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Book Review

Psychiatric Intensive Care, 2nd ed

Scott R. Turkin, MD

Published: March 15, 2010

Psychiatric Intensive Care, 2nd ed

edited by M. Dominic Beer, MD; Stephen Pereira, MD; and Carol Paton, DipClinPharm. Cambridge University Press, New York, NY, 2008, 369 pages, $72.00 (paper).

I review the second edition of Psychiatric Intensive Care, an updated and expanded improvement of a very well-received and successful text first published in 2001, with great interest and pleasure. There is much to be praised and little not to like here.

In the Foreword to the first edition, the authors asked, "What is a psychiatric intensive care unit (PICU) and why do we need a book about it?" Indeed, although we learn early in this work that the term PICU was coined in a publication by an American author in 1973 and has an extensive history internationally, it is not terminology familiar to the average American reader. The book immediately explicates the concept of this psychiatric subspecialty and the types of patient populations that its work addresses.

This text, with multiple authors all located in the United Kingdom, is well edited, comprehensive, and succinct. The book is divided into 3 parts: Therapeutic Interventions, Interface Issues, and Management of the Psychiatric Intensive Care Unit/Low Secure Unit. There are in-depth chapters in Part 1 regarding seclusion, restraint, risk management and assessment, rapid tranquilization, and management of the complex-needs patient, among others. All who provide care in inpatient psychiatric units will find them informative and insightful. Part II addresses consultation and liaison with subspecialists and practitioners of other key disciplines in the care of the most challenging psychiatric patients, making this part essential reading for an understanding of the full gamut of practitioners needed to provide up-to-date and guideline-driven treatment. As a clinician who also has administrative duties and interest in public policy, I found Part III especially interesting, as it masterfully describes key components in setting up and running units according to evidence-based medicine, when available, and best practice and guidelines when not.

As in all works with multiple authors, there is variation in style and quality among chapters but within very acceptable limits. Likewise, as in all textbooks, the references are, at best, a couple of years old, but this is a minor quibble, and there are ample references for the interested reader to guide searches for the most current information. It is unavoidable that sections of a work whose authors are represented solely by one nationality will sometimes be less useful to readers of other countries—the extensive discussion of the British experience of Regional Secure Units and their differences from PICU’s and low secure units comes to mind—and contain minor irrelevancies, such as the use of zuclopenthixol, a medication unavailable in the United States, in rapid tranquilization. The applicability of nearly all of the rest of the book cannot be disputed.

Many of the authors are members of the National Association of Psychiatric Intensive Care and Low Secure Units (NAPICU) and one of its editors, Dr Pereira, is the current chairman of that organization. There is an associated journal ( as well as an annual meeting dedicated to keeping all involved in this important specialty current and in touch. Dr Pereira has also played a central role in the development of the 2005 National Institute for Health and Clinical Excellence (NICE) guideline "Violence: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments," a document freely available online at and essential reading for all involved or interested in this topic.

This text should serve all stakeholders in inpatient psychiatry, from administrators and policy-makers through mental health care workers in all clinical disciplines, as required reading. Indeed, I’ d suggest reading this volume many times, as I did, since so much is covered so well in only 350 pages. My compliments to the authors and editors!

Scott R. Turkin, MD

Author affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Potential conflicts of interest: None reported.

Volume: 71

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