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form and produces by far the most severe medical and psychiatric symptoms Cardiovascular collapse, arrhythmias, myocardial infarction, and transient ischemic attacks have been reported Seizures, strokes, migraine symptoms, hyperthermia, and lung damage may occur, and there are several obstetric complications, including spontaneous abortion, abruptio placentae, teratogenic effects, delayed fetal growth, and prematurity Cocaine can cause anxiety, mood swings, and delirium, and chronic use can cause the same problems as other stimulants (see above) Clinicians should be alert to cocaine use in patients presenting with unexplained nasal bleeding, headaches, fatigue, insomnia, anxiety, depression, and chronic hoarseness Sudden withdrawal of the drug is not life-threatening but usually produces craving, sleep disturbances, hyperphagia, lassitude, and severe depression (sometimes with suicidal ideation) lasting days to weeks Treatment is imprecise and difficult Since the high is related to blockage of dopamine reuptake, the dopamine agonist bromocriptine, 15 mg orally three times a day, alleviates some of the symptoms of craving associated with acute cocaine withdrawal Other dopamine agonists such as apomorphine, levodopa, and amantadine are under study for this purpose Carbamazepine may be a useful adjunct in treating symptoms of alcohol withdrawal, and desipramine in moderate doses has been useful in helping maintain abstinence in the early stages of treatment Treatment of psychosis is the same as that of any psychosis: antipsychotic drugs in dosages sufficient to alleviate the symptoms Any medical symptoms (eg, hyperthermia, seizures, hypertension) are treated specifically These approaches should be used in conjunction with a structured program, most often based on the Alcoholics Anonymous model Hospitalization may be required if selfharm or violence toward others is a perceived threat (usually indicated by paranoid delusions)

Caffeine, along with nicotine and alcohol, is one of the most commonly used drugs worldwide About 10 billion pounds of coffee (the richest source of caffeine) are consumed yearly throughout the world Tea, cocoa, and cola drinks also contribute to an intake of caffeine that is often astoundingly high in a large number of people Low to moderate doses (30 200 mg/d) tend to improve some aspects of performance (eg, vigilance) The approximate content of caffeine in a (180-mL) cup of beverage is as follows: brewed coffee, 80 140 mg; instant coffee, 60 100 mg; decaffeinated coffee, 1 6 mg; black leaf tea, 30 80 mg; tea bags, 25 75 mg; instant tea, 30 60 mg; cocoa, 10 50 mg; and 12-oz cola drinks, 30 65 mg A 2-oz chocolate candy bar has about 20 mg Some herbal teas (eg, morning thunder ) contain caffeine Caffeine-containing analgesics usually contain approximately 30 mg per unit Symptoms of caffeinism (usually associated with ingestion of over 500 mg/d) include anxiety, agitation, restlessness, insomnia, a feeling of being wired, and somatic symptoms referable to the heart and gastrointestinal tract It is common for a case of caffeinism to present as an anxiety disorder It is also common for caffeine and other stimulants to precipitate

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The increment operators are meant to be a convenient shortcut to save you keystrokes, and as you go through this book, you ll see them used in various common ways, such as controlling loops. Remember, though, that one of the goals of good programming is readability. If you overuse the prefix and postfix operators in an attempt to be efficient with your typing, but six months from now you re trying to puzzle out what your code does and how, you haven t really saved any time. If you think that using these operators will make your code confusing, go ahead and write out the expression the long way. You may thank yourself later.

chronic exposure produces a variety of symptoms related to the liver, kidney, bone marrow, or heart Lead encephalopathy can be associated with sniffing leaded gasoline In addition, studies of workers chronically exposed to jet fuel showed significant increases in neurasthenic symptoms, including fatigue, anxiety, mood changes, memory difficulties, and somatic complaints These same problems have been noted in long-term solvent abuse The so-called designer drugs are synthetic substitutes for commonly used recreational drugs and are produced in small, clandestine laboratories The most common designer drugs have been methyl analogues of fentanyl and have been used as heroin substitutes MDMA (methylenedioxymethamphetamine), an amphetamine derivative sometimes called ecstasy, is also a designer drug with high abuse potential and neurotoxicity Often not detected by standard toxicology screens, these substances can present a vexing problem for clinicians faced with symptoms from a totally unknown cause

Collins ED et al Anesthesia-assisted vs buprenorphine- or clonidine-assisted heroin detoxification and naltrexone induction: a randomized trial JAMA 2005 Aug 24;294(8): 903 13 [PMID: 16118380] Fudala PJ et al Office-based treatment of opiate addiction with sublingual-tablet formulation of buprenorphine and naloxone N Engl J Med 2003 Sep 4;349(10):949 58 [PMID: 12954743] Lundqvist T Cognitive consequences of cannabis use: comparison with abuse of stimulants and heroin with regard to attention, memory and executive functions Pharmacol Biochem Behav 2005 Jun;81(2):319 30 [PMID: 15925403]

severe symptoms in compensated schizophrenic and manicdepressive patients Chronically depressed patients often use caffeine drinks as self-medication This diagnostic clue may help distinguish some major affective disorders Withdrawal from caffeine (> 250 mg/d) can produce headaches, irritability, lethargy, and occasional nausea

Relational operators compare two values and then return a Boolean value (true or false, as described in 3). The greater than operator (>), for example, returns true if the value on the left of the operator is greater than the value on the right. Thus, 5>2 returns the value true, whereas 2>5 returns the value false.

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