Suicide risk assessment: time to think again?

This paper considers recent research on suicide risk assessment to support calls for a 'rethink' of our assessment of the patients in our care, along with the adoption of a more collaborative approach to care planning with service users who remain at risk of self-harm and in need of a plan for their safety.

Admission patterns in a psychiatric intensive care unit in Ireland: a longitudinal follow-up

OBJECTIVE

This study aims to describe the course of admission and clinical characteristics of admissions to a psychiatric intensive care unit (PICU) in the Phoenix Care Centre (PCC), Dublin, Ireland.

METHODS

This retrospective chart study was conducted at the PCC, Dublin, Ireland. The cohort included all admission episodes (n = 91 complete data) over a three-year study period between January 2014 and January 2017.

RESULTS

The mean age of admitted cases was 37.1 (s.d. = 11.3; range 18-63). The mean length of stay (LOS) was 59.3 days (s.d. = 61.0; median 39.5 days). All patients were admitted under Mental Health Act legislation. Antipsychotic polypharmacy was used in 61% (n = 55) of the admissions. A diagnosis of acute psychotic disorder (B = -1.027, p = 0.003, 95% CI: -1.691, -0.363) was associated with reduced LOS in PICU.

CONCLUSION

Our study describes the cohort of patients admitted as being predominantly male, younger-aged, single, having a diagnosis of schizophrenia and being legally detained. The primary indication for referral is risk of assault, which highlights the need for the intensive and secure treatment model that a PICU can provide.

Avulsion of the scalp treated by microvascular repair: the use of leeches for post-operative decongestion

A 28-year-old fitter and turner was scalped at work. The scalp was avulsed from the nuchal area to the eyebrows in one piece. It was successfully replanted by microvascular surgery. Leeches were used to decongest the flap when venous drainage appeared inadequate during the first week. Only a small part of the flap eventually failed to survive and normal hair growth returned in all other areas.