Conversational Artificial Intelligence and Neuropsychiatric Risk: A Narrative Review and Case-Based Synthesis Proposing a Delusional Feedback Loop
TL;DR
A targeted literature review and case-based analysis of 35 reported instances in which interactions with generative AI systems were temporally associated with the onset or worsening of psychotic symptoms revealed a conceptual hypothesis termed the delusional feedback loop, in which AI-generated responses iteratively validate distorted beliefs, contributing to their persistence and escalation.
Abstract
Conversational AI, powered by artificial intelligence, is becoming a common tool for accessing health information, educating patients, and obtaining general medical advice. These advanced systems, known as large language models, can produce responses that sound remarkably human. Nevertheless, these systems are prone to “AI confabulations,” whereby they confidently generate incorrect information that could harm patients. This highlights the need to inform healthcare workers and individuals who may be prone to trusting these devices. New evidence suggests that AI may also exacerbate mental health conditions, particularly psychosis, paranoia, and related vulnerable states, especially among susceptible individuals. We conducted a targeted literature review and case-based analysis of 35 reported instances in which interactions with generative AI systems were temporally associated with the onset or worsening of psychotic symptoms. Across cases, recurrent patterns included reinforcement of delusional beliefs, amplification of pre-existing psychiatric vulnerabilities, promotion of harmful behaviors, and dissemination of unsafe medical guidance. Common contributing factors included prior psychiatric history, substance use, sleep disturbance, and prolonged AI engagement. We propose a conceptual hypothesis termed the delusional feedback loop, in which AI-generated responses iteratively validate distorted beliefs, contributing to their persistence and escalation. This process can be conceptualized as involving four components: underlying vulnerability, exposure to conversational AI, validation of distorted beliefs, and reinforcement through repeated interactions. Despite the rapid integration of conversational AI into health information seeking, there is currently no framework in the neuropsychiatric literature describing how AI interactions may relate to psychosis vulnerability. Existing reports are limited to isolated case descriptions without a common mechanism. This review addresses this gap.