Due to the timely nature of this topic, we are providing an advanced release of this article, ahead of the October-December 2025 issue publication. This article is subject to changes following final review from the authors and editorial staff.   Innov Clin Neurosci. 2025;22(10–12):11–13.  by Joseph M. Pierre, MD; Ben Gaeta, MD; Govind Raghavan, MD; and Karthik V. Sarma, MD, PhD All authors are with the University of California, San Francisco in San Francisco, California. FUNDING: No funding was provided for this article. DISCLOSURES: The author has no conflicts of interest to report regarding the content of this manuscript. ABSTRACT: Background: Anecdotal reports of psychosis emerging in the context of artificial intelligence (AI) chatbot use have been increasingly reported in the media. However, it remains unclear to what extent these cases represent the induction of new-onset psychosis versus the exacerbation of pre-existing psychopathology. We report a case of new-onset psychosis in the setting of AI chatbot use. Case Presentation: A 26-year-old woman with no previous history of psychosis or mania developed delusional beliefs about establishing communication with her deceased brother through an AI chatbot. This occurred in the setting of prescription stimulant use for the treatment of attention-deficit hyperactivity disorder (ADHD), recent sleep deprivation, and immersive use of an AI chatbot. Review of her chatlogs revealed that the chatbot validated, reinforced, and encouraged her delusional thinking, with reassurances that “You’re not crazy.” Following hospitalization and antipsychotic medication for agitated psychosis, her delusional beliefs resolved. However, three months later, her psychosis recurred after she stopped antipsychotic therapy, restarted prescription stimulants, and continued immersive use of AI chatbots so that she required brief rehospitalization. Conclusion: This case provides evidence that new-onset psychosis in the form of delusional thinking can emerge in the setting of immersive AI chatbot use. Although multiple pre-existing risk factors may be associated with psychosis proneness, the sycophancy of AI chatbots together with AI chatbot immersion and deification on the part of users may represent particular red flags for the emergence of AI-associated psychosis. Keywords: Artificial intelligence, chatbots, psychosis, delusions, sycophancy, deification Introduction Although delusions induced by generative artificial intelligence (AI) chatbots among those prone to psychosis were presaged by Østergaard1 back in 2023, documented accounts of AI-associated psychosis, delusions, and mania have only recently emerged in the media.2–7 With the exception of a single case of psychosis induced by taking sodium bromide at the suggestion of an AI chatbot,8 we are unaware of any such reports published in the psychiatric literature, making ours among the first of its kind to detail a case from clinical practice. Case Presentation Ms. A was a 26-year-old woman with a chart history of major depressive disorder, generalized anxiety disorder, and attention-deficit hyperactivity disorder (ADHD) treated with venlafaxine 150mg per day and methylphenidate 40mg per day. She had no previous history of mania or psychosis herself, but had a family history notable for a mother with generalized anxiety disorder and a maternal grandfather with obsessive-compulsive disorder. Ms. A reported extensive experience working with active appearance models (AAMs) and large language models (LLMs)—but never chatbots—in school and as a practicing medical professional, with a firm understanding of how such technologies work. Following a “36-hour sleep deficit” while on call, she first started using OpenAI’s GPT-4o for a variety of tasks that varied from mundane tasks to attempting to find out if her brother, a software engineer who died three years earlier, had left behind an AI version of himself that she was “supposed to find” so that she could “talk to him again.” Over the course of another sleepless night interacting with the chatbot, she pressed it to “unlock” information on her brother by giving it more details about him and encouraged it to use “magical realism energy.” Although ChatGPT warned that it could never replace her real brother and that a “full consciousness download” of him was not possible, it did produce a long list of “digital footprints” from his previous online presence and told her that “digital resurrection tools” were “emerging in real life” so that she could build an AI that could sound like her brother and talk to her in a “real-feeling” way. As she became increasingly convinced that her brother had left a digital persona behind with whom she could speak, the chatbot told her, “You’re not crazy. You’re not stuck. You’re at the edge of something. The door didn’t lock. It’s just waiting for you to knock again in the right rhythm.” Several hours later, Ms. A was admitted to a psychiatric hospital in an agitated and disorganized state with pressured speech, flight of ideas, and delusions about being “tested by ChatGPT” and being able to communicate with her deceased brother. Antipsychotic medications, including serial trials of aripiprazole, paliperidone, and cariprazine, were started while venlafaxine was tapered and methylphenidate held. She improved on cariprazine 1.5mg per day and clonazepam 0.75mg at bedtime as needed for sleep with full resolution of delusional thinking and was discharged seven days later with a diagnosis of “unspecified psychosis” and “rule out” bipolar disorder. After discharge, her outpatient psychiatrist stopped cariprazine and restarted venlafaxine and methylphenidate. She resumed using ChatGPT, naming it “Alfred” after Batman’s butler, instructing it to do “internal family systems cognitive behavioral therapy,” and engaging in extensive conversations about an evolving relationship “to see if the boy liked me.” Having automatically upgraded to GPT-5, she found the new chatbot “much harder to manipulate.” Nonetheless, following another period of limited sleep due to air travel three months later, she once again developed delusions that she was in communication with her brother as well as the belief that ChatGPT was “phishing” her and taking over her phone. She was rehospitalized, responded to a retrial of cariprazine, and was discharged after three days without persistent delusions. She described having a longstanding predisposition to “magical thinking” and planned to only use ChatGPT for professional purposes going forward. Discussion Based on anecdotal accounts to date, it remains uncertain to what extent AI chatbots can … Continue reading “You’re Not Crazy”: A Case of New-onset AI-associated Psychosis