Severe mental disorder (SMD) includes people with long-term mental disorders, disability and social dysfunction. The mental capacity evaluation of the people has been a key aspect in legislative systems around the world and different proposals have been made. In countries like Spain, until 2021, the mental capacity of individuals was assessed by means of legal proceedings. In the last years, there has been a notable increase in the number of claims for legal incapacity, but no data are available on the total number of persons with CM, neither on the specific pathologies, or clinical and cognitive profiles. In view of the total absence of data on the profile of people with SMD and modification of capacity, the RECAPACITA study was born. This study includes patients with SMD and CM, as well as those without CM, with the aim to describe exhaustively their clinical, neuropsychological and functional profile of people with SMD and CM, as well as obtaining a basic description of the social environment.

Objectives

To describe CM in SMD, to identify clinical diagnoses, clinical severity and neuropsychological deterioration. Methods: Cross-sectional descriptive study. 77 adult patients with SMD and CM, inpatients from the mental health sector of the Parc Sanitari Sant Joan de Déu (Spain), outpatients linked to the community rehabilitation services (CRS), and penitentiary inmates. CM, sociodemographic, clinical, functional and neuropsychological data are collected.

Results

In the sample, 59.5% present total CM. 74.7% are men (mean: 52.5 years). 87,0% have a diagnosis of schizophrenia. The estimated premorbid IQ is 91.4. The Global Assessment of Functioning (GAF) had a mean of 50.5, the “Clinical Global Impression Scale” (CGI) was 4.6 and Scale Unawareness of Mental Disorders (SUMD) was 9.28. The cognitive results shows a profile with slow proceeding speed (mean scale score: 6.6), good working memory (mean SC: 8.3) and adequate verbal comprehension (mean SC: 7.3). In memory, coding is altered (Pz: −1.9), and long-term spontaneous recall (Pz: −2.3). In abstract reasoning, a slight alteration is obtained (Mean SC: 6), as well as in semantic fluency (Mean SC: 6.3), phonological (Mean SC: 5.9), and inhibitory capacity (Mean SC: 5.7).

Conclusions

Most of the sample are men with schizophrenia, with a total MC assumed by a tutelary foundation. They show a moderate alteration in global functioning and clinical global impression, with partial awareness of the disease. They present dysexecutive mild cognitive impairment, with poor memory coding and free retrieval capacity, and a normal IQ, adequate verbal comprehension and working memory. This study is the first to present objective data on the psychiatric, functional and cognitive status of a group of patients with CM. Such research could be a good starting point to address a topic of great interest from the health, social and legal point of view of the CM processes of people with SMD.

中文翻译：

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RECAPACITA 项目：描述西班牙严重精神障碍和法律行为能力改变人群的临床、神经心理学和功能概况

严重精神障碍（SMD）包括患有长期精神障碍、残疾和社会功能障碍的人。人的心智能力评估一直是世界各国立法体系的重点内容，并提出了不同的建议。在西班牙等国家，直到 2021 年，个人的心智能力都是通过法律程序评估的。在过去几年中，因丧失法律行为能力而提出的索赔数量显着增加，但没有关于 CM 患者总数的数据，也没有关于具体病理、临床和认知特征的数据。鉴于完全缺乏关于 SMD 患者概况和能力改变的数据，RECAPACITA 研究应运而生。这项研究包括患有 SMD 和 CM 的患者，以及那些没有 CM 的患者，

目标

描述 SMD 中的 CM，以确定临床诊断、临床严重程度和神经心理恶化。方法：横断面描述性研究。77 名患有 SMD 和 CM 的成年患者、来自 Parc Sanitari Sant Joan de Déu（西班牙）精神卫生部门的住院患者、与社区康复服务 (CRS) 相关的门诊患者以及监狱囚犯。收集 CM、社会人口学、临床、功能和神经心理学数据。

结果

在样本中，59.5% 存在总 CM。74.7% 是男性（平均：52.5 岁）。87,0% 的人被诊断为精神分裂症。估计的病前智商为 91.4。整体功能评估 (GAF) 的平均值为 50.5，“临床整体印象量表”(CGI) 为 4.6，精神障碍意识量表 (SUMD) 为 9.28。认知结果显示出处理速度慢（平均量表分数：6.6）、工作记忆良好（平均 SC：8.3）和足够的语言理解能力（平均 SC：7.3）的特征。在记忆中，编码被改变（Pz：-1.9），并且长期自发回忆（Pz：-2.3）。在抽象推理中，获得了轻微的改变（平均 SC：6），以及语义流畅性（平均 SC：6.3）、语音（平均 SC：5.9）和抑制能力（平均 SC：5.7）。

结论

大多数样本是患有精神分裂症的男性，总 MC 由监护基金会承担。他们在整体功能和临床整体印象方面表现出适度的改变，对疾病有部分认识。他们表现出执行障碍的轻度认知障碍，记忆编码和自由检索能力差，但智商正常，有足够的语言理解和工作记忆。本研究首次提供了一组 CM 患者的精神、功能和认知状态的客观数据。这种研究可能是一个很好的起点，可以从 SMD 患者的 CM 过程的健康、社会和法律角度解决一个非常有趣的话题。