Advance directives based on cognitive therapy: a way to overcome coercion related problems

Mental health advance directives (ADs) are potentially useful for bipolar patients due to the episodic characteristic of their disease. The aim of the present study is to evaluate the impact of advance directives based on cognitive therapy (ADBCT) on the number and duration of hospitalizations as well as compulsory admissions and seclusion procedures.

Charts of all treatment non-adherent patients and committed patients who wrote their ADs following an ADBCT intervention within a 24 months period prior to the beginning of the study were included. Number and duration of psychiatric hospitalizations for a mood or a psychotic episode as well as compulsory admissions and seclusion procedures were recorded for each patient 2 years before ADBCT and during a follow-up period of at least 24 months.

The number of hospitalizations, the number of compulsory admission procedures and the number of days spent in psychiatric hospital reduced significantly after ADCBT in comparison to the 2 years who preceded this intervention.

This retrospective data suggest that ADBCT is effective for patients with compliance and coercion problems. However, these results need to be confirmed in randomized controlled trials.

ADBCT seems to be a useful approach for treatment-non-adherent and previously coerced patients.