Inclusion Criteria

1. Women and men aged 18-70 with a diagnosis of schizophrenia or schizoaffective disorder (depressed type or bipolar type) by structured diagnostic interview or chart review
2. Clinically stable on a stable dose of antipsychotic medication for at least one month, no current active suicidal ideation
3. Expired air CO > 9 ppm and self report of smoking >1/2 pack per day of cigarettes
4. Willing to set a smoking quit date within one month of beginning treatment
5. Not treated with investigational medication in the past 30 days
6. Competent to provide informed consent or able to provide assent with legal guardian informed consent
7. Meet DSM-IV criteria for Nicotine Dependence, as determined with the Fagerstrom Nicotine Tolerance Questionnaire (FTQ) (Fagerstrom, 1978)
8. Compliant with last 3 clinic visits

Exclusion Criteria

1. Diagnosis of dementia, neurodegenerative disease, current anorexia/bulimia nervosa, current substance abuse or dependence disorders, including alcohol, active within the last 3 months or any Axis I DSM-IV diagnosis other than schizophrenia or schizoaffective disorder
2. Severe or unstable angina; myocardial infarction in the past 2 weeks; untreated peptic ulcer; life-threatening arrhythmia; poorly controlled insulin dependent diabetes mellitus, uncontrolled hypertension, cerebrovascular event within six months; or allergy to a nicotine patch. Serious illness including cardiovascular, hepatic, renal, respiratory, endocrine, neurologic, or hematologic disease that is not stabilized such that hospitalization for treatment of that illness is likely within the next two months
3. Patients who, in the investigator's opinion, pose a current severe homicide or suicide risk
4. Subjects with a history of skin diseases (e.g., psoriasis), skin allergies, or strong reactions to topical preparations, medical dressings or tapes
5. Current use of topical medications