessed and results were compared to those measured with the typical approach. The moderation of age effects by reading goal was also assessed but was an exploratory objective.1., Method: Younger adults (141) and older adults (138) read and orally summarized six expository texts. Participants were randomly assigned to a reading goal condition, with half of each age group summarizing for a professor/boss and half summarizing for an acquaintance. Participants made judgments about the quality of their summaries before and after summarizing, took a multiple-choice test of their comprehension, and made judgments about the accuracy of their answers., Results: Age deficits in metacomprehension were generally smaller when measured with the novel approach and age differences were generally larger for the professor/boss condition than for the acquaintance condition., Discussion: The novel approach to measuring metacomprehension monitoring accuracy provides more optimism for aging than typical approaches, discussed in relation to age-related changes in language processing preferences., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

This research examines how visual representation of social media influencers affects perceptions and attitudes toward influencers and their persuasive messages. Using the theoretical frameworks of the Stereotype Content Model (SCM) and the Behaviors from Interpersonal Affect and Stereotypes (BIAS) Map, Study 1 demonstrated that influencers with broad smiles were perceived as warmer and more competent and evaluated more positively than those with closed smiles. Study 2 revealed that warmth and competence judgments led to admiration toward the smiling influencers, which in turn resulted in positive attitudinal and behavioral responses to their persuasive messages. By investigating the mediating effects of judgments and emotional responses toward influencers, this study reveals social cognitive mechanisms underlying psychological processing of influencer messaging.

Background: Learning cooking skills during childhood and adolescence is associated with positive dietary outcomes in adulthood as well as being tracked from adolescence to adulthood. In addition studies have found that perceived competence to be a greater motivator to perform a behaviour than actual competence. However, a lack of validated tools that effectively measure behavioural and dietary changes including cooking confidence in children is a limitation. Therefore, this research aimed to develop and validate age-appropriate perceived cooking competence measures for younger and older primary school aged children., Methods: Two measures of perceived Cooking Competence (CooC11 and CooC7) for older (8-12 years) and younger (6-7 years) children were developed from a critical evaluation of publically available recommendations and expert consultation. The cooking skills within the measures were illustrated by a graphic designer in consultation with a chef and reviewed in an iterative manner by the research team. The measures were piloted for clarity, ease of use and initial face validity. Multiple studies were used for both CooC11 and CooC7 to establish psychometric properties of the measures, temporal stability, internal consistency reliability, construct validity, as well as responsiveness to change for CooC11. Analysis included Exploratory Factor Analysis, Confirmatory Factor Analysis, Intraclass Correlation Coefficients, Pearson's Correlations, ANOVAs and Cronbach's Alphas., Results: Both measures had high levels of face validity and received positive user feedback. Two factors were shown in both measures with the measures showing excellent temporal stability (ICC > 0.9) and good internal consistency (Cronbach's Alphas > 0.7). Both measures showed initial discriminant validity, with significant differences (P< 0.001) between those who reported assisting their parents with dinner preparation and those who did not. Additionally, CooC11 was significantly correlated with an adult cooking measure and had a significant responsiveness to change (P< 0.01)., Conclusions: The CooC11 and CooC7 are the first validated age-appropriate measures for assessing children's perceived Cooking Competence for ages 8-12 and 6-7 years respectively. They can be used to evaluate the efficacy of children's cooking intervention studies or school nutrition education programmes.

Purpose The purpose of this study is to characterize narrative competence of typically developing bilingual children using Jamaican Creole (JC) and English. Method Story comprehension and fictional storytelling tasks in JC and English were completed by 104 bilingual preschoolers aged 4-6 years. Story comprehension was analyzed using inferential story comprehension questions representing Blank's Question Hierarchy. Fictional storytelling was analyzed using the Monitoring Indicators of Scholarly Language framework for narrative macrostructure and microstructure. Results Story comprehension was significantly correlated within each language, but only questions from Level 4 of Blank's Question Hierarchy showed significant correlations between languages. Fictional storytelling was significantly better in English than in JC for macrostructure (total score, internal response, plan, consequence) and microstructure (total score, adverbs, elaborated noun phrases). Story complexity in JC and English was significantly correlated. In terms of developmental effects, children's macrostructure and story complexity appear to be better at 4 years than 5 years, with English outperforming JC. Furthermore, age correlated with story comprehension in JC. Conclusion Comparison of narrative competence in bilingual children provides much needed insights into language development, with examination of JC and English bilinguals representing an understudied bilingual context.

Background: Financial capacity is often one of the first instrumental activities of daily living to be affected in cognitively normal (CN) older adults who later progress to amnestic mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia., Objective: The objective of this study was to investigate the association between financial capacity and regional cerebral tau., Methods: Cross-sectional financial capacity was assessed using the Financial Capacity Instrument -Short Form (FCI-SF) in 410 CN, 199 MCI, and 61 AD dementia participants who underwent flortaucipir tau positron emission tomography from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Linear regression models with backward elimination were used with FCI-SF total score as the dependent variable and regional tau and tau-amyloid interaction as predictors of interest in separate analyses. Education, age, sex, Rey Auditory Verbal Learning Test Total Learning, and Trail Making Test B were used as covariates., Results: Significant associations were found between FCI-SF and tau regions (entorhinal: p < 0.001; inferior temporal: p < 0.001; dorsolateral prefrontal: p = 0.01; posterior cingulate: p = 0.03; precuneus: p < 0.001; and supramarginal gyrus: p = 0.005) across all participants. For the tau-amyloid interaction, significant associations were found in four regions (amyloid and dorsolateral prefrontal tau interaction: p = 0.005; amyloid and posterior cingulate tau interaction: p = 0.005; amyloid and precuneus tau interaction: p < 0.001; and amyloid and supramarginal tau interaction: p = 0.002)., Conclusion: Greater regional tau burden was modestly associated with financial capacity impairment in early-stage AD. Extending this work with longitudinal analyses will further illustrate the utility of such assessments in detecting clinically meaningful decline, which may aid clinical trials of early-stage AD.

We still know little about financial capacity, which consists of multiple cognitive domains as well as specific skills, and the influence of depression in patients with vascular dementia (VaD). Participants were divided into 4 groups: (1) VaD with and (2) without depressive symptoms, (3) nondemented elders with and (4) without depression. The participants were examined with the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS-15), and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). The findings extend earlier work in other groups of older patients and indicate that VaD patients' performance in cognitive functioning and financial capacity is severely impaired, while there is a statistically significant difference between depressed and nondepressed VaD patients. Thus, depression negatively influences financial capacity. Depression and mood disorders should be considered in future capacity research with older adults and with larger VaD populations., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Promoting positive mental health, particularly through enhancing competencies (such as prosocial behaviors and learning skills), may help prevent the development of health risk behaviors in adolescence and thus support future well-being. Few studies have examined how mental health competencies in childhood are associated with adolescent health risk behaviors, which could inform preventative approaches., Methods: Using UK Millennium Cohort Study data (n = 10,142), we examined how mental health competence (MHC) measured at the end of elementary school (11 years) is associated with self-reported use of cigarettes, e-cigarettes, alcohol, illegal drugs, antisocial behavior, and sexual contact with another young person at age 14 years. A latent measure of MHC was used, capturing aspects of prosocial behavior and learning skills, categorized as high MHC, high-moderate MHC, moderate MHC, and low MHC. Logistic and multinomial regression estimated odds ratios and relative risk ratios for binary and categorical outcomes, respectively, before and after adjusting for confounders. Weights accounted for sample design and attrition and multiple imputation for item missingness., Results: Those with low, moderate, or high-moderate MHC at age 11 years were more likely to have taken part in health risk behaviors at age 14 years compared with those with high MHC. The largest associations were seen for low MHC with binge drinking (relative risk ratio: 1.6 [95% confidence interval: 1.1-2.4]), having tried cigarettes (odds ratio: 2.2 [95% confidence interval: 1.6-3.1]) and tried illegal drugs (odds ratio: 2.0 [95% confidence interval: 1.3-3.1) after adjusting for confounders (which attenuated results but largely maintained significant findings)., Conclusions: MHC in late childhood is associated with health risk behaviors in midadolescence. Interventions that increase children's MHC may support healthy development during adolescence, with the potential to improve health and well-being through to adulthood., (Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Control beliefs are established correlates of cognitive aging. Despite recent demonstrations that response time inconsistency (RTI) represents a proxy for cognitive processing efficiency, few investigations have explored links between RTI and psychosocial correlates. We examined associations among RTI and control beliefs (perceived competence and locus of control) for two choice-response time (RT) tasks varying in their attentional demands., Method: Control beliefs and RTI were measured weekly for 5 weeks in a sample of 304 community-dwelling older adults (Mage = 74.11 years, SD = 6.05, range = 64-92, 68.58% female)., Results: Multilevel models revealed that for the attentionally demanding task, reporting higher perceived competence than usual was associated with lower RTI for relatively younger participants and greater RTI for relatively older participants. For the less attentionally demanding task, reporting higher perceived competence than usual was associated with lower RTI for relatively older participants. Links between locus of control and RTI were comparatively scant., Discussion: Our findings suggest that control beliefs may have adaptive and maladaptive influences on RTI, depending on dimension of control beliefs, individual differences in level of control beliefs and age, as well as attentional task demands. Both for whom and when control beliefs can be leveraged to optimize cognitive aging are discussed., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The current study examined whether the effect of spatial training transfers to the math domain. Sixty-two 6- and 7-year-olds completed an at-home 1-week online training intervention. The spatial-training group received mental rotation training, whereas the active control group received literacy training in a format that matched the spatial training. Results revealed near transfer of mental rotation ability in the spatial-training group. More importantly, there was also far transfer to canonical arithmetic problems, such that children in the spatial-training group performed better on these math problems than children in the control group. Such far transfer could not be attributed to general cognitive improvement, since no improvement was observed for non-symbolic quantity processing, verbal working memory (WM), or language ability following spatial training. Spatial training may have benefitted symbolic arithmetic performance by improving visualization ability, access to the mental number line, and/or increasing the capacity of visuospatial WM.

As international laws on physician aid in dying (PAD) evolve, the question of permitting PAD in non-terminal illness, and in sole psychiatric illness, is under intense debate. In jurisdictions where PAD is permissible, certain safeguards and eligibility requirements must be met for all patients making a PAD request, and one of these requirements is that the patient have sound decision-making capacity with respect to the request. Legal criteria already exist for the determination of capacity, and they are quite similar between different jurisdictions. In current debates about the question of psychiatric PAD, one concern that has been raised is that cognitive distortions in mental disorders may affect a patient's decision-making capacity. At the same time, it has been established that all persons, with or without a mental disorder, experience cognitive distortions. If cognitive distortions are ubiquitous, it is likely that the severity and frequency of cognitive distortions is dimensional rather than categorical, between samples with and without mental illness. Furthermore, currently, there is no requirement for a formalized evaluation of cognitive distortions as part of capacity assessment for any type of medical decision, including PAD decisions. The current paper examines the literature related to cognitive distortions in mental disorders and in healthy populations. It proposes that the existence of cognitive distortions, alone, cannot be used as an argument for a blanket exclusion of psychiatric PAD. It therefore concludes that further research and ethical analysis should be undertaken to examine the impact of cognitive distortions on decision-making for consequential medical decisions, including PAD, in patients with and without mental disorders., Competing Interests: Declaration of Competing Interest JD is a member of the Clinicians' Advisory Council for Dying With Dignity Canada. There is no financial reimbursement for this role., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Medical practitioners are confronted daily with decisions about patients' capacity to consent to interventions. To address some of the pertinent issues with these assessments, the end-of-life decision-making capacity of a 72-year-old female with treatment-resistant schizophrenia and terminal cancer is discussed, as are the role of the treating clinician and the importance of health-related values. There is a recommendation that the focus of these assessments can rather be on practical outcomes, especially when capacity issues arise. This implies that the decision-making capacity of the patient is only practically important when the treatment team is willing to proceed against the patient's wishes. This shifts the focus from a potentially difficult assessment to the simpler question of whether the patient's capacity will change the treatment approach. Clinicians should attend to any possible underlying issues, instead of focusing strictly on capacity. Compared to the general populations people with serious mental illness (SMI) have higher rates of physical illness and die at a younger age, but they do not commonly access palliative care services. Conversations about end-of-life care can occur without fear that a person's psychiatric symptoms or related vulnerabilities will undermine the process. More research about palliative care and advance care planning for people with SMI is needed. This is even more urgent in light of the coronavirus disease-2019 (COVID-19) pandemic, and South African health services should consider recommendations that advanced care planning should be routinely implemented. These recommendations should not only focus on the general population and should include patients with SMI.

Objective: Increasing numbers of people are expected to live with comorbid cancer and dementia. Cancer treatment decision-making for these individuals is complex, particularly for those lacking capacity, requiring support across the cancer care pathway. There is little research to inform practice in this area. This ethnographic study reports on the cancer decision-making experiences of people with cancer and dementia, their families, and healthcare staff., Methods: Participant observations, informal conversations, semi-structured interviews, and medical note review, in two NHS trusts. Seventeen people with dementia and cancer, 22 relatives and 19 staff members participated., Results: Decision-making raised complex ethical dilemmas and challenges and raised concerns for families and staff around whether correct decisions had been made. Whose decision it was and to what extent a person with dementia and cancer was able to make decisions was complex, requiring careful and ongoing consultation and close involvement of relatives. The potential impact dementia might have on treatment understanding and toleration required additional consideration by clinicians when evaluating treatment options., Conclusions: Cancer treatment decision-making for people with dementia is challenging, should be an ongoing process and has emotional impacts for the individual, relatives, and staff. Longer, flexible, and additional appointments may be required to support decision-making by people with cancer and dementia. Evidence-based decision-making guidance on how dementia impacts cancer prognosis, treatment adherence and efficacy is required., (© 2020 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.)

Objective: The objective of this study is to characterize functional competence (measure of assistance needed for independence) on Performance Assessment of Self-Care Skills (PASS) Cognitively Mediated Instrumental Activities of Daily Living (C-IADL), in individuals with amnestic mild cognitive impairment (aMCI). It aims to determine: (1) the association of functional competence on PASS C-IADL tasks with neurocognitive test performance in aMCI, (2) its ability to discriminate individuals with aMCI from healthy control (HC) individuals, and (3) its added value in discriminating aMCI from HC individuals when combined with neurocognitive test performance., Design: Cross-sectional secondary analysis of baseline data from a cohort of individuals enrolled in a clinical trial (NCT02386670)., Setting: Five university-affiliated outpatient clinics in Toronto, Canada., Participants: aMCI (N = 137) and HC (N = 51) participants, all aged 60 years or older., Methods: We assessed the relationship between functional competence on three C-IADL PASS tasks (shopping, bill paying, and checkbook balancing) and neurocognitive tests in 137 participants with aMCI using multiple linear regressions. Additionally, we constructed receiver operating characteristic curves to assess the role of PASS functional competence in discriminating between 137 aMCI and 51 HC participants., Results: Functional competence on PASS was significantly associated with tests of verbal memory, information processing speed, and executive function. It demonstrated 79% accuracy in discriminating aMCI from HC participants. Combining functional competence on PASS with individual neurocognitive tests significantly increased the discriminant accuracy of individual tests, and neurocognitive test scores combined with functional competence on PASS had the highest discriminant accuracy (94%)., Conclusion: Functional competence on PASS is predicted by the underlying cognitive deficits and possibly captures additional element of effort that could improve the diagnostic accuracy of aMCI when combined with neurocognitive tests. Thus, PASS appears to be a promising tool for assessment of functional competence in aMCI in clinical or research settings. J Am Geriatr Soc 68:1787-1795, 2020., (© 2020 The American Geriatrics Society.)

Background: Recovery is a widely accepted paradigm in mental health care, whilst the correctional and forensic-psychiatric field is still searching for foundations for its implementation. Knowledge regarding recovery of persons with intellectual disabilities in secure contexts is limited. This study assesses recovery needs and resources among persons with intellectual disabilities labelled not criminally responsible and investigates the impact of the judicial label on recovery processes., Methods: A sample of 26 individuals was composed purposively, and in-depth interviews were conducted. Recurrent themes were identified using thematic analysis., Results: Traditional recovery themes emerged from the narratives, next to aspects of recovery in a forensic or correctional context. However, the operationalization and proportional impact are specific for this sample., Conclusions: The social dimension overarches all other recovery dimensions. The integration of an explicit social rhetoric is imperative, including contextual, relational, interactional and societal dimensions. This offers pathways to reverse the traditional, paternalistic model of exclusion and classification., (© 2019 John Wiley & Sons Ltd.)

Background: Determining the mental capacity of psychiatric patients for making healthcare related decisions is crucial in clinical practice. This meta-review of review articles comprehensively examines the current evidence on the capacity of patients with a mental illness to make medical care decisions., Methods: Systematic review of review articles following PRISMA recommendations. PubMed, Scopus, CINAHL and PsycInfo were electronically searched up to 31 January 2020. Free text searches and medical subject headings were combined to identify literature reviews and meta-analyses published in English, and summarising studies on the capacity of patients with serious mental illnesses to make healthcare and treatment related decisions, conducted in any clinical setting and with a quantitative synthesis of results. Publications were selected as per inclusion and exclusion criteria. The AMSTAR II tool was used to assess the quality of reviews., Results: Eleven publications were reviewed. Variability on methods across studies makes it difficult to precisely estimate the prevalence of decision-making capacity in patients with mental disorders. Nonetheless, up to three-quarters of psychiatric patients, including individuals with serious illnesses such as schizophrenia or bipolar disorder may have capacity to make medical decisions in the context of their illness. Most evidence comes from studies conducted in the hospital setting; much less information exists on the healthcare decision making capacity of mental disorder patients while in the community. Stable psychiatric and non-psychiatric patients may have a similar capacity to make healthcare related decisions. Patients with a mental illness have capacity to judge risk-reward situations and to adequately decide about the important treatment outcomes. Different symptoms may impair different domains of the decisional capacity of psychotic patients. Decisional capacity impairments in psychotic patients are temporal, identifiable, and responsive to interventions directed towards simplifying information, encouraging training and shared decision making. The publications complied satisfactorily with the AMSTAR II critical domains., Conclusions: Whilst impairments in decision-making capacity may exist, most patients with a severe mental disorder, such as schizophrenia or bipolar disorder are able to make rational decisions about their healthcare. Best practice strategies should incorporate interventions to help mentally ill patients grow into the voluntary and safe use of medications.

Patients with cancer face many difficult decisions and encounter many clinical situations that undermine decisional capacity. For this reason, assessing decision-making capacity should be thought of at every medical encounter. The culmination of variable disease trajectories, following patients to the end of life, use of high-risk treatments, and other weighty personal decisions require attention to patients' ability to engage in decisions. Oncologists develop meaningful relationships with their patients. This familiarity may lead to forgoing the process of diligently assessing a patient's cognitive ability and/or decisional capacity when important decisions need to be made. While the process may feel like it takes place spontaneously, many subtle and overt details are involved with the decisions around cancer care that require pointed questioning and probing. Thus, there are many ways to fall short in determining decisional capacity. Clinicians are inconsistent in their decisional capacity determinations and generally assume more decisional capacity than the patient has. Consult and referral services such as ethics and psychiatry can help with treatment decisions and with assessing underlying psychosocial and psychiatric conditions. Decisional capacity may fluctuate and requires a variable amount of decisional ability depending on the clinical situation; hence, it is time-specific and decision-specific. This review is intended to provide a summary of key components of decisional capacity while highlighting areas in need of clinical refinement.

This article focuses on the preferred disposition for an individual charged with a serious crime against another person, adjudicated incompetent to stand trial and not restorable to competence, whose original criminal charges are dismissed without prejudice, and who is regarded by the state as dangerous to the general public. Three current models used today in California, Oregon, and Ohio are described. All three rely on modifications of various aspects of civil commitment law. We then propose a fourth model based on a modified version of the 1989 American Bar Association (ABA) Criminal Justice Mental Health Standards, in which individuals who are found incompetent to stand trial and not restorable to competence and are considered dangerous would be committed under the same special procedures governing the management and treatment of insanity acquittees., (© 2020 American Academy of Psychiatry and the Law.)

Decision-making capacity (DMC) is the gatekeeping element for a patient's right to self-determination with regard to medical decisions. A DMC evaluation is not only conducted on descriptive grounds but is an inherently normative task including ethical reasoning. Therefore, it is dependent to a considerable extent on the values held by the clinicians involved in the DMC evaluation. Dealing with the question of how to reasonably support clinicians in arriving at a DMC judgment, a new tool is presented that fundamentally differs from existing ones: the U-Doc. By putting greater emphasis on the judgmental process rather than on the measurement of mental abilities, the clinician as a decision-maker is brought into focus, rendering the tool more of an evaluation guide than a test instrument. In a qualitative study, the perceived benefits of and difficulties with the tool have been explored. The findings show on the one hand that the evaluation aid provides basic orientation, supports a holistic perspective on the patient, sensitizes for ethical considerations and personal biases, and helps to think through the decision, to argue, and to justify one's judgment. On the other hand, the room for interpretation due to absent operationalisations, related ambiguities, and the confrontation with one's own subjectivity may be experienced as unsettling.

Objectives : This article examines the convergent validity and clinical utility of the 34-item short form of the Lichtenberg Financial Decision Rating Scale (LFDRS-SF). A briefer scale can lead to enhanced and efficient use of a person-centered approach to the assessment of financial decision-making. Methods : Using data on 200 community-dwelling older adults from Lichtenberg and colleagues (2017a), convergent validity was examined with cognitive and financial management measures using a correlational and regression approach. Receiver operating curve analyses for predicting decision-making ability classification and suspected financial exploitation classification were used to evaluate clinical utility. Results : The LFDRS-SF total risk score was significantly correlated with both cognitive and financial management measures, and the regression analysis predicted 9% of the LFDRS-SF measure. These results demonstrate not only convergent validity, but also the conceptual and empirical uniqueness of financial decision-making. Conclusions : The LFDRS-SF is a valid tool to assess real-world financial decision-making abilities. Clinical Implications : The LFDRS-SF offers an efficient way to assess financial decision-making. Training on the tool and automatic scoring and recommendations for next steps can be found at https://olderadultnestegg.com.

This article focuses on confidentiality and capacity issues affecting patients receiving care in the emergency department. The patient-physician relationship begins with presumed confidentiality. The article also clarifies instances where a physician may be required to break confidentiality for the safety of patients or others. This article then discusses risk management issues relevant to determining a patient's capacity to accept or decline medical care in the emergency department setting. Situations pertaining to refusal of care and discharges against medical advice are examined in detail, and best practices for mitigating risk in informed consent and barriers to consent are reviewed., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Clinical competence is the term used to describe an individual's capacity to express a choice regarding their participation in clinical procedures or experimental studies. Understanding the information provided is a prerequisite but consent forms are often lengthy and complicated. Alzheimer's disease patients may be vulnerable in written comprehension, due to cognitive deficits, but unfortunately to date, a specific evaluation of this ability is not included in periodical assessments., Methods: One hundred thirty Italian patients with Alzheimer's disease were compared with 130 controls in a comprehension task involving a simplified informed consent form. Their performance in this task was compared with their performance with two other types of reading material (a testament and a history text). In addition, the performance of a subgroup of very mild patients in this test was compared with their performance in a widely used interview for the assessment of clinical competence (MacArthur Competence Assessment Tool for Clinical Research)., Results: Good sensitivity and specificity of the cut-offs identified consent form and the other texts as good instruments for evaluation of written comprehension. The comprehension of consent form may be compromised since the early stages of Alzheimer's disease. Nevertheless, a simplified, written text may help patients in comparison with interviews (MacCAT-CR). Better performance was correlated to the standard of education and better cognitive functions., Conclusion: Deficits regarding the comprehension of written texts and the consent form may be early in Alzheimer's disease patients and need to be investigated during periodical neuropsychological assessment. Comprehension may be facilitated by means of specific simplification strategies.

In the course of a few short weeks, many of the established legal frameworks relating to decision-making in England & Wales in respect of those with impaired decision-making capacity have been ripped up, or apparently rendered all but unusable. Although the Mental Capacity Act 2005 itself has not been amended, the impact of other legislation (especially the Coronavirus Act 2020) means that duties towards those with impaired decision-making capacity have been radically changed. This article reflects the experience of a practising barrister in England & Wales grappling with the impact of COVID-19 upon the Mental Capacity Act 2005 across a range of fields in the weeks after the world appeared to change in mid-March 2020., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The study of early parental competences is relevant because such competences are related to children's development; however, most studies have considered competences using a variable-centered approach in which each parental competence is examined in isolation. This paper approaches these competences using a person-centered approach, generating profiles that combine different competences in Chilean mothers assessed when their children were aged 12 months and again at 30 months. The aim of this study was to generate and compare these profiles and to analyze the associations of these profiles with children's language and socioemotional skills. Mother-child interactions in the contexts of storytelling and free play were videotaped at two different times. Ninety mother-child dyads were assessed using the Adult Sensitivity Scale (E.S.A.), the Evaluation of the Mentalization of Significant Caregivers, the Checklist of Observations Linked to Outcomes (PICCOLO), Bayley's language scale and the Functional Emotional Assessment Scale (FEAS). Profiles of mothers' behaviors were identified through person-centered within-group analyses of six aspects: sensitivity, mentalization, affection, responsiveness, encouragement, and teaching. Cluster analyses yielded three similar profiles for mothers at both ages: highly competent, average competent, and poorly competent. The mothers' profiles were related to maternal age, socioeconomic status (SES) and educational level, and the mothers improved their profiles at the 30-month assessment. The mothers' profiles were related to children's language and socioemotional outcomes at both ages. These results and their applicability to promotion and intervention programs are discussed., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives : This work examines the clinical utility of the scoring system for the Lichtenberg Financial Decision-making Rating Scale (LFDRS) and its usefulness for decision making capacity and financial exploitation. Objective 1 was to examine the clinical utility of a person centered, empirically supported, financial decision making scale. Objective 2 was to determine whether the risk-scoring system created for this rating scale is sufficiently accurate for the use of cutoff scores in cases of decisional capacity and cases of suspected financial exploitation. Objective 3 was to examine whether cognitive decline and decisional impairment predicted suspected financial exploitation. Methods : Two hundred independently living, non-demented community-dwelling older adults comprised the sample. Participants completed the rating scale and other cognitive measures. Results : Receiver operating characteristic curves were in the good to excellent range for decisional capacity scoring, and in the fair to good range for financial exploitation. Conclusions : Analyses supported the conceptual link between decision making deficits and risk for exploitation, and supported the use of the risk-scoring system in a community-based population. Clinical Implications : This study adds to the empirical evidence supporting the use of the rating scale as a clinical tool assessing risk for financial decisional impairment and/or financial exploitation.

Mrs. Clark's case was an ordinary consult in an extraordinary time. She was refusing dialysis, but the psychiatric unit had concluded that she lacked capacity for such decision-making. The only difference between Mrs. Clark's current hospitalization and the last two was that it was April 2020 and a virus called Covid-19 had overtaken our hospital. As the chief of Montefiore Medical Center's bioethics service, when I received a consult before the virus, I always saw the patient. Whether the patient had been in a vegetative state for a day or for years, it didn't matter. I would lay my hand on a leg or an arm and observe. But Covid-19 enforced physical boundaries between my team and our patients; I would not be able to meet Mrs. Clark. Our hospital responded to the attack on human connection by getting creative. We asked ourselves, which tools are still available to us? Answering this involved, in part, finding new ways for our team of clinical ethicists to support the clinicians caring for Mrs. Clark., (© 2020 The Hastings Center.)

Research suggests that autistic children can provide accurate and forensically useful eyewitness evidence. However, members of a jury also rely on non-verbal behaviours when judging the credibility of a witness, and this could determine the verdict of a case. We presented mock jurors with videos (from an experimental study) of one of two child witnesses on the autism spectrum being interviewed about a mock minor crime. Results demonstrated that providing jurors with generic information about autism and/or informing them of the child's diagnostic label differentially affected credibility ratings, but not for both children. Implications for how to present information about child witnesses with autism to a jury-highlighting the need for approaches tailored to individual children-are discussed.

Aims: To explore processes used by qualified nurses in assessing mental capacity of acutely and critically ill hospitalised adult patients., Background: Mental capacity is the ability to understand, reason and make decisions. Acute and critical illness may impact upon the decision-making abilities of hospitalised adult patients but little is known about how qualified nurses across a range of acute settings assess the capacity of such patients in their care., Design: A qualitative grounded theory approach informed by the Corbin and Strauss (Basics of Qualitative Research (Third Edition). London, UK: Sage, 2008) methodological pathway., Methods: Data were collected through digitally recorded, semi-structured interviews to explore assessment of capacity processes used by 13 registered nurses employed in acute and critical care environments in a district general hospital in South Wales, UK. Data were analysed using iterative constant comparative processes leading to a core category and grounded theory. The study is presented in accordance with the COREQ checklist., Results: Informal, intuitive, holistic nurse-led processes were used to assess the mental capacity of patients which combined processes for the assessment of their physiological and mental capacity status, recognising the need to support their rights, dignity and autonomy. The assessment of mental capacity was not a lone process but one that contributed to a cyclical process in which multi-professional assessment was necessary and ongoing, and in which qualified nurses had a co-ordinating role. This led to the development of the theory, Nurse Managed Patient Focused Assessment and Care., Conclusion: This theory provides a framework to explain processes and strategies used by qualified nurses in assessing mental capacity of, and caring for, adult patients with acute and/or critical illness., Relevance to Clinical Practice: This framework may inform related clinical practice and can serve as a basis of an assessment tool in what has been identified as a fundamental role of the qualified nurse., (© 2020 John Wiley & Sons Ltd.)

Objective: Decision-making capacity assessments for hospital settings are challenging as it is dominated by the ethical and legal principles of maintaining autonomy and protection. Health clinicians, especially in rural areas, are challenged with a lack of a standardised processes and pathways for decision-making capacity assessment. A literature review was conducted to determine what measurement tools clinicians are utilising in the hospital setting for decision-making capacity assessment and how decisions relating to consent to treatment, independent living and finances are made., Design: Literature review., Method: A search of MEDLINE, EMBASE and PsycINFO databases from January 2006 to April 2019 was conducted for peer-reviewed articles to determine how decision-making capacity assessments are conducted and the tools clinicians are utilising in the hospital setting., Results: Five main themes were identified from this review: (a) domains of capacity; (b) capacity assessment; (c) capacity assessment instruments; (d) who performs capacity assessment; and (e) challenges and limitations to capacity assessment in the hospital setting. Currently, there is no gold standard for capacity assessment., Conclusion: This review shows that there is currently a lack of a uniform approach or a singular test to determine capacity. It is proposed that a multidisciplinary approach to decision-making capacity assessment could be an effective model in the hospital setting, especially in rural health due to limited access to aged care specialists. It is important that clinicians receive ongoing training in decision-making capacity assessment and further research is recommended in this specialised area of practice., (© 2020 National Rural Health Alliance Ltd.)

Tourette Syndrome is a neurodevelopmental disorder that is associated with the presence of multiple motor and one or more verbal tics. In this case report, we present a 16 years old Tourette syndrome patient who was diagnosed with comorbid Attention Deficit Hyperactivity Disorder. The patient was evaluated for legal responsibility after she made untrue allegations saying that a bus driver had sexually harassed her. We summarize the case and review the current literature to assess the socio-legal aspects of Tourette syndrome., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

This study reports on restoration outcomes of a sample of pretrial defendants ( n = 877, 69% male) who were found incompetent to stand trial and underwent restoration services in a large urban county. Each male defendant was initially assigned to restoration in one of four settings on a continuum of services of varying intensity (ie, outpatient, jail general population, dedicated jail-based restoration unit, or forensic hospital inpatient unit) based on the defendant's assessed clinical need. Of those who received services on the jail-based restoration unit ( n = 398), 40 percent were restored to competency, 31 percent were diverted out of the criminal justice system, and 29 percent were referred for more intensive inpatient services, primarily because of refusal of medication (i.e., the jail would not allow involuntary medication, even if court-ordered). Advantages of restoration on the jail unit compared with inpatient hospitalization included more rapid institution of restoration services and higher rates of diversion out of the criminal justice system at one-third of the cost of inpatient restoration services. A continuum of restoration services that allows the type of restoration service to be matched to the needs of the individual incompetent defendant has significant advantages over routine transfer to a forensic hospital for restoration., (© 2020 American Academy of Psychiatry and the Law.)

Competency restoration in jails has grown steadily over the past decade, driven primarily by cost considerations and long wait times for inpatient restoration programs. Although jail-based programs may offer an attractive temporary solution to the shortage of beds, a longer-term solution involves enhancing the continuum of competency restoration services available outside of the correctional system. Such a continuum includes inpatient, supportive residential, and outpatient services. If these services were adequately funded and managed, jail-based competency restoration services would provide no additional benefit to patients, mental health professionals, or the criminal justice system., (© 2020 American Academy of Psychiatry and the Law.)

Parents' perceptions of their parenting competence predict successful implementation of parenting tasks and contribute to their interest and involvement in parenting and to their children's development. Thus, identifying factors that contribute to parents' perceptions of parenting competence can help inform efforts to promote children's safety and well-being. The present study employs social disorganization theory to examine the relationship between collective efficacy and parents' sense of competence, measured along two dimensions: parental efficacy and parental satisfaction. It examines the direct association between the two constructs and whether the association is mediated by parent perceptions of their quality of life (QOL) and sense of hope. Data were collected from 198 parents residing in a neighborhood in southern Tel Aviv, Israel. The analyses indicated that high collective efficacy was directly associated with high parental efficacy, but not with high parental satisfaction. Using structural equation modeling, a mediation model was found whereby higher collective efficacy was associated with (a) higher QOL, which in turn was related to a greater sense of hope, which was linked with higher parental efficacy; and (b) higher QOL, which was directly associated with higher parental satisfaction. The findings provide further support to the idea that neighborhood characteristics play an important role in parents' ability to care for their children., (© 2018 Family Process Institute.)

Background: With 7.7 million South Africans currently infected with human immunodeficiency virus (HIV) and 4.8 million currently receiving antiretroviral treatment (ART), the epidemic represents a considerable burden for the country's resource-limited health system. In response to the health and human resource shortages, task shifting to community health workers (CHWs) and empowering people living with HIV (PLWH) are integral parts of a sustainable ART strategy. Despite the success of the ART programme, South Africa still faces both prevention and treatment challenges. To tackle these challenges, future endeavours need to focus on the role played by the households of PLWH in mediating between the community and PLWH themselves. Building health-enabling "HIV competent" households with the capacity to actively stimulate lifestyles that foster health, offers a potential strategy to tackle South Africa's HIV-related challenges. The aim of the "Sinako: Households and HIV" study is to investigate to what extent and how an intervention can increase HIV competence in PLWH and their households, and subsequently optimise the impact of CHW support on individual ART outcomes., Methods: The "Sinako" study is a cluster-randomised controlled trial with two arms. In the control arm, CHWs offer a standard package of support to PLWH during home visits, focused on the individual. The intervention arm includes both a focus on the individual and the household to enable the patient to self-manage their treatment within an HIV competent household. A longitudinal mixed methods design is adopted to analyse the data. For the quantitative data analysis, methods including latent cross-lagged modelling, multilevel modelling and logistic regression will be used. To assess the acceptability and feasibility of the intervention and to construct a comprehensive picture of the mechanisms underlying the impact on the household and the PLWH, qualitative data (in-depth interviews and focus group discussions) will be collected and analysed., Discussion: Stimulating HIV competence in households could be a feasible and sustainable strategy to optimise the outcomes of CHW interventions and thus be important for HIV treatment interventions in resource-limited settings., Trial Registration: Pan African Clinical Trial Registry, PACTR201906476052236. Registered on 24 June 2019.

Background: In medical practice, a patient's loss of competency is a major obstacle when choosing a treatment and a starting treatment program smoothly. A large number of studies have revealed the lack of medical competency in patients with dementia. However, there have been only a few reports focusing on the capacity of patients with mild cognitive impairment (MCI) to make a medical choice., Methods: In this study, we evaluated the competency of 40 patients with amnestic MCI (aMCI) and 33 normal subjects to make a medical choice using the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). We compared the judgement of a team conference using the recorded semi-structured interview with the clinical judgement of a chief clinician., Results: A team conference concluded that 12 aMCI patients had no competency, and the clinical judgement, without any special interview, judged that five aMCI patients had no competency. All subjects in the control groups were judged to be competent to consent to treatment by both clinicians and the team conference., Conclusions: Without supplementary tools such as explanatory documents, not a few patients with aMCI were judged by a team conference to have no competency to consent to therapy even in a relatively simple and easy case. In contrast, clinical physicians tended to evaluate the competency of aMCI patients in a generous manner.

Objective: To determine if cognition can be used to identify persons with cancer at high risk for the impaired ability to understand treatment decisions., Methods: The association between understanding treatment decisions and cognition was examined using data from 181 participants across four groups: 67 with brain metastasis, 41 with metastatic cancer that has not spread to the brain, 27 with malignant glioma, and 46 healthy controls. All diagnoses were made by board-certified oncologists and were verified histologically., Results: Results indicated that numerous cognitive functions were associated with the ability to understand treatment decisions in persons with cancer. The following proportion of participants demonstrated impaired understanding of treatment decisions in our three patient groups: approximately 51% malignant glioma, approximately 46% brain metastasis, and approximately 24% metastatic cancer. In a combined brain cancer group, we were able to use cognitive performance to predict the impaired ability to understand treatment decisions., Conclusions: An impaired ability to understand treatment decisions is prevalent in persons with brain cancer and persons with metastatic cancer. Performance on a brief cognitive battery can be used to help clinicians identify patients at particular risk for impaired medical decision making., (© 2019 John Wiley & Sons, Ltd.)

It is estimated that up to 7500 people develop schizophrenia each year in the UK. Schizophrenia has significant consequences, with 28% of the excess mortality in schizophrenia being attributed to suicide. Previous research suggests that suicide in schizophrenia may be more related to affective factors such as depression and hopelessness, rather than psychotic symptoms themselves. Considering suicide in schizophrenia within this framework enables us to develop a novel philosophical approach, in which suicide may not be related to loss of self-consciousness, thought processing dysfunctions or perception disturbances. The action of suicide may be due neither to persistent hallucinations nor other psychotic symptoms, such as delusional beliefs, but to other underexamined, perhaps rational reasons, such as extreme social isolation, severe depression or emotional withdrawal. This paper does not examine the moral character of suicide. Instead, it argues that we should conceive the action of suicide in schizophrenia as an act that is not necessarily irrational. People with schizophrenia might end their life based on reasons if suicide is the best means to achieve their ends. However, the paper does not support assisted suicide. It aims to provide a better understanding of the reasons why people take their own lives and suggests that understanding can inform effective interventions to reduce high rates of suicide., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Considering the numbers of children and adolescents in conflict with the law, there is a concern about the ways in which they are being dealt with in the criminal justice system. This paper examines issues relating to the minimum age of criminal responsibility, the differences across countries, and the broad principles and international guidelines in this regard. Additionally, the rebuttable presumption of doli incapax , which is included in many legal systems, is discussed. This is done specifically with concerns regarding the psychological evaluation of criminal capacity, considering the lack of valid and reliable measures, as well as the vagueness of the concept of criminal capacity. An examination of the neurodevelopment evidence in relation to children's criminal behaviour, risk taking, and impulse control are discussed. The latest research evidence raises doubt about the extent to which adolescents can be held criminally responsible. The responsibility of expert witnesses to enlighten courts on this matter is crucial to avoid unnecessarily criminalising children and adolescents who may not have the requisite capacity to be held criminally liable.