Sometimes patients present in a state where they stop talking, stop eating, do not open their eyes and may alternately be immobile at times for long periods and/or excited at other times. This is an emergency needing quick diagnosis with need to rule out underlying medical, neurological and psychiatric causes or a combination of causes and immediate treatment, however elicitation of causes through laboratory and detailed observation is time consuming since one has to wait to see the development of clinical picture as the person responds partially to presumptive treatment.