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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0607

Melanoma, mania, and medical decision-making: a case of impaired capacity in an older adult

MELANOMA, MANIA, AND MEDICAL DECISION-MAKING: A CASE OF LOSS OF CAPACITY IN AN OLDER ADULT

Although the ability to express a choice appeared preserved in an older patient with mania who refused oncological treatment, understanding, appreciation, and reasoning were impaired; capacity was restored after her condition improved.

The aim is to discuss, through a case report, the importance of a detailed assessment of decision-making capacity in patients with cancer whose refusal of treatment carries a serious risk of harm. The poster emphasizes that capacity is domain-, task-, and time-specific and that the threshold for capacity rises as the risk associated with a decision increases. It uses the four criteria proposed by Appelbaum and Grisso in 1988 as a framework: communicating a consistent choice, understanding relevant information, appreciating the situation and the personal significance of the information, and reasoning through the rational processing of information. The case concerns a 77-year-old woman receiving care for melanoma who was readmitted multiple times after repeatedly missing oncology follow-up appointments; a psycho-oncology consultation was requested because of anxiety and delusions. Psychiatric assessment revealed a severe mania-like presentation characterized by irritability, pressured and tangential speech, impaired attention, limited insight, and paranoid ideation directed toward healthcare professionals. Assessment of the affected domains found the ability to communicate a choice to be partially preserved: the patient could express a choice, but it remained inconsistent over time and across interactions with different people. Understanding, appreciation, and reasoning were judged to be impaired, and the patient was found to lack capacity to refuse oncological treatment. Following improvement in her medical condition and initiation of olanzapine, the patient regained capacity and was discharged without complications. The section on confounding factors recommends separately assessing psychosis, neurocognitive disorders, mania, health literacy, delirium, medication effects, and physiological causes. In conclusion, the poster emphasizes the need for critical, in-depth assessment of capacity using additional questions in high-risk settings such as oncology, as well as frequent reassessment, because capacity is a dynamic concept that can vary over time and across domains.

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