Psychiatric Intensive Care Units: a Literature Review

Background: Psychiatric Intensive Care Units (PICU) have been part of most inpatient psychiatric services for some time, although information about their functioning and outcome has not previously been collated. Aim: To conduct a systematic literature review to assess the current state of knowledge about such services. Method: A search of electronic databases was undertaken, followed by obtaining additional references from items obtained. Results: Over 50 papers in English containing some empirical data were identified. Most studies were retrospective. Typical PICU patients are male, younger, single, unemployed, suffering from schizophrenia or mania, from a Black Caribbean or African background, legally detained, with a forensic history. The most common reason for admission is for aggression management, and most patients stay a week or less. Evidence of the efficacy of PICU care is very poor. Conclusions: Most research so far has been small scale, and more substantial work using better methodologies is clearly required.

[1]  B. Huitfeldt,et al.  The relationship of crowding and aggressive behavior on a psychiatric intensive care unit. , 1991, Hospital & community psychiatry.

[2]  R. Hafner,et al.  The Use of Seclusion: A Comparison of Two Psychiatric Intensive Care Units , 1989, The Australian and New Zealand journal of psychiatry.

[3]  K. Bhui,et al.  The London Survey of Psychiatric Intensive Care Units: psychiatric intensive care; patient characteristics and pathways for admission and discharge , 2005 .

[4]  M. Dolan,et al.  Characteristics and outcomes of patients admitted to a psychiatric intensive care unit in a medium secure unit , 2001 .

[5]  Julie Morris,et al.  Violence, dissatisfaction and rapid tranquillisation in psychiatric intensive care , 1998 .

[6]  T. Wykes,et al.  Patient satisfaction with intensive care psychiatric services: Can it be assessed? , 1993 .

[7]  H. Gordon,et al.  Special care units in Special Hospitals , 1998 .

[8]  Z. Walker,et al.  Violent Incidents in a Psychiatric Intensive Care Unit , 1994, British Journal of Psychiatry.

[9]  Lindsay Reid,et al.  Starting from scratch. , 2010, The practising midwife.

[10]  L. J. Naismith,et al.  Violent Incidents on Special Care Wards in a Special Hospital , 1989, Medicine, science, and the law.

[11]  C. Paton,et al.  Hot beds of general psychiatry , 1997 .

[12]  Steve Brown,et al.  The psychiatric intensive care unit (PICU): Patient characteristics, treatment and outcome , 2004 .

[13]  M. Dolan,et al.  A psychiatric intensive care unit in a medium-security unit , 2001 .

[14]  Alan D. Smith.  Survey of locked facilities in Scottish psychiatric hospitals , 1997 .

[15]  G. Waller,et al.  Psychopathology and violent behaviour in psychiatric intensive care , 1992 .

[16]  A. Feinstein,et al.  Evaluating the Use of a Psychiatric Intensive Care Unit: Is Ethnicity a Risk Factor for Admission? , 2002, The International journal of social psychiatry.

[17]  K. Bhui,et al.  The London Survey of Psychiatric Intensive Care Units: service provision and operational characteristics of National Health Service units , 2005 .

[18]  S. Cooper,et al.  Aggressive behaviour in a psychiatric observation ward , 1983, Acta psychiatrica Scandinavica.

[19]  J. Yesavage,et al.  Hostile words and assaultive behavior on an acute inpatient psychiatric unit. , 1983, The Journal of nervous and mental disease.

[20]  D. Wasylenki,et al.  A Psychiatric Intensive Care Unit in a Psychiatric Hospital , 1989, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[21]  S. O'Connor.  An analytic approach in a psychiatric intensive care unit , 1998 .

[22]  C. Paton,et al.  Good practice issues in psychiatric intensive-care units , 1999 .

[23]  Dan Schuch,et al.  The research assistant , 2001 .

[24]  R. Dix.  A nurse-led psychiatric intensive care unit , 1995 .

[25]  E. Allan,et al.  Planning a psychiatric intensive care unit. , 1988, Hospital & community psychiatry.

[26]  N. Hunt,et al.  Prediction of Violence on a Psychiatric Intensive Care Unit , 2000, Medicine, science, and the law.

[27]  Mitchell Gd.  A survey of psychiatric intensive care units in Scotland. , 1992 .

[28]  J. Chiles,et al.  Therapeutic role of a psychiatric intensive care unit in acute psychosis. , 1987, Comprehensive psychiatry.

[29]  S. Rachlin.  On the need for a closed ward in an open hospital: the psychiatric intensive-care unit. , 1973, Hospital & community psychiatry.

[30]  M. Pompili,et al.  Mass media and suicide. , 2003 .

[31]  D. Castle,et al.  Types of Patients in a Psychiatric Intensive Care Unit , 2001, The Australian and New Zealand journal of psychiatry.

[32]  L. O'brien,et al.  Mental health nursing practice in acute psychiatric close-observation areas. , 2004, International journal of mental health nursing.

[33]  P. Cornwall,et al.  High-dose antipsychotic medication , 1996 .

[34]  A. Saverimuttu,et al.  Aggressive incidents on a psychiatric intensive care unit. , 2000, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[35]  J. Basson,et al.  Assessment of a secure/intensive care/forensic ward , 1981, Acta psychiatrica Scandinavica.

[36]  L. O'brien,et al.  Close-observation areas in acute psychiatric units: a literature review. , 2003, International journal of mental health nursing.

[37]  R. Goldney,et al.  The Safe Use of High Dose Neuroleptics in a Psychiatric Intensive Care Unit , 1986, The Australian and New Zealand journal of psychiatry.

[38]  L. Bowers,et al.  Philosophy, care and treatment on the psychiatric intensive care unit: themes, trends and future practice. , 2002, Journal of psychiatric and mental health nursing.

[39]  L. Warneke.  A Psychiatric Intensive Care Unit in a General Hospital Setting , 1986, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[40]  M. Michalon,et al.  Factors affecting length of stay in a psychiatric intensive care unit. , 1990, General hospital psychiatry.

[41]  R. Goldney,et al.  The Psychiatric Intensive Care Unit , 1985, British Journal of Psychiatry.

[42]  J. Hallmayer,et al.  Catatonia in a psychiatric intensive care facility: incidence and response to benzodiazepines. , 2000, Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists.

[43]  C. Hyde,et al.  Psychiatric intensive care in acute psychosis , 1996, International clinical psychopharmacology.

[44]  B. Huitfeldt,et al.  The relationship fo crowding and aggressive behaviour on a psychiatry intensive care unit , 1991 .

[45]  A. Khan,et al.  Antipsychotic effect of milieu in the acute treatment of schizophrenia. , 1990, General hospital psychiatry.

[46]  W. A. Birnie,et al.  The Psychiatric Acute Observation Unit in a General Hospital , 1988, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[47]  G. Mitchell.  A survey of psychiatric intensive care units in Scotland. , 1992, Health bulletin.

[48]  A. Broome,et al.  Some patterns of disturbed behaviour in a closed ward environment. , 1978, Journal of advanced nursing.