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Assessing capacity

We agree with Drs. Meraj and Poje in “Capacity assessment: A fundamental skill” (Current Psychiatry, September 2011, p. 72-73) that clinical judgment often is used in addition to or in lieu of quantitative scales when evaluating medical decision-making capacity. We further agree that the formulation by Appelbaum^{The primary and secondary symptoms of schizophrenia: Current and future management” (Current Psychiatry, supplement to September 2011, p. S5-S9).}

I have a suggestion to add to the list of secondary negative symptoms based only on my observations: demoralization caused by repeated failures in all dimensions—self, interpersonal, social, and industrial. I have seen demoralization in schizophrenia patients manifest as low self-esteem, hopelessness, apathy, and self reproach.

Robert A. Williams, MD
Biological Psychiatry Institute, Ltd.
Phoenix, AZ