Impact of a Smoking Ban on a Locked Psychiatric Unit

Letter to the Editor

Sir: Drs. Haller, McNiel, and Binder argue that the implementation of a smoking ban on a locked psychiatric unit does not promote aggressive behavior. My experience has been otherwise. Paranoid and psychotic patients addicted to nicotine who refuse nicotine patches are prone to aggressive acting out behavior. Nicotine, by its agonist action on nicotine receptors in the central nervous system, is known to reduce aggression. In addition, nicotine facilitates memory. I have observed elderly psychotic patients on a locked unit, deprived of nicotine after having been chain smokers for many years and refusing nicotine patches, become acutely hypotensive and develop marked sinus bradycardia because of the abrupt loss of catecholamine agonist activity, which occurs when nicotine is withdrawn.