Abstract
This study aims to describe the course of admission and clinical characteristics of admissions to a psychiatric intensive care unit (PICU) in the Phoenix Care Centre (PCC), Dublin, Ireland. This retrospective chart study was conducted at the PCC, Dublin, Ireland. The cohort included all admission episodes (n = 91 complete data) over a three-year study period between January 2014 and January 2017. The mean age of admitted cases was 37.1 (s.d. = 11.3; range 18-63). The mean length of stay (LOS) was 59.3 days (s.d. = 61.0; median 39.5 days). All patients were admitted under Mental Health Act legislation. Antipsychotic polypharmacy was used in 61% (n = 55) of the admissions. A diagnosis of acute psychotic disorder (B = -1.027, p = 0.003, 95% CI: -1.691, -0.363) was associated with reduced LOS in PICU. Our study describes the cohort of patients admitted asbeing predominantly male, younger-aged, single, having a diagnosis of schizophrenia and being legally detained. The primary indication for referral is risk of assault, which highlights the need for the intensive and secure treatment model that a PICU can provide.
Highlights
There is limited literature on psychiatric intensive care units (PICUs) in the Republic of Ireland
Phoenix Care Centre (PCC) is a state-of-the-art purpose-built mental health facility which includes a PICU located in inner-city Dublin
To identify potential confounding variables, we examined variables collected at baseline [i.e. gender, age at admission, ethnicity, relationship status, diagnosis, psychotic disorder diagnoses], a psychotic disorder with or without comorbid alcohol/substance misuse, referral source, previous PICU admission, interventions used during admission, number of seclusion episodes, number of restraint episodes, antipsychotic dose a % of BNF maximum recommended daily dose, high-dose antipsychotic use defined as cumulative antipsychotic dose > 100% of BNF maximum recommended daily dose, antipsychotic polypharmacy use, use of mood stabiliser, benzodiazepines, depot antipsychotic medication, behaviour preceding referral to admission, assault, aggression, absconding, self-harm, multiple risks identified pre-admissions (>1), the total number of risks identified, and forensic history
Summary
There is limited literature on psychiatric intensive care units (PICUs) in the Republic of Ireland. In the last three decades, psychiatric care in Ireland has transitioned from asylum care to a community mental health service model. This led to a reduction in the total number of patients in institutional care in Ireland. The Phoenix Care Centre (PCC) is a built for purpose facility that was built on the grounds of St. Brendan’s Hospital as set out in the national policy and initiatives ‘A Vision for Change’ for mental health in 2006 (Health Service Executive, 2015; HSE, 2017). PCC is a state-of-the-art purpose-built mental health facility which includes a PICU located in inner-city Dublin
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