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. 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. 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. 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.

中文翻译：

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文献综述的元回顾评估了严重精神障碍患者做出有关医疗保健决策的能力。

确定精神病患者做出医疗保健相关决定的心理能力在临床实践中至关重要。这篇综述文章的元综述全面检查了有关精神疾病患者做出医疗决定的能力的当前证据。按照PRISMA的建议，系统地审查评论文章。截至2020年1月31日，对PubMed，Scopus，CINAHL和PsycInfo进行了电子搜索。结合了自由文本搜索和医学主题词，以鉴定以英语发表的文献综述和荟萃分析，并对患有严重精神疾病的患者的能力进行了总结研究。做出与医疗保健和治疗相关的决策，在任何临床环境中进行，并对结果进行定量综合。根据纳入和排除标准选择出版物。AMSTAR II工具用于评估评论的质量。审查了11种出版物。跨研究方法的可变性使得难以准确估计精神障碍患者决策能力的普遍性。但是，多达四分之三的精神病患者，包括精神分裂症或躁郁症等重症患者，可能有能力根据其疾病做出医疗决定。大多数证据来自在医院中进行的研究。在社区中，关于精神障碍患者的医疗保健决策能力的信息很少。稳定的精神病患者和非精神病患者可能具有与医疗保健相关的决策类似的能力。患有精神疾病的患者具有判断风险回报情况并适当决定重要治疗结果的能力。不同的症状可能会损害精神病患者决策能力的不同领域。精神病患者的决策能力受损是暂时的，可识别的，并且对旨在简化信息，鼓励培训和共同决策的干预措施有反应。这些出版物令人满意地符合了AMSTAR II的关键领域。尽管决策能力可能存在障碍，但大多数患有严重精神疾病（例如精神分裂症或躁郁症）的患者能够做出合理的医疗决策。