An Integrative Review on Psychiatric Intensive Care

Figures & data

Table 1. Inclusion based on Population, Concept and Context (PCC).

Population (no exclusion criteria)	Concept	Context
Patients with a PICU history	Psychiatric Intensive Care Units (PICU), and equivalent terms, i.e., ‘psychiatric ICU’	Research articles that have explicitly included a PICU as sample
Patients’ record from PICU admission	Locked psychiatric care units carrying out psychiatric intensive care	Research articles that have a specific focus on psychiatric intensive care
Staff working at a PICU		Research articles published between 2018-2022. Research articles published in any country
Relatives of patients with a PICU history
Visitors to a PICU

Figure 1. PRISMA 2009 flow diagram.

Table 2. Visualization of how the articles were distributed across the themes and sub-themes.

Themes	Sub-themes	Included articles
Treatment Options (10.6%, n = 5)	Pharmacological	Casol et al. (2023); Winkler et al. (2011)
	Non-pharmacological	Gaudiano et al. (2020); Mark et al. (2021); Myhre et al. (2018)
Patients’ Characteristics (27.7%, n = 13)	Sociodemographic data	Accinni et al. (2022); Gintalaite-Bieliauskiene et al. (2020); Moyes et al. (2021); Okasha et al. (2021); Pereira et al. (2021); Tarsitani et al. (2022); Ward and Prasad (2021)
	Admission patterns	Chompoosri & Kunchanaphongphan (2020); Raaj et al. (2023); Challinor et al. (2021)
	Symtopms and behaviors	Mele et al. (2022); Langsrud et al. (2018); Langsrud et al. (2019)
Everyday Nursing Care and the Environment (34.0%, n = 16)	Patients’ view	Allikmets et al. (2020); Davies et al. (2020); Walsh-Harrington et al. (2020)
	Ward atmosphere and ward culture	Butler et al. (2020); Hochstrasser et al. (2018); Hughes & Davies (2018)
	Nurses’ practice	Foster (2019); Foster (2020); Foster and Smedley (2019a); Foster & Smedley (2019b); Price et al. (2018); Salzmann-Erikson (2018a); Salzmann-Erikson (2018b); Yang et al. (2018); Yusuf et al. (2020)
	Relatives	Sedgwick et al. (2019)
Work Models and Developments (27.7 %, n = 13)	Organizational development	Cunningham et al. (2021); Moss et al. (2023); Sethi et al. (2021); Thompson et al. (2021); van Melle et al. (2019)
	Predicting aggressions	Kucera et al. (2022); Howe et al. (2018); Meggison et al. (2021); Pujol et al. (2020); Ruud et al. (2021); Theruvath-Chalil et al. (2020)
	Screening	Cooper et al. (2018); Covshoff et al. (2023)

Casol, M., Tong, A., Ng, J. C. Y., & McGloin, R. (2023). Characterization of psychotropic PRN medications in a Canadian psychiatric intensive care unit. Journal of the American Psychiatric Nurses Association, 29(2), 103–111. https://doi.org/10.1177/1078390321994668

 PubMed Web of Science ®Google Scholar

Winkler, D., Naderi-Heiden, A., Strnad, A., Pjrek, E., Scharfetter, J., Kasper, S., & Frey, R. (2011). Intensive care in psychiatry. European Psychiatry: The Journal of the Association of European Psychiatrists, 26(4), 260–264. https://doi.org/10.1016/j.eurpsy.2010.10.008

 PubMed Web of Science ®Google Scholar

Gaudiano, B. A., Ellenberg, S., Ostrove, B., Johnson, J., Mueser, K. T., Furman, M., & Miller, I. W. (2020). Feasibility and preliminary effects of implementing acceptance and commitment therapy for inpatients with psychotic-spectrum disorders in a clinical psychiatric intensive care setting. Journal of Cognitive Psychotherapy, 34(1), 80–96. https://doi.org/10.1891/0889-8391.34.1.80

 PubMed Web of Science ®Google Scholar

Mark, I., Bell, D., Kirsh, L., & O'Brien, A. (2021). The use of virtual reality in a psychiatric intensive care unit: A pilot study. Journal of Psychiatric Intensive Care, 17(2), 123–128. https://doi.org/10.20299/jpi.2021.008

 Google Scholar

Myhre, M. Ø., Strømgren, B., Arnesen, E. F., & Veland, M. C. (2018). The feasibility of brief behavioural activation treatment for depression in a PICU: A systematic replication. Journal of Psychiatric Intensive Care, 14(1), 15–23. https://doi.org/10.20299/jpi.2018.001

 Google Scholar

Accinni, T., Frascarelli, M., Vecchioni, S., Tarsitani, L., Biondi, M., & Pasquini, M. (2022). Gender modulation of psychopathological dimensions associated to suicidality | Modulazione della variabile di genere sulle dimensioni psicopatologiche associate alla suicidalità. Rivista di psichiatria, 57(1), 23–32. https://doi.org/10.1708/3749.37324

 PubMed Web of Science ®Google Scholar

Gintalaite-Bieliauskiene, K., Dixon, R., & Bennett, L. (2020). A retrospective survey of care provided to patients with borderline personality disorder admitted to a female psychiatric intensive care unit. Journal of Psychiatric Intensive Care, 16(1), 35–42. https://doi.org/10.20299/jpi.2020.002

 Google Scholar

Moyes, H. C. A., MacNaboe, L., & Townsend, K. (2021). The rate and impact of substance misuse in psychiatric intensive care units (PICUs) in the UK. Advances in Dual Diagnosis, 14(4), 198–216. https://doi.org/10.1108/ADD-06-2021-0008

 Web of Science ®Google Scholar

Okasha, T. A., Sabry, W. M., Zaki, N. H., Rabie, M. A., & Elhawary, Y. A. (2021). Characteristics and outcomes of patients admitted to the first psychiatric intensive care unit in Egypt. The South African Journal of Psychiatry: SAJP: The Journal of the Society of Psychiatrists of South Africa, 27, 1527. https://doi.org/10.4102/sajpsychiatry.v27i0.1527

 PubMed Web of Science ®Google Scholar

Pereira, S. M., Walker, L. M., Dye, S., & Alhaj, H. (2021). National survey of psychiatric intensive care, low secure and locked rehabilitation services: NHS patient characteristics. Journal of Psychiatric Intensive Care, 17(2), 79–88. https://doi.org/10.20299/jpi.2021.004

 Google Scholar

Tarsitani, L., Della Rocca, B., Pancheri, C., Biondi, M., Pasquini, M., Ferracuti, S., Ventriglio, A., & Mandarelli, G. (2022). Involuntary psychiatric hospitalization among migrants in Italy: A matched sample study. The International Journal of Social Psychiatry, 68(2), 429–434. https://doi.org/10.1177/00207640211001903

 PubMed Web of Science ®Google Scholar

Ward, K., & Prasad, S. (2021). Characteristics of patients admitted to an adult PICU as compared to general adult inpatient units: A service evaluation. Journal of Psychiatric Intensive Care, 17(1), 41–50. https://doi.org/10.20299/jpi.2020.020

 Google Scholar

Chompoosri, P., & Kunchanaphongphan, T. (2020). Factors associated with prolonged psychiatric intensive care unit admission at Somdet Chaophraya Institute of Psychiatry, Thailand. Journal of Psychiatric Intensive Care, 16(1), 9–14. https://doi.org/10.20299/jpi.2020.003

 Google Scholar

Raaj, S., Navanathan, S., Matti, B., Bhagawan, A., Twomey, P., Lally, J., & Browne, R. (2023). Admission patterns in a psychiatric intensive care unit in Ireland: A longitudinal follow-up. Irish Journal of Psychological Medicine, 40(3), 361–368. https://doi.org/10.1017/ipm.2021.18

 PubMed Web of Science ®Google Scholar

Challinor, A., Lewis, E., Mitchell, A., & Williams, D. (2021). Reducing delays in the transfer of patients from psychiatric intensive care units (PICU) to acute inpatient services: A quality improvement project. Journal of Psychiatric Intensive Care, 17(2), 99–106. https://doi.org/10.20299/jpi.2021.001

 Google Scholar

Mele, F., Buongiorno, L., Montalbò, D., Ferorelli, D., Solarino, B., Zotti, F., Carabellese, F. F., Catanesi, R., Bertolino, A., Dell’Erba, A., Dell’Erba, A., & Mandarelli, G. (2022). Reporting incidents in the psychiatric intensive care unit: A retrospective study in an Italian University Hospital. The Journal of Nervous and Mental Disease, 210(8), 622–628. https://doi.org/10.1097/NMD.0000000000001504

 PubMed Web of Science ®Google Scholar

Langsrud, K., Kallestad, H., Vaaler, A., Almvik, R., Palmstierna, T., & Morken, G. (2018). Sleep at night and association to aggressive behaviour; Patients in a psychiatric intensive care unit. Psychiatry Research, 263, 275–279. https://doi.org/10.1016/j.psychres.2018.03.012

 PubMed Web of Science ®Google Scholar

Langsrud, K., Vaaler, A., Morken, G., Kallestad, H., Almvik, R., Palmstierna, T., & Güzey, I. C. (2019). The predictive properties of violence risk instruments may increase by adding items assessing sleep. Frontiers in Psychiatry, 10(MAY), 323. https://doi.org/10.3389/fpsyt.2019.00323

 PubMedGoogle Scholar

Allikmets, S., Marshall, C., Murad, O., & Gupta, K. (2020). Seclusion: A patient perspective. Issues in Mental Health Nursing, 41(8), 723–735. https://doi.org/10.1080/01612840.2019.1710005

 PubMed Web of Science ®Google Scholar

Davies, R., Murphy, K., & Sethi, F. (2020). Sensory room in a psychiatric intensive care unit. Journal of Psychiatric Intensive Care, 16(1), 23–28. https://doi.org/10.20299/jpi.2019.016

 Google Scholar

Walsh-Harrington, S., Corrigall, F., & Elsegood, K. (2020). Is it worthwhile to offer a daily “bite-sized” recovery skills group to women on a psychiatric intensive care unit (PICU)? Journal of Psychiatric Intensive Care, 16(1), 29–34. https://doi.org/10.20299/jpi.2020.xxx

 Google Scholar

Butler, S., Adeduro, R., Davies, R., Nwankwo, O., White, N., Shaw, T. A., Skelton, L., Shannon, G., Smale, E., Corrigan, M., Martin, D., & Sethi, F. (2020). Art and mental health in the women’s psychiatric intensive care unit. Journal of Psychiatric Intensive Care, 16(1), 15–22. https://doi.org/10.20299/jpi.2019.015

 Google Scholar

Hochstrasser, L., Voulgaris, A., Möller, J., Zimmermann, T., Steinauer, R., Borgwardt, S., Lang, U. E., & Huber, C. G. (2018). Reduced frequency of cases with seclusion is associated with “opening the doors” of a psychiatric intensive care unit. Frontiers in Psychiatry, 9(FEB), 57. https://doi.org/10.3389/fpsyt.2018.00057

 PubMedGoogle Scholar

Hughes, J. A., & Davies, B. E. (2018). Developing a ward ethos based on positive behavioural support within a forensic mental health ‘psychiatric intensive care unit. Mental Health & Prevention, 10, 28–34. https://doi.org/10.1016/j.mhp.2018.03.003

 Google Scholar

Foster, C. (2019). Investigating professional quality of life in nursing staff working in adolelscent Psychiatric Intensive Care Units (PICUs). The Journal of Mental Health Training, Education and Practice, 14(1), 59–71. https://doi.org/10.1108/JMHTEP-04-2018-0023

 Web of Science ®Google Scholar

Foster, C. (2020). Investigating the impact of a psychoanalytic nursing development group within an adolescent psychiatric intensive care unit (PICU). Archives of Psychiatric Nursing, 34(6), 481–491. https://doi.org/10.1016/j.apnu.2020.08.008

 PubMed Web of Science ®Google Scholar

Foster, C., & Smedley, K. (2019a). Understanding the nature of mental health nursing within CAMHS PICU: 1. Identifying nursing interventions that contribute to the recovery journey of young people. Journal of Psychiatric Intensive Care, 15(2), 87–102. https://doi.org/10.20299/jpi.2019.012

 Google Scholar

Foster, C., & Smedley, K. (2019b). Understanding the nature of mental health nursing within CAMHS PICU: 2. Staff experience and support needs. Journal of Psychiatric Intensive Care, 15(2), 103–115. https://doi.org/10.20299/jpi.2019.013

 Google Scholar

Price, O., Baker, J., Bee, P., & Lovell, K. (2018). The support-control continuum: An investigation of staff perspectives on factors influencing the success or failure of de-escalation techniques for the management of violence and aggression in mental health settings. International Journal of Nursing Studies, 77, 197–206. https://doi.org/10.1016/j.ijnurstu.2017.10.002

 PubMed Web of Science ®Google Scholar

Salzmann-Erikson, M. (2018a). Moral mindfulness: The ethical concerns of healthcare professionals working in a psychiatric intensive care unit. International Journal of Mental Health Nursing, 27(6), 1851–1860. https://doi.org/10.1111/inm.12494

 PubMed Web of Science ®Google Scholar

Salzmann-Erikson, M. (2018b). Using focused ethnography to explore and describe the process of nurses’ shift reports in a psychiatric intensive care unit. Journal of Clinical Nursing, 27(15-16), 3104–3114. https://doi.org/10.1111/jocn.14502

 PubMed Web of Science ®Google Scholar

Yang, J., Tang, S., & Zhou, W. (2018). Effect of mindfulness-based stress reduction therapy on work stress and mental health of psychiatric nurses. Psychiatria Danubina, 30(2), 189–196. https://hrcak.srce.hr/file/297446

 PubMed Web of Science ®Google Scholar

Yusuf, A., Surya Aditya, R., Fitryasari, R., Kurniasari Solikhah Politeknik Kesehatan Kementerian Kesehatan Malang, F., Diah Ciptaning Tyas, M., Kurniasari Solikhah, F., & Winarni, W. (2020). Evaluation of aggressive behaviour management in PICU (Psychiatric Intensive Care Unit): A focus group study journal of global pharma technology evaluation of aggressive behaviour management in PICU (Psychiatric Intensive Care Unit): A focus group study. Journal of Global Pharma Technology, 12(6), 335–339. https://www.researchgate.net/publication/343054990

 Google Scholar

Sedgwick, R., Duff, A., Lines, S., Akenzua, A., & Jones, F. (2019). Family-inclusive practice in a psychiatric intensive care unit. BJPsych Bulletin, 43(6), 259–263. https://doi.org/10.1192/bjb.2019.11

 Web of Science ®Google Scholar

Cunningham, R., Kranidiotis, L., & Walker, T. (2021). A study of admissions to a PICU in a Trust that has undergone significant bed closures and other service re-design. Journal of Psychiatric Intensive Care, 17(1), 21–28. https://doi.org/10.20299/jpi.2020.018

 Google Scholar

Moss, S. J., Vasilakis, C., & Wood, R. M. (2023). Exploring financially sustainable initiatives to address out-of-area placements in psychiatric ICUs: A computer simulation study. Journal of Mental Health (Abingdon, England), 32(3), 551–559. https://doi.org/10.1080/09638237.2022.2091769

 PubMed Web of Science ®Google Scholar

Sethi, F., Skelton, L., Blake, L., Rose, E., & Dye, S. (2021). The psychiatric intensive care unit clinical model and COVID-19. Journal of Psychiatric Intensive Care, 17(1), 61–68. https://doi.org/10.20299/jpi.2020.022

 Google Scholar

Thompson, A. D., Ramasamy, R., Simmons, S., Gurtovenko, K., Caufield, S., Sasser, T., Beauchamp, B., & O’Brien, M. (2021). What do we do when things fall apart? Rapid creation of a pilot psychiatric intensive care unit in response to increased acuity on a psychiatric inpatient unit for children and adolescents. Evidence-Based Practice in Child and Adolescent Mental Health, 6(4), 435–446. https://doi.org/10.1080/23794925.2021.1981176

 Google Scholar

van Melle, A. L., Voskes, Y., de Vet, H. C. W., van der Meijs, J., Mulder, C. L., & Widdershoven, G. A. M. (2019). High and intensive care in psychiatry: Validating the HIC monitor as a tool for assessing the quality of psychiatric intensive care units. Administration and Policy in Mental Health, 46(1), 34–43. https://doi.org/10.1007/s10488-018-0890-x

 PubMed Web of Science ®Google Scholar

Kucera, P., Kingston, E., Ferguson, T., Jenkins, K., Fogarty, M., Sayles, H., & Cohen, M. Z. (2022). Effects of implementing an acuity tool on a psychiatric intensive care unit. Journal of Nursing Care Quality, 37(4), 313–318. https://doi.org/10.1097/NCQ.0000000000000652

 PubMed Web of Science ®Google Scholar

Howe, A., Nasreen, R., Brammer, F., Varma, S., & Sethi, F. (2018). The valproate checklist in a female psychiatric intensive care unit. Journal of Psychiatric Intensive Care, 14(1), 39–45. https://doi.org/10.20299/jpi.2017.013

 Google Scholar

Meggison, N., Anyameluhor, F., El-Ahmar, H., & Morley, L. (2021). Ligature Record: improved capture of risk information in CAMHS PICU using a mnemonic-style documentation aid. Journal of Psychiatric Intensive Care, 17(2), 113–122. https://doi.org/10.20299/jpi.2021.007

 Google Scholar

Pujol, J. F., Gras, M. E., Calvó-Perxas, L., & Vilalta-Franch, J. (2020). Scale for the evaluation of risk of aggressiveness in psychiatric intensive care units | Escala para la Evaluación del Riesgo de Agresividad en una Unidad de Agudos de Psiquatría. Actas espanolas de psiquiatria, 48(1), 8–18.

 PubMed Web of Science ®Google Scholar

Ruud, T., Haugom, E. W., Pincus, H. A., & Hynnekleiv, T. (2021). Measuring seclusion in psychiatric intensive care: Development and measurement properties of the clinical seclusion checklist. Frontiers in Psychiatry, 12, 768500. https://doi.org/10.3389/fpsyt.2021.768500

 PubMed Web of Science ®Google Scholar

Theruvath-Chalil, R., Davies, J., & Dye, S. (2020). Introduction of the Brøset Violence Checklist on a PICU. Journal of Psychiatric Intensive Care, 16(1), 3–8. https://doi.org/10.20299/jpi.2019.002

 Google Scholar

Cooper, C., Madhavan, G., & Choong, L. S. (2018). Re-audit of physical health monitoring for adult inpatients on a psychiatric intensive care unit. Journal of Psychiatric Intensive Care, 14(1), 33–38. https://doi.org/10.20299/jpi.2017.011

 Google Scholar

Covshoff, E., Blake, L., Rose, E. M., Bolade, A., Rathouse, R., Wilson, A., Cotterell, A., Pittrof, R., & Sethi, F. (2023). Sexual and reproductive health needs assessment and interventions in a female psychiatric intensive care unit. BJPsych Bulletin, 47(1), 4–10. https://doi.org/10.1192/bjb.2021.107

 PubMed Web of Science ®Google Scholar

Availability of data and materials

All data generated or analyzed during this study are included in this published article [and its supplementary information files].