MODELING PSYCHIATRIC-PATIENTS TREATMENT DECISION-MAKING

Decision-making processes of psychiatric inpatients were assessed at a dmission and prior to discharge, and compared to hospital staff member s using a paired comparison paradigm in which subjects chose between h ypothetical antipsychotic medications. Multidimensional analyses of bi nary choice matrices revealed that all subjects based decisions on the risks and benefits of medication, and weighted risks and benefits in roughly equal proportions. Hospital staff demonstrated greater interna l consistency in their decisions than the inpatient sample at both tim e points. For newly admitted inpatients, severity of psychiatric sympt oms and nonverbal intelligence were related to internal consistency of decision making, and behavioral indices of medication compliance pred icted relative weighting of risks and benefits. For predischarge and c omparison samples, verbal intelligence and treatment preferences predi cted both outcome measures. Reliance on verbal reports of decision mak ing may be misleading when assessing competence in acutely impaired ps ychiatric patients.