Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-27T19:26:13.071Z Has data issue: false hasContentIssue false
  • English
  • Français

The London Survey of Psychiatric Intensive Care Units: psychiatric intensive care; patient characteristics and pathways for admission and discharge

Published online by Cambridge University Press:  15 September 2005

Stephen M Pereira ,
May Sarsam ,
Kamaldeep Bhui  and
Carol Paton
Stephen M Pereira
Affiliation:
Honorary Senior Lecturer in Psychiatry
May Sarsam
Affiliation:
Clinical Psychologist in Training, Division of Clinical Psychology, University of Liverpool, Merseycare NHS Trust
Kamaldeep Bhui
Affiliation:
Professor in Epidemiological Psychiatry, Barts and the London School of Medicine, London
Carol Paton
Affiliation:
Chief Pharmacist, Oxleas NHS Trust, Dartford, Kent, UK

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Background: Psychiatric intensive care facilities have previously been poorly defined, with uncertainty existing about the appropriateness of admissions.

Aim: To offer the first large-scale systematic survey describing the clinical characteristics of patients admitted to Psychiatric Intensive Care Units.

Method: A questionnaire was sent to ward managers of every Psychiatric Intensive Care Unit in London for completion on a chosen census day. Individual demographic and clinical patient characteristics were collected, along with admission and discharge pathways.

Results: Of 186 patients on 17 NHS PICUs in London, we obtained data for 172. 80% of patients were male, with a mean age of 33; 50% were Black and all but 2 were involuntarily detained. 66% had a diagnosis of schizophrenia and 55% of admissions were due to physical aggression. 73% of the sample had at least one ‘complex need’, which was most commonly substance misuse. Black patients were younger, more likely to be male and to have a forensic history (54% vs. 31%) than white patients. A slightly lower percentage (70% vs. 79%) of Black patients were described as having complex needs. White patients were more likely to have a personality disorder or a second diagnosis.

Conclusions: Patients admitted to psychiatric intensive care units were most likely to have major psychosis, complex needs and to use illicit substances. Ethnic variations warrant further study.

Declaration of Interest: The project was partly funded by the Department of Health.

Keywords

PICUspatient characteristicscare pathways
Type
Original Paper
Information
Journal of Psychiatric Intensive Care , Volume 1 , Issue 1 , September 2005 , pp. 17 - 24
Copyright
© 2005 NAPICU

References

Atakan, Z. (2001) The complex needs patient. In: Psychiatric Intensive Care. Beer, D, Pereira, P, Paton, C (eds). London: Greenwich Medical Media, pp. 169–196.
Audini, B. and Lelliott, P. (2002) Age, gender and ethnicity of those detained under Part II of the Mental Health Act 1983. British Journal of Psychiatry. 180: 222–226.Google Scholar
Barlow, K., Grenyer, B. and Ilkiw-Lavelle, O. (2000) Prevalence and precipitants of aggression in psychiatric inpatient units. Australian and New Zealand Journal of Psychiatry. 34: 967–974.Google Scholar
Bhugra, D., Leff, J., Mallett, R., Der, G., Corridan, B. and Rudge, S. (1997) Incidence and outcome of schizophrenia in Whites, African-Caribbeans and Asians in London. Psychological Medicine. 27(4): 791–798.Google Scholar
Brown, G.W. and Prudo, R. (1981) Psychiatric disorder in a rural and an urban population: 1. Aetiology of depression. Psychological Medicine. 11(3): 581–599.Google Scholar
Coid, J., Kahtan, N. and Gault, S. (1999) Patients with personality disorder admitted to secure forensic psychiatry services. British Journal of Psychiatry. 175: 528–536.Google Scholar
Coid, J., Kahtan, N., Cook, A., Gault, S. and Jarman, B. (2001) Predicting admission rates to secure forensic psychiatry services. Psychological Medicine 31: 531–539.Google Scholar
Ford, I. and Whiffin, M. (1991) The role of the psychiatric ICU. Nursing Times. 87(51): 47–49.Google Scholar
Goldney, R., Bowes, J., Spence, N., Czechowicz, A. and Hurley, R. (1985) The psychiatric intensive care unit. British Journal of Psychiatry. 146: 50–54.Google Scholar
Gordon, H. (1998) Special care units in special hospitals. The Journal of Forensic Psychiatry 9(3): 571–587.Google Scholar
Hickling, F.W., McKenzie, K., Mullen, R. and Murray, R. (1999) A Jamaican psychiatrist evaluates Diagnoses at a London psychiatric hospital. British Journal of Psychiatry 175: 283–285.Google Scholar
Hyde, C.E., Harrower-Wilson, C. and Morris, J. (1998) Violence, Dissatisfaction and rapid tranquillisation in psychiatric intensive care. Psychiatric Bulletin. 22: 477–480.Google Scholar
Johns, L.C., Nazroo, J.Y., Bebbington, P. and Kuipers, E. (2002) Occurrence of hallucinatory experience in a community sample and ethnic variations. British Journal of Psychiatry. 180: 174–178Google Scholar
Khan, A., Cohen, S. and Stowell, M. (1987) The therapeutic role of a PICU in acute psychosis. Comprehensive Psychiatry. 28(3): 264–269.Google Scholar
Lelliott, P., Wing, J. and Clifford, P. (1994) A national audit of new long-stay psychiatric patients I: method and description of the Cohort. British Journal of Psychiatry. 165: 160–169.Google Scholar
Lewis, G., Croft-Jefferies, C. and David, A. et al. (1990) Are British psychiatrists racist? British Journal of Psychiatry. 157: 410–415.Google Scholar
Maden, A. (2001) Medium secure care and research in forensic psychiatry. British Journal of Psychiatry. 178: 5–6.Google Scholar
Montoya, I.D., Svikis, D., Marcus, S.C., Suarez, A., Tanielian, T. and Pincus, HA. (2000) Psychiatric care of patients with depression and co-morbid substance use disorders. Journal of Clinical Psychiatry. 61(9): 698–705.Google Scholar
Office of National Statistics (2002) Projections for Ethnicity in London Boroughs from the 2001 Census (unpublished report).
Pereira, S., Sarsam, M., Bhui, K. and Paton, C. (2005a) The London Survey of Psychiatric Intensive Care Units: service provision and operational characteristics of National Health Service units. Journal of Psychiatric Intensive Care. 1(1): 7–15.Google Scholar
Rachlin, S. (1973) On the need for a closed ward in an open hospital: The psychiatric intensive-care unit. Hospital and Community Psychiatry. 24(12): 829–835.Google Scholar
Sharpley, M., Hutchinson, G., McKenzie, K. and Murray, R.M. (2001) Understanding the excess of psychosis among the African-Caribbean population in England: review of current hypotheses. British Journal of Psychiatry – Supplementum. 40: s60–68.Google Scholar
Smith, A.D. (1997) Characteristics of inpatients transferred to a locked ward in a Scottish psychiatric hospital. Health Bulletin. 55(2): 77–82.Google Scholar
Thornicroft, G., Davies, S. and Leese, M. (1999) Health service research and forensic psychiatry: a Black and White case. International Review of Psychiatry. 11: 250–257.Google Scholar
Wessely, S. and Castle, D. (1998) Mental disorder and crime (comment). Archives of General Psychiatry. 55(1): 86–88.Google Scholar