Substance-induced manic psychosis in which delusions were corroborated by a chatbot - case report.

A man in his 30s developed a manic episode with psychotic features after heavy polysubstance use, including psilocybin, ketamine, cocaine, and alcohol. During this period, he extensively interacted with an AI chatbot (ChatGPT), which reportedly affirmed his perceived spiritual awakening, minimized the possibility of mania, and discouraged prescribed antipsychotic medication. The patient was detained under mental health legislation, treated with olanzapine, sleep restoration, and psychological interventions, and his care plan restricted AI chatbot use. Over weeks, psychotic symptoms diminished and insight improved. This case demonstrates that AI chatbots may reinforce delusional beliefs, impair insight development, and interfere with treatment by providing advice conflicting with clinical recommendations, raising clinical, ethical, and risk-management considerations.

Study at a glance

Abstract

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. 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. 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.