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more frequently in individuals who have blood relatives with a diagnosis of manic or hypomanic attacks Patients who swing rapidly back and forth between manic and depressive attacks (at least four cycles per year) usually respond poorly to lithium prophylaxis initially, but some improve with continued long-term treatment Carbamazepine (see below) has been used with success in this group In addition to its use in manic states, lithium is sometimes useful in the prophylaxis of recurrent unipolar depressions (perhaps undiagnosed bipolar disorder) Lithium may ameliorate nonspecific aggressive behaviors and dyscontrol syndromes The dosages are the same as used in bipolar disorder Most patients with bipolar disease can be managed long-term with lithium alone, although some will require continued or intermittent use of a neuroleptic, antidepressant, or carbamazepine An excellent resource for information is the Lithium Information Center, Madison Institute of Medicine, 7617 Mineral Point Road, Suite 300, Madison, WI 53717-1914, http://wwwmimincorg/aboutlithinfoctrhtml Before treatment, the clinical workup should include a medical history and physical examination; complete blood count; T4, thyroid-stimulating hormone, blood urea nitrogen (BUN), serum creatinine, and serum electrolyte determinations; urinalysis; and electrocardiography in patients over age 45 or with a history of cardiac disease 1 Dosage Lithium carbonate is generally prescribed in the 300 mg unit In a small minority of patients, a slow release form or units of different dosage may be required Lithium citrate is available as a syrup The dosage is that required to maintain blood levels in the therapeutic range For acute attacks, this ranges from 1 to 15 mEq/L Although there is controversy about the optimal long-term maintenance dose, many clinicians reduce the acute level to 06 1 mEq/L in order to reduce side effects The dose required to meet this need will vary in different individuals For acute mania, doses of 1200 1800 mg/d are generally recommended Augmentation of antidepressants is usually achieved with half of these doses Once-a-day dosage is acceptable, but most patients have less nausea when they take the drug in divided doses with meals Lithium is readily absorbed, with peak serum levels occurring within 1 3 hours and complete absorption in 8 hours Half of the total body lithium is excreted in 18 24 hours (95% in the urine) Blood for lithium levels should be drawn 12 hours after the last dose Serum levels should be measured 5 7 days after initiation of treatment and changes in dose For maintenance treatment, lithium levels should be monitored initially every 1 2 months but may be measured every 6 12 months in stable, long-term patients Levels should be monitored more closely when there is any condition that causes volume depletion (eg, diarrhea, dehydration, use of diuretics) 2 Side effects Mild gastrointestinal symptoms (take lithium with food), fine tremors (treat with propranolol, 20 60 mg/d orally, only if persistent), slight muscle weakness, and some degree of somnolence are early side effects that are usually transient Moderate polyuria (reduced renal responsiveness to ADH) and polydipsia (associated with increased plasma renin concentration) are often present Potassium administration can blunt this effect, as may once-daily dosing of lithium Weight gain (often a result of calories in fluids.

Any statement that returns a value is an expression. You ve already seen the assignment expression, which we ll discuss in more detail in a moment, and we ve mentioned that the assignment expression returns the value that s assigned. In this chapter, you ll see a number of mathematical expressions, which return a computed value, and also comparison expressions, which return the Boolean value true or false.

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Apple s MultiFinder, released in 1987, was a cooperative multitasking environment that allowed all loaded programs to be viewed on the same screen. The functionality of MultiFinder was later migrated to Apple s System 7. Still, it was up to the user, not the operating system, to switch between programs. Cooperative multitasking is implemented as follows. When a user runs a program by double-clicking on its icon in the Finder, the operating system loads the program into memory and schedules it for execution on the CPU. The program runs only when the currently running program surrenders the CPU. It is the responsibility of each program not the operating system to occasionally hand over the CPU to allow other programs to run. This implementation is considerably better than previous scheduling methods, but it is not optimal because one rogue program can monopolize the CPU and disallow other program from running.3 Contrast this approach with the way UNIX traditionally schedules processes. The UNIX process scheduler divides CPU time into time slices, assigning each process a quantum of CPU time. If the running process has not terminated by the end of its quantum, the operating system performs a process switch by preempting the running process and activating the next. The priority of a process is usually taken into account when choosing the next process to run. Process scheduling can also be altered at the user level through the nice and renice commands, which let you change the current scheduling priority of a process.

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