Psychiatric Intensive Care

Reviews / Votes

I have to admit that I approached this publication with caution. I usually dislike books in which numerous authors (in this case, 21) each make a small contribution. The different styles can make for heavy reading. In addition, as a general psychiatrist I am wary of the emergence of yet another sub-specialty, which could take scarce resources away from mainstream services. Notwithstanding these prejudices, this book pleasantly surprised me, and I warmed to it. It is well written, the different chapters follow each other logically, and there seem to be no weak entries. The editors deserve much congratulation. The book is packed full of extremely sensible advice on how to manage difficult clinical problems in the most challenging of patients. The many draft policies it contains could form the basic policy and procedures framework for any psychiatric unit, not just a psychiatric intensive care unit. This book has something for everyone trainees, consultants, nurses, managers and those professions allied to medicine. For anyone contemplating working in a PICU, or planning to establish one, this book is probably an essential initial read. However, I believe it deserves a wider readership, although it is expensively priced, no doubt reflecting its multi-authorship. The book is edited and largely written by the "usual suspects" from NAPICU (National Association of Psychiatric Intensive Care Units) and represents a UK approach to the practice of psychiatric intensive care. The book's strengths include a very readable style, a multidisciplinary authorship and chapters that cover the many diverse aspects of psychiatric intensive care. Within the book one can find useful and up to date information on all aspects of the management of patients in the PICU setting. When reading it you get the firm impression that most of the chapters are written by people with real "hands on" practical experience in their fields. The book also usefully covers management issues relevant to PICU's including the relationship and interface between PICU's and other parts of the psychiatric services along with sound advice on the day to day management of the PICU. The inclusion of sample policies on visiting, restraint of patients and other issues is a helpful starting point for those setting up a new unit. Highlights of the book include the chapters on "The Complex Needs Patient" (Atakan) and "Rapid Tranquillisation" (Holmes et al). I also found the last third of the book (Section3: Structure and Management) particularly useful - worth buying the book for this alone if you are setting up a new PICU or similar unit Minor gripes include some poor referencing with cited references missing from the end of chapter reference lists and anachronistic mention of registrars and senior registrars - grades of junior doctors now defunct. I would have liked the chapter on biological treatments (inappropriately titled "Pharmacological Therapy") to have included more on the specific use of electroconvulsive therapy (ECT) within psychiatric intensive care e.g. for treatment-resistant mania rather than just summarising the general use of ECT. In some ways that last point sums up what remains an unresolved issue for me - just where does general psychiatry end an This edited text seeks to define the emerging sub-specialty of patient intensive care units (PICUs) and to provide practical advice on current best practice. The editors achieve their aim with a very readable and well thought-out book, which will appeal to a wide readership. Edited by two psychiatrists and a pharmacist, with multi-disciplinary contributors from nurses, psychiatrists, psychologists and occupational therapists, the book has three distinct sections. They examine therapeutic interventions; forensic risk issues with section three exploring the structure and management of PICUs. One of the strengths of the books is its readable style, supported by a logical and attractive layout. It is easy to access with practical emphasis including highlighted key points, diagrams, useful short case studies and examples. The content of the chapters demonstrates that the authors are experienced clinicians, with a first-rate grasp of the real issues that affect clinical practice. Contents include information of policy formulation with examples, risk assessment, use of restraint and a thoughtful examination of issues surrounding seclusion. There is sound practical advice on the management of challenging patients with difficult problems and the complex needs of patients. I especially enjoyed (yes that's correct, enjoyed) the chapters on pharmacological therapy and rapid tranquilization, which were uncomplicated yet comprehensive and well written. Book reviews should also examine any relative weakness in a text but this book has few, if any! It does fail to give an exact definition of PICUs but this, I feel, is a reflection of the variety of services across regions / trusts rather than a failure of behalf of the editors. This book will have a wide appeal to nurses, psychiatrists and other clinicians, including students and trainees. Despite the book's focus on PICUs, the practical nature of its contents are applicable to those working at all levels of menta This book is addressed to "All healthcare and related professionals working in, or interacting with, psychiatric intensive care units, as well as managers with a responsibility to commission, provide and monitor such units". In addition to the three editors, there are 19 contributors. This useful book shows the strengths and weaknesses of a work written by a committee and for everybody. On the positive side it is comprehensive and multi-disciplinary. It is clinically oriented and most chapters will be of interest to clinical staff working on intensive care units. Chapters deal with important issues such as seclusion, physical restraint and rapid tranquillisation. On the negative side, it lacks the unity, simplicity and clarity that reflects the practice and experience of a single author or, at most, of a small team. The standard of individual chapters is uneven, and jargon and acronyms (such as PICUs, SCIPs and NAPICUs) abound. Also, it is difficult for this type of 'comprehensive' multi-author book to be really up to date. For instance, the otherwise useful sections on pharmacology and rapid tranquillisation do not do justice to recently publised evidence on the risk of cardiac complications and sudden death from high-dose medication. The internet affords easy access to journal articles and reviews, and books trying to provide current information and reviews of the literature have an increasingly short shelf-life. The potentially enduring chapters in this volume are those that provide some sort of manual for clinical procedures and practice. A useful section is devoted to the setting up and management of intensive care units. Such units require clear leadership and lines of responsibility. I would endorse the recommendation that there should be only one or, at the most, two clinical teams - although this often entails transfer of consultant responsibility when patients are admitted or discharged from the unit. A chapter on good practice raises the question of