Nicotine replacement methods on a psychiatric unit

Patients with psychiatric illness smoke more heavily than others in the community. They have more difficulty quitting and have more withdrawal symptoms than others. Objective: The purpose of the present study was to examine the utilization of nicotine replacement methods in a population of psychiatric patients. Method: In a naturalistic retrospective review, we examined the records of 55 patients who were hospitalized on a smoke-free psychiatric unit. We abstracted the frequency of utilization of nicotine replacement. The rate of utilization was considered a ratio of the number of days utilized to the number of days prescribed. Results: There were 38 patients (69%) who used the transdermal patch, 26 patients (47%) used the inhaler, 4 patients (7%) used nicotine gum, and 2 patients (4%) used the nasal spray. The rate of utilization of the nicotine inhaler (63%) exceeded that of the transdermal nicotine patch (30%) (t = 4.6, p < .0001). Conclusion: The hospitalization of smokers with mental illness in smoke-free psychiatric units often leads to further behavioral deterioration. The patients in the present study demonstrated a definite preference for the nicotine inhaler over the transdermal patch. Possible clinical and pathophysiological implications of this finding are discussed.