Abstract
We welcome the paper on psychiatric intensive care units (PICU's) by Dr Wynaden et al. in December 2001 issue of this journal [1]. However, the description of one PICU cannot be generalized. As an illustration, we present a prospective naturalistic study performed in Slovenia.
We compared the PICUs of two psychiatric hospitals: a University Psychiatric Hospital, Ljubljana (UPH), with catchment area of 750 000 inhabitants (48 bed PICU); and a smaller regional Psychiatric Hospital Begunje (PHB) (catchment area 300 000; 40 bed PICU). The demographic, social and disease-related data of all consecutively admitted patients in February and March 1998 were collected. Diagnoses were made according to ICD-10 criteria. The Brief Psychiatric Rating Scale (BPRS) [2] and Global Assessment Scale (GAS) [3] were used to determine the level of psychopathology.
A total of 332 patients were admitted to UPH PICU, and 99 to the PHB PICU. The sociodemographic data were similar, but the UPH had more patients with schizophrenia, but fewer with alcohol use disorders and affective disorders; BPRS scores were almost the same. The patients in UPH were more severely disabled, with lower mean GAS score (35.4) than patients in PHB (41.8, p < 0.0001).
In UPH the average stay in PICU was 7.1 days and in PHB 14.0 days (p < 0.001). Over the study period 18.1% of patients in UPH and 28.3% of patients in PHB needed some kind of restraint or seclusion (p = 0.027); the most frequent indications were violence (28.3% in UPH and 78.6% in PHB) and suicidality (25.0% in UPH and 35.7% in PHB). Net-bed seclusion was used only in UPH. The parenteral route of administration of antipsychotics was more frequent in UPH (41.2%) than in PHB (6.1%) patients (p < 0.001).
Possible explanations for the observed differences between the PICUs include tradition in the use of parenteral therapy in UPH, burden on staff, number of available beds versus number of admissions, different attitude towards seclusion and restraint (different tolerance based on staff/patient ratios), and different patient characteristics. However, we were surprised to find such large differences between two hospitals only 50 km apart. Studies of PICUs in different hospitals and countries are welcomed since they may contribute to better acute psychiatric care.