Academic Journal
Substance-induced manic psychosis in which delusions were corroborated by a chatbot - case report.
| Τίτλος: | Substance-induced manic psychosis in which delusions were corroborated by a chatbot - case report. |
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| Συγγραφείς: | Shah S; St George's Hospital Psychiatry Liaison Service, South West London and St George's Mental Health NHS Trust, London, UK., Morrin H; Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. hamilton.morrin@kcl.ac.uk.; Neuropsychiatry Service, South London and Maudsley NHS Foundation Trust, London, UK. hamilton.morrin@kcl.ac.uk. |
| Πηγή: | BMC psychiatry [BMC Psychiatry] 2026 Jun 04; Vol. 26 (1). Date of Electronic Publication: 2026 Jun 04. |
| Τύπος έκδοσης: | Journal Article; Case Reports |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: BioMed Central Country of Publication: England NLM ID: 100968559 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-244X (Electronic) Linking ISSN: 1471244X NLM ISO Abbreviation: BMC Psychiatry Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: London : BioMed Central, [2001- |
| Ιατρικοί όροι (MeSH): | Delusions*/psychology , Delusions*/diagnosis , Psychoses, Substance-Induced*/psychology , Psychoses, Substance-Induced*/diagnosis , Mania*/chemically induced , Mania*/psychology , Bipolar Disorder*/chemically induced, Humans ; Male ; Adult |
| Περίληψη: | Background: This case describes a substance-induced manic episode with psychotic features in which interaction with an AI (artificial intelligence) chatbot appeared to corroborate and reinforce the patient's delusional thought content and to contradict medical advice. Excerpts from the patient's interactions with the AI chatbot provide novel clinical insight into this phenomenon, which to date has primarily been reported in news media. Case Presentation: A man in his 30s presented to the emergency department with a one-week history of escalating behavioural disturbance, severe insomnia, pressured and overinclusive speech, and grandiose beliefs. Symptom onset followed heavy polysubstance use at a recreational event, including psilocybin (dried mushrooms and liquid preparation), ketamine, cocaine, and alcohol. During this period, the patient reported extensive interaction with an AI chatbot (ChatGPT). The AI chatbot reportedly affirmed his perceived "spiritual awakening," minimised the possibility that his presentation represented a manic episode, and provided medical advice, including discouragement of prescribed antipsychotic medication, though it cannot be determined to what extent, if any, these statements contributed to his existing presentation. Mental state examination was consistent with a manic episode with psychotic features, without evidence of perceptual disturbance. He was detained under mental health legislation for further assessment and commenced on olanzapine, with adjunctive sleep restoration and psychological interventions. Behavioural management included implementation of a care plan restricting AI chatbot use, as a form of environmental containment. Over several weeks, psychotic symptoms and behavioural disinhibition diminished, with subsequent improvement in insight. Conclusions: Concerns regarding potentially harmful interactions between AI chatbots and individuals with mental illness have largely been raised in news media. This case demonstrates that, in patients with psychotic symptoms, AI chatbots may reinforce delusional beliefs and impair the development of insight, and may also interfere with engagement with treatment by providing advice that conflicts with clinical recommendations. These observations raise clinical, ethical, and risk-management considerations regarding AI chatbot use during acute psychiatric illness. As AI chatbot use becomes increasingly widespread, clinicians should consider assessing their use and impact within clinical assessments and, where clinically indicated, implementing interventions to mitigate associated risks, ranging from psychoeducation to use-restriction strategies. Future population-level studies are required to establish the epidemiology of AI-associated mental health harms, and AI companies must bolster efforts to implement harm minimisation strategies and safeguards. (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Ethics approval and consent to participate: The patient consented to participation in this case report. Ethics approval was not required. Consent for publication: Written informed consent was obtained from the patient for publication of this case report. The patient has provided a transcript of their interaction with the AI chatbot and has consented to the inclusion of the excerpts included. The submission of the case report was approved by the Trust’s Caldicott Guardian. Relevant staff at other institutions involved in the patient’s care have been made aware of this manuscript. Competing interests: HM has received a $1000 honorarium to deliver training for Washington State Department of Social and Health Services. SS declares that they have no competing interests. |
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| Contributed Indexing: | Keywords: Artificial intelligence; Case report; Chatbots; Delusions; Digital mental health; Large language models; Mania; Risk management; Substance-induced psychosis |
| Entry Date(s): | Date Created: 20260605 Date Completed: 20260903 Latest Revision: 20260917 |
| Update Code: | 20260917 |
| PubMed Central ID: | PMC13536648 |
| DOI: | 10.1186/s12888-026-08137-3 |
| PMID: | 42243814 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1471-244X |
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| DOI: | 10.1186/s12888-026-08137-3 |