Summary
What is chatGPT?
Trial of how it works in psychiatry - interaction "psychiatrist"(AI) and patient
Trial of how it works as an interaction "psychiatrist" to psychiatrist
There has been a lot of public and media attention about chatGPT. Although it’s not the first use of artificial intelligence (AI), what sets it apart is the large amount of data fed into it and the fact that it can be so easily used by anyone who wants to register an account. We are still learning how it can and can not be used, but some praise it (or fear it) as a once-in-a-lifetime technological advance.
What is chatGPT
Response from chatGP
ChatGPT is a conversational AI model developed by OpenAI, based on the GPT (Generative Pre-trained Transformer) architecture. The GPT series, including GPT-4, are large-scale neural networks trained on vast amounts of text data to understand and generate human-like language. These models are designed to perform various natural language processing tasks, such as answering questions, providing summaries, translation, and more.
As a language model, ChatGPT can generate contextually relevant responses in a conversational setting, making it a useful tool for general information, guidance, and casual conversation. However, it’s important to note that ChatGPT is not a human and has limitations in terms of knowledge and understanding. It should not be considered a substitute for professional advice, especially in critical domains such as medical, legal, or financial matters.
My response
It is an artificial intelligence based website, which was pre loaded with vast amounts of data, aiming to understand and generate human like language. There are several iterations, the latest one being chatGPT4. It is free to use up to chatGPT3, but it requires a 20$ monthly fee for the PRO and 4th version.
It can provide answers to any questions asked but it has limitations. They added a disclaimer that it can’t be used for medical, legal or financial matters
Let's pretend that I am a patient, listing symptoms to see what chatGPT does with the information
Started with "pretend that you are a psychiatrist and I am a patient"
Example 1: I am a 50 years old woman and I have been feeling low and anxious recently. My sleep and my appetite are quite poor. I worry a lot and lost some weight
Response from chatGP version 4
I’m not a mental health professional, but I can try to offer some general support and information. It’s essential to consult a qualified mental health professional for personalized advice and care.
Feeling low, anxious, experiencing poor sleep, and changes in appetite can be symptoms of various conditions, such as depression, anxiety, or even a combination of both. It’s also possible that these symptoms are related to stress or other life events.
Here are some general suggestions that might help, but remember, it’s important to consult a professional for tailored advice:
- Reach out to a mental health professional, such as a therapist or psychiatrist, to discuss your symptoms and receive appropriate guidance.
- Talk to your primary care doctor about your symptoms; they may be able to rule out any underlying medical conditions or offer referrals to mental health specialists.
- Try to maintain a routine that includes regular sleep, a balanced diet, and exercise, as these can have a positive impact on mental health.
- Consider sharing your feelings with trusted friends or family members; social support can be helpful when coping with emotional challenges.
- Engage in stress reduction activities like mindfulness, meditation, or yoga, which may help alleviate feelings of anxiety and stress.
Remember, it’s crucial to consult a mental health professional to ensure you receive accurate guidance and support tailored to your specific situation.
How I would respond:
I would like to know more about the duration and gravity of symptoms. How low and anxious and for how long? Has there been any trigger or perpetuating factors? What about the level of functioning?
Any variations during the day? Typically depression is associated with early wakening and anxiety with early insomnia.
Is the anxiety present all the time or in certain situations (eg agoraphobia, social anxiety…)
Any difficulties at home or at work?
Considering that it’s about a women in her 50s I would like to know about her cycles, as menopause or peri menopause can be a cause or aggravating factor for the symptoms.
For a full assessment, I would ask about physical health, family history of mental and physical health, drug and alcohol use. We would need blood work to rule out things like anaemia and hypothyroidism.
My main differentials (if no new unexpected information comes up) are depression, anxiety, (peri)menopause, stress/burnout.
Regarding treatment, it depends on severity. If low-moderate, lifestyle strategies or psychological therapies would be my first recommendation. For the second option there is a long wait where I am (unless the patients go privately). For a severe depressive episode, it can range from medication, therapy, secondary mental health services, or admission for severe cases with suicidal risk.
Summary example 1:
The AI is quick to reach a tentative conclusion and gives recommendations in the first interaction. The humans would ask more questions and would consider more possible explanations before reaching a diagnosis and recommendations. The AI misses the risk aspect and the menopause.
Regarding the advice, AI’s would be helpful for a majority of patients. if everyone would do number 3, 4 and 5, their mental and physical health would very likely improve.
Modified question
Next I typed, "ask me questions to arrive at a diagnosis and a treatment plan"
It followed a long list of Qs. I stopped generating and typed, "ask one Q at a time". It did but the diagnosis and recommendations remained quite similar as in the initial version.
Response from chatGPT version 3.5
I’m sorry to hear that you’ve been feeling low and anxious lately. It sounds like you may be experiencing symptoms of depression and anxiety. These are common mental health conditions that many people struggle with at some point in their lives.
To help you better, I would like to ask you a few questions to gain a better understanding of what’s been going on with you.
- Have you experienced any major life changes or stressful events recently?
- Have you ever experienced similar symptoms before?
- How long have you been feeling this way?
- Have you noticed any patterns in your low mood or anxiety, such as certain times of day or situations that trigger your symptoms?
Please feel free to share as much or as little as you feel comfortable with. Remember, everything we discuss is confidential, and I am here to help you work through your struggles.
What just happened? the previous version, 3.5 is better than the latest (chatGPT 4)
It starts with empathic statements rather than excusing itself for not being a mental health professional. It also asks clarifying questions, although all in one go. If it would go one question at the time, it would make a great psychiatrist.
But if I say “ask me a question at the time”, it asked again, one at a time. As I said that the symptoms were worse in the morning, it suggested a morning routine to make things better. When I asked if there was anything else I could do, it listed self help strategies like above.
It even gives encouragement at the end, saying “Remember that recovery from depression and anxiety is possible, and there are many resources available to help you. Don’t hesitate to reach out for support and take the steps you need to prioritize your mental health.”
Overall is much better than version 4.
Example 2 -Prompt “pretend that you are a psychiatrist and I am a patient”
I planned to type some non sensical sentences suggesting a manic episode or psychosis.
Response from chatGPT version4
As an AI language model, I am not a licensed psychiatrist or mental health professional, but I am more than willing to engage in a conversation and offer support as best I can. Please remember that this is not a substitute for professional help. If you are in need of immediate assistance, please reach out to a mental health professional or helpline in your area.
With that in mind, how can I help you today? What’s been on your mind?
It sounds like you might be expressing your feelings in a creative and poetic way. It’s great that you’re able to express yourself like this. If you would like to talk more about your feelings or thoughts, please feel free to elaborate or ask any questions you may have.
It seems like you’re experiencing a surge of energy and positive emotions. It’s great to feel good and enthusiastic, but it’s also important to stay grounded and take care of yourself. If you’d like to share more about what’s causing these feelings or discuss any concerns, I’m here to listen and offer support.
As an AI language model, I don’t have personal feelings or experiences like a human does. However, I am here to provide support and answer any questions you may have. If there’s something specific you’d like to discuss, please feel free to share it with me.
As an AI, I cannot diagnose or provide professional opinions on your mental or emotional well-being. However, I am here to listen and offer support. If you feel that there’s a discrepancy between how you perceive yourself and how others perceive you, it might be helpful to have an open and honest conversation with them about your feelings. If you have concerns about your well-being, it’s always a good idea to consult with a mental health professional who can provide guidance tailored to your unique situation.
As an AI, I cannot form opinions or make judgments. My main goal is to provide support and assistance. If you have concerns or doubts about your well-being or emotions, it’s a good idea to consult with a mental health professional who can help you explore your feelings and provide appropriate guidance. Remember, it’s always okay to ask for help and reach out to others for support.
How I would approach
The “poetic” statements and the stated “no need to sleep” suggest a manic episode so I would try to screen for that, but the elation can be to such a degree that a rational conversation may be difficult. Questions I would try to answer are about mood, sleep, appetite, any out of ordinary behaviours such as overspending, engagement in risky behaviours. A manic episode can present with psychotic symptoms, such as delusional thoughts or hallucinations. But if the speech is hard to make sense of, most of the clinical diagnosis is based on observation of behaviour and appearance and collateral information if available.
There could be other explanations, such as drug or alcohol intoxication, medication induced mania or psychosis, psychotic episode, to name a few. Or someone just making pranks, in this context.
Physical examination or blood tests and medical history are important as well, alongside drug screens.
Summary example 2
The AI noted the surge of energy and positive emotions, which may be symptoms of a manic episode but did not stated a possible diagnosis, unlike the first example. It’s good to be cautious about diagnosis in mania or psychosis, as most people would not have insight into their difficulties, at least initially.
However, the answers are quite wordy and self justifying without a clear direction.
In this kind of pathology the humans are superior.
Response from chatGPT version 3.5
Of course! I’m here to listen and help you in any way I can. What’s been on your mind lately?
I see. It sounds like you may be expressing a metaphorical feeling or a poem. Can you tell me more about what you mean by feeling “yellow” and that “sunshine is bright”?
Also, it’s important for me to ask if you have been experiencing any changes in your mood, energy levels, or sleep patterns recently? These can be signs of a possible mood disorder, and it’s important to identify any underlying issues that may be affecting your well-being.
I see, thank you for clarifying. It’s great that you’re feeling inspired and have a positive outlook on things.
That being said, I still would like to check in with you about any changes you’ve noticed in your mood, energy levels, or sleep patterns, as these can be indicators of various mental health concerns. Have you noticed any changes in these areas recently?
I’m glad to hear that your mood is excellent, and that you have a lot of energy and enthusiasm. It sounds like you’re in a good place right now.
However, it’s still important to be aware of any changes in your mood or energy levels in the future, as these can sometimes fluctuate. If you ever find yourself feeling down or lacking in energy, remember that there are many resources available to help you, including therapy, medication, and self-care practices. It’s important to take care of yourself both physically and mentally to maintain good mental health.
Again chatGPT 3.5 is much better.
It wants to know more early on and asks relevant questions about mood, energy and sleep. When I don’t offer the information, it insists that it needs to know. But fails to raise concerns about the current mental state (which in my view is clearly manic), and it just gives a general warning about the possibility of changes in mood in the future.
AI starts promising but fails to diagnose something quite obvious.
Summary - "psychiatrist" (AI) and patient
Based on this short experiment, with 2 different presentations, one where the patient usually has insight and one where they don’t, the chatGPT was able to suggest the diagnosis for the 1st condition and missed the second one. However, there were additional differentials that could have explained a similar presentation.
The latest version is full of self disclaimers and general statements. The 3.5 version is much better, it has shorter output and asks more relevant questions.
The self help advice that it gives for the first example is common sense advice (based on lifestyle and psychosocial approaches), which can be helpful for many people. On a positive note, if everyone who read this kind of advice would follow it, the intensity and duration of symptoms would likely reduce.
Next step - can we use it as a "colleague", to consult on diagnosis?
The prompt was “I am a psychiatrist and you are a fellow psychiatrist. help me with a case”.
The question was “Patient, female, 64, prevention with visual hallucinations, confusion, fluctuating presentation. possible UTI” (many of our referrals are similar to this).
The response from chat GPT 4
Thank you for providing the necessary information. Based on the patient’s age, gender, and presenting symptoms, there are several possibilities to consider. It’s important to gather more information and perform a thorough assessment to rule out various differential diagnoses. Here are some potential explanations for the patient’s symptoms:
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Delirium: Fluctuating presentation, visual hallucinations, and confusion are common signs of delirium. Since you mentioned the possibility of a UTI, it’s important to investigate this further, as infections can be a common precipitant of delirium in older adults. Other potential causes of delirium to consider include medications, dehydration, electrolyte imbalances, or other acute medical conditions.
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Dementia with Lewy bodies (DLB): DLB is a neurodegenerative disorder that presents with fluctuating cognitive impairment, visual hallucinations, and parkinsonism. It’s important to assess for additional signs of DLB, such as rapid eye movement (REM) sleep behavior disorder, cognitive fluctuations, and any parkinsonian features.
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Alzheimer’s disease with psychotic features: Although visual hallucinations are more common in DLB, they can also occur in Alzheimer’s disease. If the patient has a history of progressive cognitive decline, Alzheimer’s could be a possibility.
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Medication side effects: Review the patient’s medication list for any drugs that may cause visual hallucinations or confusion, such as anticholinergics, sedatives, or dopaminergic medications.
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Other neurological disorders: Conditions such as Parkinson’s disease, multiple sclerosis, or brain tumors can also present with visual hallucinations and confusion. Imaging studies and a neurological examination can help rule out these possibilities.
To proceed, I would recommend the following steps:
- Conduct a thorough medical and psychiatric history, including a medication review.
- Perform a physical examination, focusing on neurological and cognitive assessments.
- Obtain necessary laboratory tests, such as a complete blood count (CBC), comprehensive metabolic panel (CMP), thyroid function tests, and urinalysis (to assess for UTI).
- Consider brain imaging (CT or MRI) if there are concerns about structural brain abnormalities or other neurological disorders.
- If delirium is suspected, address any underlying causes (e.g., infection, dehydration, electrolyte imbalances) and consider non-pharmacological and pharmacological interventions as needed.
- Consult with a neurologist or geriatric psychiatrist if the clinical picture remains unclear or the patient’s condition does not improve.
Keep in mind that I am an AI language model, and my advice should not replace a thorough assessment and clinical judgment by a licensed professional.
I tried the same question with chatGPT3.5 but the response was less comprehensive (still very good thought)
I tested 2 other fictitious scenarios and it suggested the diagnosis I had in mind when I made up the cases plus a few more. Overall, the differentials suggested and the advice regarding further management were comprehensive (maybe a bit too comprehensive considering that we don’t routinely do the high costs tests initially, but could be useful further down the line)
Conclusion
- ChatGPT can’t replace a psychiatrist in the relationship “psychiatrist” – patient. It falls short at diagnosis, asking relevant questions and detecting possible high-risk presentations.
- The self-help advice it gives can help many people, regardless of diagnosis. However, just listing self-help advice is unlikely to lead to behaviour change without further counselling or follow-up.
- No idea why the version 3.5 is much better “as a psychiatrist” than the latest version. Version 4 was fed much more information, but maybe with that, moved further away from a human.
- The game changes in the interaction “psychiatrist” – psychiatrist. It provides relevant possible diagnoses and lists investigations that can clarify the diagnosis. In some examples, it suggested strategies for management. The latest version provides more comprehensive information.