Managing psychiatric emergencies

Behavioral emergencies are common; goals of the intervention are rapid evaluation, containment and referral to appropriate follow up. Clinicians will be likely called on to assess and manage agitation, acute psychosis and suicidality alone or in combination. Reaching an accurate diagnosis must be emphasized. Physician should be aware of the differences among the major psychiatric disorders, also to look for medical reasons in patients with psychiatric presentations. Mechanisms that lead to agitation also predispose to impulsivity, aggression and psychosis. This patient population needs careful and special approach in order to evaluate, treat and refer. Suicide is a serious, growing and complex public health problem and its rate continue to rise. This article will discuss how to assess acute psychosis, agitation, impulsivity, aggression and suicidality

Study of some immunological parameters in-patients with chronic lymphatic and chronic myeloid leukemias.

Immunological studies were performed to assess humoral and cellular immunity on 15 patients with chronic lymphatic leukemia [CLL], 15 patients with chronic myeloid leukemia [CML] and 10 healthy subjects as controls. Patients with CLL revealed lowering in serum immunoglobulins [IgG, IgM, IgA], high total B and total-T lymphocytes associated with a decrease in response to phytohemagglutinin [PHA], concanavalin [Con A] and pokeweed mitogen [PWM]. The T- suppressor [Ts] lymphocyte percentage was increased, while the T-helper [Th] lymphocyte percentage was decreased and consequently associated with decrease in Th/Ts ratio. There was a direct correlation between IgG and the percentage of T-helper as well as between IgM level and Th/Ts ratio. The decrease in immunoglobulins, especially IgG, IgM, were more pronounced in late stages. In patients with CML, there was an insignificant change in serum immunoglobulins and total B-lymphocytes. The total T- lymphocytes were reduced and associated with decrease in response to PHA, CON A, PWM. The T-helper lymphocyte percentage and Th/Ts ratio were significantly decreased, while the T-suppressor percentage showed no significant difference. These changes in cellular and humoral immunity appeared to be important clue in predicting the prognosis and denote an immunodeficiency state in these patients with liability to infection, which is a frequent cause of morbidity and mortality