Appreciation of research information in patients with bipolar disorder

Authors

  • Sahana Misra,

    1. Portland Veterans Affairs Medical Center
    2. Department of Psychiatry, Oregon Health and Science University
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  • Robert Socherman,

    1. Portland Veterans Affairs Medical Center
    2. Department of Psychiatry, Oregon Health and Science University
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  • Peter Hauser,

    1. Portland Veterans Affairs Medical Center
    2. Department of Psychiatry, Oregon Health and Science University
    3. Behavioral Health and Neurosciences Division, Portland VA Mood Disorders Research and Treatment Center
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  • Linda Ganzini

    1. Portland Veterans Affairs Medical Center
    2. Department of Psychiatry, Oregon Health and Science University
    3. Columbia Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland Veterans Affairs Medical Center
    4. Department of Medicine, Oregon Health and Science University, Portland, OR, USA
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  • A preliminary version of this study was presented at the annual meeting of the American Psychiatry Association, May 21, 2005, Atlanta, GA, USA.

  • PH receives research support from GlaxoSmithKline and AstraZeneca Pharmaceuticals and is on the speakers bureau for Abbott Laboratories, AstraZeneca Pharmaceuticals, Bristol-Myers Squibb Co., GlaxoSmithKline, and Janssen Pharmaceuticals. SM, RS, and LG have no reported conflict of interest.

Sahana Misra, MD, Portland VAMC (R&D 66), 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239, USA.
Fax: +1 503  721 1085; e-mail: misras@ohsu.edu

Abstract

Objective:  Ethicists have debated whether patients with serious mental illness can appreciate the risks of research participation and make autonomous decisions. We compared the abilities of euthymic and manic bipolar patients to appreciate and make voluntary decisions regarding research participation.

Methods:  Twenty-six subjects with mania and 25 euthymic subjects reviewed hypothetical consent forms for three research studies of varying risk. We assessed subjects’ appreciation of: their diagnosis and need for treatment; the researcher’s role; the risks of participation; and the degree of influence of family, the treating clinician, and payment on decisions to participate.

Results:  Most subjects (92%) agreed they had bipolar disorder requiring medication treatment. Subjects were less likely to participate in riskier studies. About half of subjects erroneously believed that researchers would make decisions based solely on what would be the best care for them (therapeutic misconception); and in randomized medication trials, they mistakenly believed they had improved chances of receiving one treatment over another. There were no differences between mood groups on these measures. Over half of subjects (59%) indicated that their mental health provider might influence them to participate in a study even when they did not want to, but most rejected a role for family in decision making. Payment was rated as having little impact on decisions to participate in research.

Conclusion:  Mania does not substantially influence appreciation of research participation. Subjects with bipolar disorder, regardless of mood state, are at risk for therapeutic misconception and optimistic bias. Special protections may be needed when mental health professionals approach their own patients to participate in research.

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