Although a number of case reports have been published that suggest warfarin has the potential to interact with several fruit products, it is difficult to determine their relevance, as scientific evidence is scarce. Until further information is available, clinicians may want to encourage patients to consume cranberry products and grapefruit juice in small to moderate quantities and to inquire about the recent consumption of mangos, pomegranate juice, and avocados when taking a dietary history or when assessing possible causes for international normalized ratio (INR) instability.

Given the similarities in receptor binding and pharmacologic activities of zolpidem and the benzodiazepines, we chose to use a standard benzodiazepine detoxification protocol to treat zolpidem withdrawal. Confirmation of this has been evidenced by successful zolpidem detoxification using a standard 7-day benzodiazepine/diazepam taper regimen.

Final-year student pharmacists would benefit from the curricular incorporation of courses and advanced pharmacy practice experiences in Psychiatry. Community pharmacists caring for customers with psychiatric disorders should take advantage of continuing education series that highlight updates and new developments regarding psychotherapeutic agents in order to improve clinical outcomes of patients.

Nonadherence within the schizophrenic population is a challenge for both the patient and the clinician. This problem not only causes an increase in health care use and cost but also places the patient at risk of relapse and dissatisfaction with medical care. Nonadherence is influenced by several factors including disease, treatment, and psychological and social factors. All of these factors must be addressed if the clinician hopes to reduce nonadherence within this patient population. This article will attempt to identify factors that contribute to nonadherence and review strategies that can be implemented to address each of these factors.

Gilles de la Tourette syndrome (GTS) is a neuropsychiatric, lifelong disorder with onset in childhood. The essential features of this disorder are multiple motor tics and one or more vocalizations. The neurochemical pathophysiology of GTS involves an unknown abnormality in the central dopaminergic system. Atypical antipsychotics, such as aripiprazole, serve as a new therapeutic option for GTS. The authors describe a unique case of Tourette's syndrome (TS) in an adolescent in which aripiprazole resolved the patient's symptoms. A 17-year-old, 5'11'' tall, African American male weighing 220 lbs was diagnosed with TS at 9 years old. By age 16, the patient developed prominent symptoms of intermitted eye blinking, forehead raising, finger snapping, heavy breathing, and head bobbing. Clonidine, in addition to homeopathic remedies (N-acetylcholine and alpha lipoic acid), was administered to the patient without significant diminution of symptoms. Later, aripiprazole was initiated at 5 mg/d. As a result, noticeable symptomatic improvement occurred within 48 hours. Aripiprazole was titrated over the next 4 weeks to 6.5 mg/d, with significant results. Over the next 6 months, aripiprazole was titrated again to 10 mg/d with additional symptom reduction. This case illustrates a patient who responded to aripiprazole with no reported adverse effects, when standard therapy failed to improve symptoms.