Implementation of Psychiatric Advance Directives from aTransdiagnostic Approach

Abstract

Psychiatric Advance Directives (PADs) are a process that allows people with mental illnesses to express their will regarding any health action they want to receive once their cognitive capacity may be diminished. The application of PADs distinguishes between diagnoses that could employ this tool and the therapeutic measures that can be included in the directives of the PAD. However, this classificatory model does not consider aspects about the everyday life of people, such as the care of plants, pets, or properties, which are decisive for patient decision making. The transdiagnostic approach may be an option to support the implementation of PADs, because it explains the transversality of mental illnesses from a dimensional and phenomenological perspective: the biography, rather than the biology of the patient. Objective. To empirically identify content elements of PADs from the transdiagnostic approach. Method. We carried out a qualitative study with semi structured interviews, in which four psychiatrists from two mental health clinics in Santiago, Chile, were interviewed. Results. The thematic analysis allowed us to identify three significant themes of PADs that should be considered: 1) treatment, 2) diagnosis, and 3) hospitalization. Discussion and conclusion. The subjective-pathogenic situation that a person lives creates circumstances, actions, and experiences for a better treatment. These transdiagnostic dimensions enable a practical work for implementing PADs and obtaining more benefits for patients.