Obligatory Cessation of Smoking by Psychiatric Inpatients

OBJECTIVE: Signs and symptoms of nicotine withdrawal and alterations in psychopathology were evaluated among acutely ill psychiatric patients admitted to a hospital with a smoking ban. It was hypothesized that smokers would experience symptoms of withdrawal and that these symptoms would aggravate and confound psychiatric symptoms. METHODS: Sixty acute psychiatric inpatients, 44 of whom were smokers, were assessed on three consecutive days using the Nicotine Withdrawal Checklist (NWC) and the Brief Psychiatric Rating Scale (BPRS). RESULTS: BPRS scores were significantly and positively correlated from day 1 through day 3, as were NWC scores. Mean BPRS scores declined significantly from day 1 to day 3, and mean NWC scores declined significantly from day 1 to day 2. Although smokers reported increased tension over the three days and a greater persistence of anxiety compared with nonsmokers, no statistically significant differences in overall BPRS scores were found between the two groups. In contrast, symptoms of nicotine withdrawal occurred significantly more frequently among smokers and were statistically significantly correlated with scores on the Fagerstrom Tolerance Questionnaire, which assesses the degree of nicotine dependence. Despite subjects' reports of feeling distressed and of experiencing nicotine withdrawal symptoms, abrupt cessation of smoking did not significantly affect either the severity or the improvement of psychopathological symptoms during hospitalization. No specific diagnostic group appeared to be selectively sensitive to nicotine withdrawal symptoms. CONCLUSIONS: No immediate benefits or adverse effects from the smoking ban were detected. No compelling reasons to reverse the smoking ban were observed.