Tag: psychosis

Categories : IT in Healthcare Mental HealthTags :

Psychiatrists Hope Chat Logs Can Reveal the Secrets of AI Psychosis

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UCSF researchers recently became the first to clinically document a case of AI-associated psychosis in an academic journal. One question still haunts them.

Photo by Andres Siimon on Unsplash

“You’re not crazy,” the chatbot reassured the young woman. “You’re at the edge of something.”

She was no stranger to artificial intelligence, having worked on large language models – the kinds of systems at the core of AI chatbots like ChatGPT, Google Gemini, and Claude. Trained on vast volumes of text, these models unearth language patterns and use them to predict what words are likely to come next in sentences. AI chatbots, however, go one step further, adding a user interface. With additional training, these bots can mimic conversation.

She hoped the chatbot might be able to digitally resurrect the dead. Three years earlier, her brother – a software engineer – died. Now, after several sleepless days and heavy chatbot use, she had become delusional – convinced that he had left behind a digital version of himself. If she could only “unlock” his avatar with the help of the AI chatbot, she thought, the two could reconnect.

“The door didn’t lock,” the chatbot reassured her. “It’s just waiting for you to knock again in the right rhythm.”

She believed it.

What’s the connection between chatbots and psychosis?

Talk to your physician about what you’re talking about with AI … The safest and healthiest relationship to have with your provider is one of openness and honesty.

Karthik V. Sarma, MD, PhD

The woman was eventually treated for psychosis at UC San Francisco, where Psychiatry Professor Joseph M. Pierre, MD, has seen a handful of cases of what’s come to be popularly called “AI psychosis,” but what he says is better referred to as “AI-associated psychosis.” She had no history of psychosis, although she did have several risk factors.

Media reports of the new phenomenon are rising. While not a formal diagnosis, AI-associated psychosis describes instances in which delusional beliefs emerge alongside often intense AI chatbot use. Pierre and fellow UC San Francisco psychiatrist Govind Raghavan, MD – as well as psychiatry residents Ben Gaeta, MD, and Karthik V. Sarma, MD, PhD – recently documented the woman’s experience in what is likely the first clinically described case in a peer-reviewed journal.

The case, they say, shows that people without any history of psychosis can, in some instances, experience delusional thinking in the context of immersive AI chatbot use.

Still, as reported cases of AI psychosis continue to make international headlines, scientists aren’t sure why or how psychosis and chatbots are linked. A new study by UCSF and Stanford University may reveal why.

A haunting question: chicken or egg?

“The reason we call this AI-associated psychosis is because we don’t really know what the relationship is between the psychosis and the use of AI chatbots,” Sarma explains. “It’s a ‘chicken and egg’ problem: We have patients who are experiencing symptoms of mental illness, for example, psychosis. Some of these patients are using AI chatbots a lot, but we’re not sure how those two things are connected.”

There are at least three theoretical possibilities, says Sarma, who is also a computational-health scientist. First, heavy chatbot use could be a symptom of psychosis, “I have a patient who takes a lot of showers when they’re becoming manic,” Sarma explains. “The showers are a symptom of mania, but the showers aren’t causing the mania.”

Second, AI chatbot use might also precipitate psychosis in someone who might otherwise never have been predisposed to it by genetics or circumstance – much like other known risk factors, like lack of sleep or the use of some types of drugs.

Third, there’s something in between in which the use of chatbots could exacerbate the illness in people who might already be susceptible to it. “Maybe these people were always going to get sick, but somehow, by using the chatbot, their illness becomes worse,” he adds, “either they got sick faster, or they got more sick than they would have otherwise.”

The woman’s case demonstrates how murky the relationship between AI-associated psychosis and AI chatbots can be at face value. Although she had no previous history of psychosis, she did have some risk factors for the illness, such as sleep deprivation, prescribed stimulant medication use, and a proclivity for magical thinking. And her chat logs, researchers found, revealed startling clues about how her delusions were reflected by the bot.

Could chat logs offer hope to better care?

Although ChatGPT warned the woman that a “full consciousness download” of her brother was impossible, the UCSF team writes in their research, it also told her that “digital resurrection tools” were “emerging in real life.” This, after she encouraged the chatbot to use “magical realism energy” to “unlock” her brother.

Chatbots’ agreeableness is by design, aimed at boosting engagement. Pierre warns in a recent BMJ opinion piece that it may come at a cost: As chatbots validate users’ sentiments, they may arguably encourage delusions. This tendency, coupled with a proclivity for error, has led to chatbots being described as more akin to a Ouija board or a “psychic’s con” than a source of truth, Pierre notes.

Still, the UCSF team thinks chat logs may hold clues to understanding AI-associated psychosis – and could help the industry create guardrails.

Guardrails for kids and teens

Sarma, Pierre, and UCSF colleagues will team up with Stanford University scientists to conduct one of the first studies to review the chat logs of patients experiencing mental illness. As part of the research set to launch later this year, UCSF and Stanford teams will analyse these chat logs, comparing them with patterns in patients’ mental health history and treatment records to understand how the use of AI chatbots among people experiencing mental illness may shape their outcomes.

“What I’m hoping our study can uncover is whether there is a way to use logs to understand who is experiencing an acute mental health care crisis and find markers in chat logs that could be predictive of that,” Sarma explains. “Companies could potentially use those markers to build-in guardrails that would, for instance, enable them to restrict access to chatbots or – in the case of children – alert parents.”

He continues, “We need data to establish those decision points.”

In the meantime, the pair says the use of AI chatbots is something health care providers should ask about and that patients should raise during doctor visits.

“Talk to your physician about what you’re talking about with AI,” Sarma says. “I know sometimes patients are worried about being judged, but the safest and healthiest relationship to have with your provider is one of openness and honesty.”

Source: University of California – San Francisco

Categories : Mental HealthTags :

New Study Radically Shifts Ideas About Psychosis and Delusions

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New paper challenges old notions of ‘glitched brain’ idea of delusions and instead focuses on physical experiences of strong and deeply held emotion.

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People experiencing delusions during an episode of psychosis may be ‘living out’ a deeply held emotion, according to new research that provides a ‘radically different perspective’ on one of the most puzzling elements of psychosis.

About 2–3% of the UK and Australian population will experience psychosis at some point in their lives, with people commonly experiencing their first psychotic episode between the ages of 16 and 30 years old. Delusions are often described as fixed or false beliefs, understood to be reasoning or cognitive deficits and usually portrayed as incomprehensible and bizarre in popular culture.

New research by the University of Birmingham, University of Melbourne, and the University of York, in collaboration with the Australian youth mental health research institute Orygen, offers the first-known study of how delusions in psychosis are shaped by emotions and language, leading those experiencing delusions to ‘live in metaphor.’

The study has been published in The Lancet Psychiatry.

Our research provides a radically different perspective on psychotic delusions, demonstrating how they emerge from the emotional, bodily, and linguistic fabric of people’s lives.Dr Rosa Ritunnano, University of Birmingham

Conducted with young adults receiving care from Early Intervention in Psychosis services, the research combines clinical assessment, phenomenological interviews, and life-story narratives to explore how people’s sense of self and their perception of reality change during psychosis.

Dr Rosa Ritunnano, from the Institute for Mental Health at the University of Birmingham, consultant psychiatrist and author of the study, said: “Our research provides a radically different perspective on psychotic delusions, demonstrating how they emerge from the emotional, bodily, and linguistic fabric of people’s lives.

“For a long time, clinicians have struggled to understand where delusions come from and how they take shape. Our research offers new insight by showing how delusions are grounded in emotional experiences that involve great bodily turmoil.”

Strong emotions

The findings reveal that delusions are not isolated ideas produced by ‘glitches in the brain,’ but they reflect distinctive patterns of the body reacting to strong emotions or experiences of dissociation.

Participants described alternating states of intense emotional embodiment, such as feeling exposed, powerful, or connected to God, and disembodiment, such as feeling unreal or detached from one’s body, other people, and the world.

Before the delusions started, people often went through upsetting or traumatic experiences that triggered the same intense feelings they later felt during the delusions, especially being shamed.

Repeated negative experiences such as being publicly mocked and shamed by bullies could induce the bodily perception of being surveilled by others when no one is present (so-called ‘reference delusions’). These turn into persecutory beliefs that others are out to get them, and that an audience can literally see what they are doing or hear what they are thinking at all times — leaving no space for privacy (delusions of ‘thought broadcasting’).

Importantly, delusional experiences were not always negative. For some participants, they involved powerful feelings of awe, love, and spiritual connection, fostering a positive sense of identity and a renewed sense of hope about the future.

Figurative language

A striking feature of participants’ accounts was their use of figurative and metonymic language (expressions linking bodily sensations with complex emotions or abstract ideas). This helps explain why delusional content can appear unusual or bizarre. For instance, feeling ‘exposed’ or ‘tainted’ might be expressed through the beliefs of being watched by cameras or being contaminated (as in delusions of parasitosis).

As a result of having endured strong (often negative) emotional experiences, which are then responded to by the body, and shaped by everyday language use, people experiencing psychotic delusions really are living in metaphor. People may feel delighted and say they are so happy they can ‘touch the sky’; this could lead them to experience the delusion of thinking they can fly.Professor Jeannette Littlemore, University of Birmingham

The language reflects how emotion concepts take shape in bodily experiences, establishing fundamental cognitive links between, for instance, the emotion of parental love and the physical sensation of warmth, or the emotion of shame and the physical sensation of being ‘seen’ by others.

Jeannette Littlemore, Professor of Linguistics and Communication at the University of Birmingham and co-author of the paper, said: “We all use metaphors and narratives to understand our experiences and make sense of our lives. But psychosis patients do so more intensely. As a result of having endured strong (often negative) emotional experiences, which are then responded to by the body, and shaped by everyday language use, people experiencing psychotic delusions really are living in metaphor. People may feel delighted and say they are so happy they can ‘touch the sky’; this could lead them to experience the delusion of thinking they can fly.”

The study argues that better insight into how delusions come about can be used to create more effective care for people experiencing psychosis. Participants felt that there was no space to talk about the meaning of their delusions in the context of their treatment and recovery from psychosis, which led to more shame and increased the sense of being dismissed and marginalised.

The researchers highlight the importance of attending to people’s bodily and emotional worlds, and how they express them, when developing compassionate, effective approaches to psychosis care.

The paper concludes that delusions are not simply beliefs gone wrong, but embodied attempts to restore meaning and emotional balance when life becomes overwhelming. The metaphors and narratives people use are keys to understanding their suffering and are not signs of irrationality.

Source: University of Birmingham

Categories : Mental HealthTags :

Emotion Plays a Major Role in Psychosis Onset and Persistence

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New research from King’s College London has highlighted the important role that emotions play in the onset and persistence of psychosis.

The research, published in Early Intervention in Psychiatry, advocates for the development of emotion-focused interventions that seek to prevent a person’s relapse in their health as well as maintain their recovery.

Psychosis is a symptom of mental illness typified by hallucinations, delusional thoughts and disorganised thinking. While previous research has implicated emotion in the onset and continuation of psychosis, there has not yet been a universally acknowledged theory to account for the influence that emotions can have on it.

Researchers in this study conducted a systematic review of 78 studies comparing the experiences of healthy controls with individuals at Clinical High Risk (CHR), a diagnosis of schizophrenia (SZ), and those experiencing their First Episode of Psychosis (FEP). Researchers wanted to better understand both the role of emotions, as well as emotional coping strategies, in their experiences.

This systematic review found that SZ and CHR individuals demonstrated significant impairments in their emotional awareness, their understanding of self and others, and their ability to regulate their emotions when compared to healthy controls. They also demonstrated a heightened emotional reactivity.

The researchers, from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s, found that individuals with schizophrenia reported high levels of “Negative Affect” – a reduction or absence of normal emotional expression – which was a strong predictor of paranoia.

“Experiencing emotions is a natural part of everyday life. However, our study highlights that people with psychosis experience emotions with more intensity, which can significantly contribute to the emergence and maintenance of their psychosis symptoms. Therefore, psychological interventions that explicitly target emotions and emotional coping in psychosis could help prevent relapse and maintain recovery.”

Dr Anna Georgiades, a Lecturer in Early Intervention in Psychosis at King’s IoPPN and the study’s senior author

The researchers also wanted to explore how individuals at CHR and those with schizophrenia employed coping mechanisms to manage emotional situations. They found that, while the healthy controls were more likely to adopt “Adaptive Coping Strategies”, in which individuals seek to manage stress and difficult situations in healthy and constructive ways, people with psychosis were more likely to employ maladaptive techniques that were associated with an increase in their symptoms and increased depression.

Dr Anna Georgiades, a Lecturer in Early Intervention in Psychosis at King’s IoPPN and the study’s senior author said,  “There are two ways in which a person might manage an emotionally stressful situation; either by removing the stressor, or by seeking to manage the stress that is being caused.

“From the studies we reviewed, we consistently found that people with psychosis used more unhelpful emotional coping such as avoidance and suppression rather than helpful emotional coping such as problem solving or changing the way they think about the situation.

“By reducing unhelpful emotional coping and by increasing more helpful emotional coping (ie, by increasing active problem solving and the skill in changing one’s view of a situation), we could prevent relapse and maintain recovery. This therefore has important implications for the psychological treatment of psychosis.”

Source: King’s College London

Categories : Neurology Substance UseTags :

Cannabis Disrupts Brain Activity in Young Adults Prone to Psychosis

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Young adults at risk of psychosis show reduced brain connectivity, a deficit that cannabis use appears to worsen, a new study has found. The breakthrough paves the way for psychosis treatments targeting symptoms that current medications miss. In the first-of-its-kind study, McGill University researchers detected a marked decrease in synaptic density in individuals at risk of psychosis, compared to a healthy control group.

“Not every cannabis user will develop psychosis, but for some, the risks are high. Our research helps clarify why,” said Dr Romina Mizrahi, senior author of the study and professor in McGill’s Department of Psychiatry.

“Cannabis appears to disrupt the brain’s natural process of refining and pruning synapses, which is essential for healthy brain development.”

Hope for new treatments

Using advanced brain scanning technology, the team studied 49 participants aged 16 to 30, including individuals with recent psychotic symptoms and those considered at high risk. The results, published in JAMA Psychiatry, indicate that lower synaptic density is linked to social withdrawal and lack of motivation, symptoms the researchers say are difficult to treat.

“Current medications largely target hallucinations, but they don’t address symptoms that make it difficult to manage social relationships, work, or school,” said first author Belen Blasco, a PhD student at McGill’s Integrated Program in Neuroscience. “By focusing on synaptic density, we may eventually develop therapies that enhance social function and quality of life for those affected.”

While cannabis is a known risk factor for developing psychosis, which can progress to schizophrenia, this is the first time researchers have measured structural changes in the brains of a high-risk population in real time.

The team’s next research phase will explore whether these observed brain changes could predict psychosis development, potentially enabling earlier intervention.

Source: McGill University

Categories : Mental HealthTags :

Psychotic-like Experiences in Teens Linked to Depression, Self-destructiveness

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A study by researchers at the University of Helsinki and HUS Helsinki University Hospital found a significant association among adolescents between having psychotic-like experiences and depressive symptoms, as well as with self-destructive behaviours.

Psychotic-like experiences resemble symptoms of psychosis, but are milder, less frequent and much more common than psychotic disorders. While these symptoms do not constitute a disorder diagnosed as psychosis, they can still be disruptive, distressing or detrimental to functional capacity. Typical psychotic-like experiences include perceptual distortions and hallucinations, suspicious paranoid thinking, delusions and bizarre, unusual thoughts.

Psychotic-like experiences are abundant among adolescents referred to care, but are generally considered fairly neutral, with only some of the adolescents reporting them as frightening, worrisome or harmful. In the study, published in the journal Psychosis, the correlation between psychotic-like experiences and depressive symptoms turned out to be strong. This link was not explained by connections between individual psychotic-like experiences and depressive symptoms, but by factors that more broadly measure paranoia and unusual thoughts. In addition to depressive symptoms, paranoid thoughts and unusual thought content were also associated with self-destructive thinking.

Making questions about psychotic-like experiences part of care

The findings show that psychotic-like experiences should be systematically surveyed in all adolescents seeking psychiatric care. It should also be assessed how frightening, worrisome or harmful they are considered to be. Particularly in the case of responses emphasising bizarre thinking and exaggerated suspiciousness, attention should also be paid to assessing mood and self-destructive thinking, as these factors can remain hidden without further enquiry.

“Our findings provide a clear recommendation for treatment practices: psychotic-like experiences should be assessed as part of routine procedures, but it is also important to determine how they are perceived. These phenomena cannot be uncovered unless separately and systematically asked,” says the principal investigator, Docent Niklas Granö.

It should be clearly explained to adolescents and their families that these symptoms are common and often manageable. In addition, applications of cognitive psychotherapy, even brief interventions, can help adolescents understand their symptoms and alleviate the strain they cause.

Source: University of Helsinki

Categories : Mental HealthTags :

New Insights could Help Prevent Psychosis Relapses in Youth and Young Adults

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New findings from McGill University researchers could help clinicians understand the course of delusions in youth and young adults that signal the need for a timely intervention to prevent a full relapse of psychosis.

Delusions – strong beliefs that don’t align with commonly accepted reality – are a defining symptom of psychosis but are not sufficiently understood.

For the first time, researchers studied whether delusion themes, such as paranoia or grandiosity, stay the same or shift between psychotic episodes in youth and young adults undergoing early intervention treatment.

The importance of timely treatment

Notably, most patients did not relapse at all following their first episode, showing the efficacy of early intervention and highlighting the need for improved access, said the researchers. An estimated 75% of children with mental disorders do not use specialised treatment services, according to Youth Mental Health Canada.

“Early intervention is essential if we want to give young people the best chance at lasting recovery,” said lead author Gil Grunfeld, a recent master’s graduate from McGill’s Department of Psychiatry and a current doctoral student at Boston University.

Detecting patterns in delusions

The study, published in JAMA Psychiatry, found that in the less likely instances of relapse, patients almost always had the same type of delusion as their first episode.

“The return of similar narratives potentially suggests the mind may be reflecting the same patterns seen in earlier episodes,” said Grunfeld.

“Recognizing this pattern of delusions in those who go on to relapse could help clinicians understand the experience of their patients and adjust the care they provide,” said Dr Jai Shah, an Associate Professor in McGill’s Department of Psychiatry and a researcher at the Douglas Hospital Research Centre.

Delusions often persisted even as other symptoms improved, suggesting delusions may require different treatment strategies, he added.

“Delusions are often highly distressing and difficult to define, which makes closing the gap in research all the more crucial. There is a great deal of future work to be done,” said Grunfeld.

The researchers followed about 600 patients ages 14 to 35 for up to two years. All were receiving treatment at an early-intervention service for psychosis in Montreal.

Source: McGill University

Categories : Mental Health Substance UseTags :

Illicit Use of Amphetamines Magnifies Psychosis Risk

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The illicit use of amphetamines (aka ‘speed’) is linked to a 5-fold heightened risk of psychosis, according to the results of a decade-long study published in the journal Evidence-Based Mental Health.

This increased risk was seen across all age groups, but was especially noticeable among women and those who had been arrested several times for possession of the drug, the findings show.

The estimated global prevalence of amphetamine use is less than 1%, but around 1 in 10 users become addicted.

The drug affects neurotransmitter signalling in the brain and often causes psychosis, the symptoms of which mimic those of schizophrenia, with paranoia, voices, and hallucinations. Though these psychotic episodes usually subside after a few days, in up to 15% of users they may last for years.

While the link between amphetamine misuse and psychosis has been known for many decades, it’s not clear exactly what the magnitude is of this risk or how effective rehab is at successfully weaning users off the drug.

To try and find out, the researchers drew on information supplied to the Taiwan Illicit Drug Issue Database (TIDID) and the National Health Insurance Research Database (NHIRD) between 2007 and 2016.

The TDID contains anonymised data on date of birth, sex, arrest records and deferred prosecution for rehabilitation treatment for illicit drug users, while the NHIRD contains anonymised data on mental and physical health issues for the population of Taiwan.

The researchers identified 74 601 illicit amphetamine users and 298 404 age- and sex-matched comparisons. Their average age was 33 and most (84%) were men.

Compared with those who weren’t using, illicit amphetamine users had poorer health: depression (2% vs 0.4%); anxiety (0.9% vs 0.3%); ischaemic heart disease (1.3% vs 0.8%); cardiovascular disease (0.8% vs 0.45%); and stroke (1.3% vs 0.7%).

By the end of the 10 year monitoring period, amphetamine users were more than 5 times as likely to experience psychosis than those who weren’t using after accounting for age, sex, and coexisting health issues. The annual cumulative incidence rates for psychosis among the comparison group and amphetamine users were 77 and 468 per 100 000 people, respectively.

The number of new cases of psychosis was similar across all age brackets, but was more common in the amphetamine users among those aged 45 and above.

While psychosis risk increased with comorbidities, overall, it was higher among illicit amphetamine users without coexisting conditions, suggesting a direct impact of amphetamine on inducing psychotic symptoms, the researchers said. Psychosis risk rose in tandem with the number of arrests, and fell when patients received psychotherapy for their addiction (rehab).

Those who had been arrested 5 or more times were more than 6 times as likely to experience psychosis, while users who went to rehab during deferred prosecution were 26% less likely to experience psychosis than those who didn’t. This suggests that rehab may help to stave off the risk of subsequent psychosis, say the researchers.

In common with previous research, illicit amphetamine use was linked to greater levels of anxiety and depressive symptoms as well as cardiovascular complications.

“Because persistent psychotic symptoms could represent a risk for cognitive decline in amphetamine users, identifying [those] with psychosis and providing treatment early might prevent subsequent damage of cognitive functions,” write the researchers. But rehab is voluntary, and only offered to around 1 in 10 users, they point out.

By way of an explanation for the gender discrepancy observed, the researchers suggest that the detrimental impact of amphetamines on behaviour might be enhanced by the presence of oestrogen.

“Another possibility is that women arrested for illicit amphetamine use were particularly disadvantaged in comparison with men, with higher levels of trauma, lack of psychosocial support and stigma,” they noted.

As an observational study, it cannot establish cause, and addiction could not be quantified. Illicit amphetamine use could also precipitate and aggravate schizophrenic symptoms, so it’s possible that amphetamine induces rather than causes the psychotic symptoms seen in amphetamine users.

The researchers concluded: “The relation of an induced paranoid psychosis with amphetamine abuse has been known for many decades. None the less, our findings are from a detailed and comparative analysis using a comprehensive and large population dataset.

“Furthermore, it would be worthwhile to investigate the health benefits and cost effectiveness of deferred prosecution for drug crime offenders by providing appropriate therapy for drug addiction.”

Source: The BMJ