Authors' Response to the Comments on "How Do Our Patients Respond to the Concept of Psychiatric Advance Directives? An Exploratory Study from India".

Sir,

We thank Dr. Ramesh and Dr. Somani for their interest in our article entitled “How do our patients respond to the concept of psychiatric advance directives? An exploratory study from India.”[1] The authors of the letter have observed that the study did not explore the attitude of the patients or the family members toward the concept of the advance directives (AD).[2] We agree that we have not discussed the attitude part of this paper as we have only focused on the treatment choice made by the patients.

Authors have also opined that open-ended questions should have been used instead of simple yes or no questions to assess the treatment choices. We would like to refer here to another letter published in this same issue, where Narasimha et al. (2018) have advocated the use of a structured tool in studies like ours.[3] These differences of opinion may be because of the little evidence available on the topic of the AD and its worthwhile to take up research comparing semi-structured and structured tools in the future. Further, we agree with the authors’ opinion that the usage of specific rating scales, such as brief psychiatric rating scale (BPRS), young's mania rating scale (YMRS), and hamilton depression rating scale (HAM-D), would have been better and the importance of the assessment of capacity and cognitive status.

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