Psychiatric Intensive Care Unit Research Articles

Acculturation stress and mental health outcomes in a sample of migrant inpatients: Findings from a naturalistic study.

Migrants face numerous risk factors for mental disorders, including stressors and traumatic events during the pre-, peri-, and post-migratory phases. Acculturation stress, a significant post-migratory stressor, can adversely affect mental health during the cultural adaptation process. This study aims to assess the clinical implications of acculturation stress in migrants admitted to a psychiatric intensive care unit, with a focus on identifying predictors of acculturative stress and their impact on clinical outcomes. We conducted a retrospective study of 268 immigrant patients hospitalized between 2004 and 2019 at the psychiatric inpatient unit of the University of Foggia. We collected socio-demographic and clinical data using ad hoc schedules and validated assessment instruments, including the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning (GAF), and the Clinical Global Impression (CGI). Diagnoses were based on DSM-IV-TR/DSM-5 criteria. We analyzed associations between demographic and clinical characteristics of patients reporting acculturative stress and those not reporting it, using appropriate statistical methods. The majority of patients were diagnosed with affective (45.1%) or psychotic disorders (31.7%), with 57.1% experiencing their first psychiatric episode. Acculturation stress was reported by 51.9% of patients (N = 139), predominantly among males (71.9%), single individuals (80.9%), and those of Islamic faith (56.8%). Patients experiencing acculturation stress were more likely to be unemployed (57.6%) and without a residence permit (63.3%). This stress was particularly prevalent among patients with psychotic disorders (25.9%) and first-episode psychiatric cases (64.7%). At discharge, patients with acculturation stress showed less improvement on CGI, GAF, and BPRS scores compared to those without such stress. Acculturation stress is influenced by several socio-demographic factors and is crucial for the full symptomatic remission of migrant patients. Culturally-oriented mental health services, including language and cultural integration programs, are essential in reducing acculturative stress and improving the overall well-being of immigrants.

A mixed methods study into the effectiveness of sensory rooms in reducing agitation levels in a psychiatric intensive care unit

Background:Reducing incidences of violence, and the use of restrictive interventions within psychiatric intensive care units (PICUs), is a priority nationally. One method for reducing violence and aggression from escalating in PICUs is sensory rooms. This study aimed to explore the effectiveness of sensory rooms as an alternative strategy to manage agitation levels in a PICU and understand the patient and staff experiences of using sensory rooms as an alternative intervention to standard approaches for agitation reduction. Method:A mixed methods approach collected data over six months using an observational rating scale pre and post-sensory room, and conducting nine semi-structured interviews with patients and staff. Results:71 patient contacts recorded, there was a statistically significant difference in pre and post-sensory room agitation ratings (p<0.001), with 66% (n = 47) experiencing a reduction in agitation rating post-usage. The sensory room was used as both a proactive and reactive strategy to manage agitation. Five themes emerged from the interviews: the sensory room supports emotional regulation, improves the patient's experience, develops therapeutic relationships, and offers an alternative agitation management strategy; however, it can be an underused resource due to access limitations. Conclusion:Staff and patients had positive experiences using a sensory room to manage agitation; it offers a safe space away from the busy ward environment. Several different factors impact staff using the intervention. Findings provide considerations for services when developing sensory rooms in PICUs, to ensure they are established as a reliable alternative for the management of agitation.

A qualitative study examining medical students′ expectations of psychiatric inpatient and intensive care settings

Background There is limited literature to date regarding medical students’ expectations of the psychiatric inpatient environment. This study aims to explore what medical students expect from psychiatric wards and psychiatric intensive care units prior to their placement. Psychiatric intensive care, arguably the most intense experience students will have in psychiatry, was used to highlight the full extent of student preconceptions. Methodology: Students were invited to complete a semi-structured questionnaire over a six-month period, from July to December 2021. Questions explored emotions prior to placement, expectations of the ward atmosphere, layout, patient behaviour and care strategies. 37 responses were received. Analysis followed the well-recognised six stages of thematic analysis. Results: Five themes emerged from the data: (1) Mixed feelings about placement; (2) Varied views about patient behaviour and illness; (3) Restrictive and controlled practice; (4) Similarities to acute general hospital care; (5) Care with empathy and compassion. Some of the expectations of students were markedly different to the reality of psychiatric inpatient and intensive care settings, with ideas of patients being physically restrained, unconscious and attached to ventilators. Conclusion: This study offers a unique insight into what medical students expect from psychiatry inpatient and intensive care settings, an issue that all clinicians who have student contact should be aware of. Results can better inform student preparation and placement supervision, leading to more meaningful learning and improved wellbeing.

Exploring Patients Service Experience of Psychiatric Intensive Care Unit (PICU) Admissions

Background: A psychiatric intensive care unit (PICU) is a tertiary mental health service that provides short-term care for patients who present with highly challenging behaviours during their psychiatric admission and require close supervision and observation due to their elevated risk of self-harm and harm towards others. A key feature of a PICU is its high level of staffing and more secured facilities. The main purpose of a PICU admission is to optimise management of patients who pose a risk to themselves and others whilst benefiting from a low-stimulus environment. However, the body of knowledge that sub serves the perspective of patients’ ‘service experience’ regarding PICU admissions remains relatively unexplored. Objective: The purpose of this study is to explore patients’ service experience of PICU admissions with the hope that this will help improve service delivery on these wards/units. Methods: The study employed a descriptive qualitative research approach. Data for this study was collected using a semi-structured questionnaire over a six-month period. The study participants involved psychiatric patients admitted to PICU under the Irish Mental Health Act of 2001 legislation from other approved centres in Ireland. Results: Six themes emerged from participants’ responses namely, communication and therapeutic engagement, unit environment, recreational and activity therapies, privacy and confidentiality, access to information as well as general experience of care and service provision in PICU. The results provide moderately less evidence for the engagement of PICU patients in recreational activities during the period of admission in PICU. Additionally, there was significantly inadequate pre-discharge debriefing for patients prior to discharge from PICU. Lastly, a greater proportion of the study participants were satisfied with PICU services and expressed their willingness to recommend PICU to individuals who may benefit from PICU services. Conclusion: Understanding the experiences of this patient population and their perspectives on PICU services is crucial to informing and developing concrete strategies for clinical practice in acute psychiatric settings. Therefore, therapeutic programs and more flexible activities are required to facilitate easy access by patients that will enhance or positively shape their experiences of PICU and other acute psychiatric services.

An Evaluation of the Prevalence of Use of High Dose Antipsychotic Therapy Across the General Adult Inpatient Wards and the Psychiatric Intensive Care Unit in Mersey Care NHS Foundation Trust

An Evaluation of the Prevalence of Use of High Dose Antipsychotic Therapy Across the General Adult Inpatient Wards and the Psychiatric Intensive Care Unit in Mersey Care NHS Foundation Trust

An Evaluation of High Dose Antipsychotic Therapy Prescribing Across the General Adult Inpatient Wards and the Psychiatric Intensive Care Unit in Mersey Care NHS Foundation Trust

An Evaluation of High Dose Antipsychotic Therapy Prescribing Across the General Adult Inpatient Wards and the Psychiatric Intensive Care Unit in Mersey Care NHS Foundation Trust

An Evaluation of the High Dose Antipsychotic Therapy Patients on the General Adult Inpatient Wards and the Psychiatric Intensive Care Unit in Mersey Care NHS Foundation Trust – Is Clozapine Being Considered in Each Case?

An Evaluation of the High Dose Antipsychotic Therapy Patients on the General Adult Inpatient Wards and the Psychiatric Intensive Care Unit in Mersey Care NHS Foundation Trust – Is Clozapine Being Considered in Each Case?

A Service Evaluation and Improvement Project: Reducing Delays in Transfer of Patients From Psychiatric Intensive Care Unit (PICU) to Prison After Completion of Treatment

A Service Evaluation and Improvement Project: Reducing Delays in Transfer of Patients From Psychiatric Intensive Care Unit (PICU) to Prison After Completion of Treatment

Assessment of Admissions to Psychiatric Intensive Care Unit (PICU) at Farnham Road Hospital, Guildford: A Clinical Audit

Assessment of Admissions to Psychiatric Intensive Care Unit (PICU) at Farnham Road Hospital, Guildford: A Clinical Audit

High Dose Antipsychotic Therapy Prescription Amongst Patients Admitted to the Psychiatric Intensive Care Unit (PICU), Mill View Hospital, Hove

High Dose Antipsychotic Therapy Prescription Amongst Patients Admitted to the Psychiatric Intensive Care Unit (PICU), Mill View Hospital, Hove

An Audit of Junior Medical Seclusion Review Documentation in the Adult Psychiatric Intensive Care Unit (PICU) setting

An Audit of Junior Medical Seclusion Review Documentation in the Adult Psychiatric Intensive Care Unit (PICU) setting

Improving Carers’ Engagement for Patients Admitted to Psychiatric Intensive Care Unit (PICU): A Quality Improvement Project

Improving Carers’ Engagement for Patients Admitted to Psychiatric Intensive Care Unit (PICU): A Quality Improvement Project

A Survey of Referrals to Psychiatric Intensive Care Unit (PICU): Patient Characteristics and Outcome

A Survey of Referrals to Psychiatric Intensive Care Unit (PICU): Patient Characteristics and Outcome

Identifying predictors of adverse outcomes after termination of seclusion in psychiatric intensive care units.

Seclusion is a restrictive practice that many healthcare services are trying to reduce. Previous studies have sought to identify predictors of seclusion initiation, but few have investigated factors associated with adverse outcomes after seclusion termination. To assess the factors that predict an adverse outcome within 24 h of seclusion termination. In a cohort study of individuals secluded in psychiatric intensive care units, we investigated factors associated with any of the following outcomes: actual violence, attempted violence, or reinitiation of seclusion within 24 h of seclusion termination. Among the seclusion episodes that were initiated between 29 March 2018 and 4 March 2019, we investigated the exposures of medication cooperation, seclusion duration, termination out of working hours, involvement of medical staff in the final seclusion review, lack of insight, and agitation or irritability. In a mixed-effects logistic regression model, associations between each exposure and the outcome were calculated. Odds ratios were calculated unadjusted and adjusted for demographic and clinical variables. We identified 254 seclusion episodes from 122 individuals (40 female, 82 male), of which 106 (41.7%) had an adverse outcome within 24 h of seclusion termination. Agitation or irritability was associated with an adverse outcome, odds ratio 1.92 (95% CI 1.03 to 3.56, P = 0.04), but there was no statistically significant association with any of the other exposures, although confidence intervals were broad. Agitation or irritability in the hours preceding termination of seclusion may predict an adverse outcome. The study was not powered to detect other potentially clinically significant factors.

Exploring Social Interactions in the Context of Justice System Involvement: Perspectives of Patients and Psychiatric Nurses.

Psychiatric nurses who work with people who are involved with the justice system experience ethical and moral tension arising from their dual role (care and control). This is known to significantly affect the development of a therapeutic relationship between nurses and patients. (a) better understand how justice system involvement affects people living with mental disorders and the nurses who work with them; (b) explore the influence of judiciarization on social interactions between these actors. Grounded theory (GT) was used as the qualitative methodology for this research. Semi-structured interviews were conducted with participants. The study was carried out in three different units of a psychiatric institution: Psychiatric Intensive Care Unit, Emergency Department, and Brief Intervention Unit. A sample of 10 patients and 9 psychiatric nurses was recruited (n = 19). Theoretical sampling was used to recruit participants. We followed the iterative steps of qualitative GT analysis (open coding, axial coding, constant comparison, and modelization). Three main themes emerged from the qualitative analysis: (a) Experience of Justice System Involvement, (b) Crisis, (c) Relational Aspects and Importance of the Approach. These results will inform nurses and healthcare providers about the impacts of justice system involvement on people living with mental illness and how clinical practices can be better adapted to this population with complex health needs.

Treating taboo thoughts on a psychiatric intensive care unit: a four-phase mixed methods single case experimental design.

Well-designed evaluations of psychological interventions on psychiatric intensive care units (PICUs) are a rarity. To evaluate the effectiveness of cognitive behaviour therapy for intrusive taboo thoughts with a patient diagnosed with bipolar affective disorder admitted to a PICU due to significant ongoing risk of harm to self. This was a four-phase ABC plus community follow-up (D) mixed methods n=1 single case experimental design. Four idiographic measures were collected daily across four phases; the baseline (A) was during PICU admission, the first treatment phase (B) was behavioural on the PICU, the second treatment phase (C) was cognitive on an acute ward and the follow-up phase (D) was conducted in the community. Four nomothetic measures were taken on admission, on discharge from the PICU, discharge from the acute ward and then at 4-week follow-up. The participant was also interviewed at follow-up using the Change Interview. Compared with baseline, the behavioural and the cognitive interventions appeared effective in terms of improving calmness, optimism and rumination, but the effects on sociability were poor. There was evidence across idiographic and nomothetic outcomes of a relapse during the follow-up phase in the community. Eleven idiographic changes were reported in the interview and these tended to be unexpected, related to the therapy and personally important. Single case methods can be responsive to tracking the progress of patients moving through in-patient pathways and differing modules of evidence-based interventions. There is a real need to implement robust outcome methodologies on PICUs to better evaluate the psychological aspects of care in this context.

The acceptability and feasibility of a cognitive behavioural therapy managing emotions group on a male psychiatric intensive care unit: a mixed methods evaluation

Research suggests that the provision of psychological interventions within acute inpatient settings is effective and important for improving clinical outcomes. There remains limited research on the application of such interventions for individuals admitted to psychiatric intensive care units (PICU), and notably none for male-only PICU environments specifically. Two published protocols have been evaluated in female and mixed gender PICU settings, one a cognitive behavioural therapy (CBT) anger management group and one dialectical behaviour therapy (DBT) skills group. No studies have reported on a general CBT-based group in a male PICU. This study aimed to assess the acceptability and feasibility of a CBT-based managing emotions skills group, delivered in brief 30-minute sessions, within a 7-bed male PICU. All individuals admitted to the PICU during the study period were invited to attend a five-session group. A mixed methods design was used incorporating measuring attendance and retention, a pre–post quasi-experimental design and a qualitative component. Pre- and post-group self-report outcome measures of calmness, anxiety, recovery, and qualitative feedback were gathered and analysed. Pre- and post-outcome measures demonstrate significant improvements in calmness and reduction in anxiety following attendance. Attendance, retention and qualitative feedback data suggests that the group was acceptable and feasible for the participants. Initial findings suggest that adapted CBT skills group-based interventions tailored to the male PICU population are acceptable, feasible, and beneficial to participants. The clinical and research implications are discussed.

Evaluation of Psychiatric High and Intensive Care (EPHIC-study): monitoring innovative care from a value-based approach

IntroductionSystematic monitoring and evaluation of innovative healthcare programs are essential to develop sustainable solutions to health needs in the population (Porter & Teisberg, 2006). Development of Psychiatric High and Intensive Care Units (HIC’s) in Belgium, following the Dutch Model (van Mierlo et al., 2013), is an innovative model for patients with acute and severe psychiatric illness, resulting in potential danger. HIC aims to provide intensive, need-adapted care with interventions that reduce (perceived) coercion, focusing on participative processes and continuity of care.Objectives(1) What are the clinical characteristics of admitted patients? (2) How does clinical symptomatology evolve during admission? (3) How do patients, relatives and caregivers experience the process of care and recovery? (4) What is the role of HIC’s in the reformed mental health care?MethodsThis is an explorative, hypothesis-generating study, using a mixed-method approach, consisting of qualitative and quantitative methods against a value-based framework. Data collection lasted 18 months in the first 9 HIC’s in Belgium. Results are based on validated questionnaires completed by adult patients and their HIC caregivers at admission and discharge (N=472).ResultsWe provide the first, preliminary results. Suicidality, psychotic and substance-related symptoms are the most important primary symptoms. Almost 70% have 2 or more symptoms, with psychiatric comorbidity of 50%. Substance-related- and psychotic disorders are the two most common diagnoses, followed by personality disorder cluster B and depressive disorder. 83% have been in residential care in the past, of whom 87% twice or more. The median age is 36 years, but the median age of onset of mental disorders is 21 years, which equals to 15 years in mental disorder progress and comorbidity development. Over 50% meet the criteria for Severe Mental Illness and 56% are involuntary admitted. There is a high degree of unmet needs: no outpatient care is provided for one out of five prior to admission and there is a low follow-up by mobile teams prior to and after admission (around 12% each). We found significant improvements after an average stay of 22 days for aggression, suicidality and crisis (respectively decrease of 68%, 25% and 9%); readiness to change and motivation for treatment (respectively increase of 5% and 14%) The Client Satisfaction Questionnaire scores range from 1 to 4, with an average score 3.15 out of 4.ConclusionsBased on these preliminary results we can conclude that aggression, suicidality, crisis, readiness to change and motivation for treatment all improve significantly after a short stay of 3 weeks. Despite a vulnerable, severely distressed population, patients are generally satisfied with received care. There is a high degree of unmet needs: insufficient provided outpatient care and low follow up by mobile teams.Disclosure of InterestNone Declared

Cariprazine as monotherapy in a case of First Episode of Psychosis (FEP)

IntroductionFirst-Episode Psychosis (FEP) is a variable condition, characterized by the emergence of new psychotic features for a period of at least 1 week. ( Marques et al.. European Psychiatry 2016; 33 S258) The treatment is antipsychotic medications, which are generally divided into two categories: first and second generation antipsychotics, and they are dopamine antagonists or dopamine partial agonists.ObjectivesThe purpose of this presentation is to assess the efficacy of monotherapy treatment with cariprazine of the First Episode of Psychosis (FEP) in a young patient.MethodsA 19-year old man was involuntarily admitted to the psychiatric intensive care unit because of aggressive and inappropriate behaviour towards his mother including threats to kill her and exhibiting his genitals. His medical history included short periods of depressed mood, as well as physical symptoms such as loss of hair and gastrointestinal symptoms, since he was 18 years old.When the patient was admitted he was cautious and anxious. During the interview he made reference to auditory hallucinations that commanded him to sexually stimulate himself in front of his mother and also persecutory delusions. Upon admission his total PANSS score was 127. The positive subscale score was 21. The patient was treated with monotherapy cariprazine, gradually increasing the dose from 1,5 mg to 6 mg per day . Furthermore, he was adjunctively treated with sertraline, gradually increasing the dose from 50 to 150 mg.ResultsAfter a period 24 days since admission the patient clinically improved and was discharged. His total PANSS score was 73 and the positive subscale was 9. He suffered no adverse effects from his treatment.ConclusionsThe use of cariprazine as a treatment for a FEP of a young male significantly improved his PANSS score after a 24-day treatment and also his disorganised behaviour. Of note, rapid tranquilization was avoided. According to the literature this is considered satisfactory response to treatment (Leucht et al. Schizophr Res. 2005; 79:231-8.). Nevertheless further investigation on the efficacy of the particular medication is necessary as its use is relatively recent in the treatment of psychosis. (Garnock et al. CNS Drugs. 2017; 31:513-525)Disclosure of InterestNone Declared

Facilitating a hearing voices group on acute and psychiatric intensive care units to promote acceptance and hope: preliminary learning and reflections

Purpose Hearing voices can be a debilitating and traumatic experience, and psychiatric hospitals can feel unsafe and overstimulating to voice hearers. Research suggests this may prolong a service user’s admission time and lead to an unhelpful experience. Therefore, a hearing voices group (HVG) was developed to create a safe space where voice hearers could share their story with others with lived experience and access support. Design/methodology/approach The group was developed by the first author under the supervision of the inpatient psychology lead. Both a practice-based and expert by experience-based approach were considered during the development of the group structure. The group also aligned with the Hearing Voices Network and the Trust’s values. A questionnaire was developed to evaluate the effectiveness of the group using six five-point Likert scale questions and three open questions to collect the data, which was then analysed. Findings The themes from the qualitative data showed that staff and ward-based promotion of the group were paramount to ensuring patient engagement. The results also showed that voice hearers found the group therapeutic, and some found the coping skills shared to be beneficial and effective. Research limitations/implications A large percentage of women (76%) reported that they had attended a HVG before. This was not the case for service users from the male unit and psychiatric intensive care unit. This result is considered to reflect the fact that women in that unit had the opportunity to attend more than once during their admission, rather than that they had accessed these groups in other settings or in the community. Therefore, in the future, it would be useful to change this question to “have you attended any other HVGs in the past, prior to this admission?”, which might be more appropriate for data collection. Originality/value To the best of the authors’ knowledge, this is the original work of the first author, who is an expert by experience and an assistant psychologist. The results suggest that HVGs can be beneficial for patients in acute and intensive mental health care and highlight some necessary adaptations and the importance of adopting an MDT approach in promoting therapeutic groups.