Nicotine deprivation has been found to increase agitation in smokers, especially in those with high baseline irritability (9). Patients with psychiatric illness and substance use disorders smoke at higher rates than the general population, and the incidence is approximately 70% in patients with schizophrenia (10). Remarkably, in a recent study of psychiatric inpatient units, none of the patients who were identified as current smokers received a diagnosis of nicotine dependence or withdrawal, and nicotine replacement therapy was prescribed for only 56% of these patients (11). Compared with nonsmokers and smokers who received nicotine replacement, smokers who did not receive nicotine replacement had higher levels of irritability and agitation, were more likely to be craving cigarettes, and were twice as likely to be discharged against medical advice. Moreover, a trend was observed for higher rates of lorazepam use and need for seclusion among smokers who did not receive nicotine replacement therapy. Notably, even when nicotine replacement therapy was prescribed, smokers typically received just under half the amount of nicotine they would have received when they were smoking.