Reply to Letter to the Editor "Impact of a Smoking Ban on a Locked Psychiatric Unit"

Letter to the Editor

Sir: Dr. Pearlman states that "paranoid and psychotic patients addicted to nicotine who refuse nicotine patches are prone to aggressive acting out behavior," yet he does not provide data to support this statement. We do not doubt that some patients who refuse nicotine gum or patches may become agitated as part of the nicotine withdrawal syndrome. In the DSM-IV, the diagnosis of nicotine withdrawal requires at least four of the following signs: "dysphoric or depressed mood; insomnia; irritability, frustration, or anger; anxiety; difficulty concentrating; restlessness or impatience; decreased heart rate; and increased appetite or weight gain."