We described a patient with gender identity disorder (GID) and bipolar disorder treated with varenicline for smoking cessation. We followed the patient's wish to call her by last name. She discontinued smoking after 12 weeks from the administration of varenicline without adverse events; however, she resumed the habit of smoking several times. She maintained smoking cessation after noticing that interpersonal mental stress was the trigger of smoking, and we proposed some ways to cope with the mental stress. On smoking cessasion with varenicline for GID patients, not only attention to the exacerbation of psychiatric comorbidities and development of suicidal ideations but also an appreciation of gender diversity is important.

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Object: Smoking increases cardiovascular and pulmonary mortality in every patient. The smoking rate is higher in psychiatric wards than the others. The anxiety about changes in physical conditions, rather than mental conditions, prevents medical stuff from smoking ban in psychiatric hospital property. We compared symptoms, drug-induced extrapyramidal symptoms scale (DIEPSS), and dosage of antipsychotic medications among patients with schizophrenia, before and after smoking ban in hospital property.
Method: The subjects were 26 inpatients with psychotic disorders. Symptoms (somnolence, insomnia, urinary difficulties and dysphagia), objectives (heart rate, QTc and bowel motions) and DIEPSS (drug-induced extrapyramidal symptoms scale) were compared before and after smoking ban in hospital property.
Results: Three months after stop-smoking, muscle rigidity, tremor and dyskinesia were significantly improved. Twelve months later, dysphagia was slightly but significantly, impaired. DIEPSS were not changed, at this point. The dosages of psychiatric medications were decreased at both points after cessation of smoking.
Discussion: The decreases in psychiatric medications might be promoted by decrease in dopamine rather than by reduction of CYP1A2 activities induced by nicotine.
Conclusion: The cessation of smoking can reduce dosage of antipsychotic medications significantly and safely.

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