Background and Aims: Since January 2003, within the context of the Swiss health law, the different states were under the obligation to integrate anticipated directives in their sanitary policies. We questioned ourselves on the consequences of this new law on our patients suffering from bipolar disorder. In this recent context of _empowerment_, the application of this patient's right, enabled us to develop a novel psycho-educational tool. The final goal of this psycho-educational work undertaken with hospitalised patients as they come out of an acute maniac phase is to prevent future relapse and hospitalisations.
Methods: A _Patient's Notebook_ was created allowing patients to think and elaborate their anticipated directives going throw different topics encountered during a manic phase (dangerous behaviour, medication, treatment against one's will...) within the light of our 3-year experience with anticipated directives, we have been able to stress the importance of two clinical dimensions which we named: The clinical time; the clinical legitimacy given by the witness of the crisis.
Results: The work described here above lead to improvement of therapeutic alliance and morbid consciousness, reinforced compliance to treatment, and brought reflection around relapses.
Conclusions: Therefore, it is not only important to develop relevant clinical tools, as here based on a health law, but also to analyse the time and context they are the most beneficial to our patients. The poster presents the development of what was initially a health law into a psycho-educational tool and it's clinical impact.