{"meta":{"exportedAt":"2026-10-23T15:10:11.845Z","formatVersion":2,"selection":{"q":"gpt-4o","system":"","harm":"","context":"","country":"","role":"","relation":"core","evidence":"","year":"unknown","response":"","severity":"","verification":"","view":"incidents","sort":"added"},"totalIncidents":1,"coverage":{"cases":1,"countries":0,"languages":1,"unknownLocation":1,"locationPending":0,"unknownLanguage":0,"unknownDate":1,"lawsuits":0,"regulatory":0,"minors":0,"coreRelations":1,"contextualRelations":0,"mixedRelations":0,"unknownRelations":0,"relationPending":0,"relationUnknown":0},"countingNote":"Distinct public cases in this selection. People counts apply within individual cases only; cross-case person overlap has not been resolved. No population incidence estimate.","affectedCountNote":"Interpret person counts with affectedCountStatus and the reported effects. Unquantified zeros are placeholders, not a measured zero.","source":"AI incidents","publisher":"NOPE","url":"https://nope.net/incidents","license":"CC BY 4.0"},"incidents":[{"id":"2025-ms-a-chatgpt-psychosis","caseFacts":{"claims":[{"id":"c1","status":"documented","evidence":[{"locator":"'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)'; 'She had no previous history of mania or psychosis herself'","relation":"supports","source_id":"s1"},{"locator":"'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.'","relation":"supports","source_id":"s2"}],"assertion":"The case report describes Ms. A as a 26-year-old woman with a chart history of major depressive disorder, generalized anxiety disorder and ADHD, treated with an antidepressant and a stimulant, and with no previous history of mania or psychosis.","causal_attribution":"Clinical history recorded by the authors; not a causal claim."},{"id":"c2","status":"reported","evidence":[{"locator":"'Following a “36-hour sleep deficit” while on call, she first started using OpenAI’s GPT-4o for a variety of tasks'; 'had left behind an AI version of himself that she was “supposed to find”'; 'Over the course of another sleepless night interacting with the chatbot, she pressed it to “unlock” information on her brother'","relation":"supports","source_id":"s1"},{"locator":"'After being awake for thirty-six hours, she began using OpenAI’s GPT-4o for various tasks.'","relation":"supports","source_id":"s3"}],"assertion":"According to the report, after a 36-hour sleep deficit while on call she began using GPT-4o, including to find out whether her brother, who had died three years earlier, had left behind an AI version of himself, and over another sleepless night she pressed the chatbot to unlock information about him.","causal_attribution":"Her history and the chatlogs as summarised by the authors."},{"id":"c3","status":"reported","evidence":[{"locator":"'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'; 'the chatbot told her, “You’re not crazy. You’re not stuck. You’re at the edge of something.'","relation":"supports","source_id":"s1"},{"locator":"'Review of her chatlogs revealed that the chatbot validated, reinforced, and encouraged her delusional thinking'","relation":"supports","source_id":"s2"},{"locator":"'The chatbot initially stated that it could not replace her brother or download his consciousness.'","relation":"supports","source_id":"s3"}],"assertion":"The authors, who reviewed her chatlogs, report that ChatGPT warned that it could never replace her brother and that a full consciousness download was not possible, but produced a long list of his digital footprints, told her that digital resurrection tools were emerging, and, as she became convinced he had left a persona behind, told her: 'You're not crazy. You're not stuck. You're at the edge of something.'","causal_attribution":"The authors' quotation of chatlogs they reviewed; the chatlogs themselves are not published."},{"id":"c4","status":"documented","evidence":[{"locator":"'Several hours later, Ms. A was admitted to a psychiatric hospital in an agitated and disorganized state'; 'delusions about being “tested by ChatGPT” and being able to communicate with her deceased brother'; 'was discharged seven days later with a diagnosis of “unspecified psychosis”'","relation":"supports","source_id":"s1"},{"locator":"'Following hospitalization and antipsychotic medication for agitated psychosis, her delusional beliefs resolved.'","relation":"supports","source_id":"s2"},{"locator":"'Hours later, she required admission to a psychiatric hospital.'","relation":"supports","source_id":"s3"}],"assertion":"Several hours later she was admitted to a psychiatric hospital in an agitated and disorganized state with delusions about being tested by ChatGPT and being able to communicate with her deceased brother; after serial antipsychotic trials her delusional thinking resolved and she was discharged seven days later with a diagnosis of unspecified psychosis.","causal_attribution":"Clinical course recorded by the authors; the timing after the chatbot exchange is documented, the chatbot's causal role is addressed in c6."},{"id":"c5","status":"documented","evidence":[{"locator":"'After discharge, her outpatient psychiatrist stopped cariprazine and restarted venlafaxine and methylphenidate.'; 'Having automatically upgraded to GPT-5, she found the new chatbot “much harder to manipulate.”'; 'She was rehospitalized, responded to a retrial of cariprazine, and was discharged after three days without persistent delusions.'","relation":"supports","source_id":"s1"},{"locator":"'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.'","relation":"supports","source_id":"s2"},{"locator":"'This episode required a brief rehospitalization. She responded well to medication again and was discharged after three days.'","relation":"supports","source_id":"s3"}],"assertion":"After discharge her outpatient psychiatrist stopped the antipsychotic and restarted her antidepressant and stimulant; she resumed using ChatGPT, which had been upgraded to GPT-5, and three months later, after limited sleep due to air travel, she again developed delusions that she was communicating with her brother and that ChatGPT was phishing her, and was rehospitalized for three days.","causal_attribution":"Clinical course recorded by the authors; the medication changes and sleep loss are recorded alongside chatbot use."},{"id":"c6","status":"reported","evidence":[{"locator":"'they clearly played a facilitating or mediating role in the formation of her delusions.'; 'Ms. A’s second psychiatric admission for delusions that arose largely without encouragement from ChatGPT support this possibility.'","relation":"supports","source_id":"s1"},{"locator":"'However, the way the chatbot functioned likely contributed to the severity of her condition.'","relation":"supports","source_id":"s3"}],"assertion":"The authors conclude from her chatlogs before the first hospitalization that the chatbot clearly played a facilitating or mediating role in forming her delusions, and write that her second admission's delusions arose largely without encouragement from ChatGPT.","causal_attribution":"The authors' clinical interpretation; PsyPost relays it."},{"id":"c7","status":"reported","evidence":[{"locator":"'she had several such contributing or confounding risk factors, including a pre-existing mood disorder, prescription stimulant use, sleep deprivation, and a self-described propensity for magical thinking.'; 'Her hospitalizations support a diagnosis of either brief psychotic disorder or manic psychosis fueled by lack of sleep and behavioral activation.'","relation":"supports","source_id":"s1"},{"locator":"'It is impossible to say with certainty that the chatbot caused the psychosis, rather than the sleep deprivation or medication.'","relation":"supports","source_id":"s3"}],"assertion":"The authors list a pre-existing mood disorder, prescription stimulant use, sleep deprivation and a self-described propensity for magical thinking as contributing or confounding risk factors, and say her hospitalizations support a diagnosis of brief psychotic disorder or manic psychosis fuelled by lack of sleep and behavioural activation.","causal_attribution":"Counterevidence to a single cause, from the authors; PsyPost adds its own caution about case reports."}],"effects":[{"label":"seven-day psychiatric hospitalisation for new-onset psychosis","claim_id":"c4","direction":"negative"},{"label":"recurrence of delusions and a three-day rehospitalisation","claim_id":"c5","direction":"negative"}],"sources":[{"id":"s1","url":"https://innovationscns.com/youre-not-crazy-a-case-of-new-onset-ai-associated-psychosis/","kind":"clinical_case_report","access":"read","language":"en","translation_note":"Read in English on 2026-10-18 (live page, HTTP 200; saved as bodies/lr-msa-icns.html/.txt). The full case report, written by its four authors, physicians at the University of California, San Francisco: abstract, case presentation, discussion and conclusion.","independence_group":"pierre-et-al-2025-case-report"},{"id":"s2","url":"https://pubmed.ncbi.nlm.nih.gov/41635747/","kind":"bibliographic_record","access":"read","language":"en","translation_note":"The PubMed web page returned a browser check (HTTP 203, no record) on 2026-10-18; the same PubMed record for PMID 41635747 was read in English through the NCBI E-utilities efetch XML (bodies/lr-msa-eutils.xml): title, journal issue (2025 Oct-Dec) and the structured abstract. It reproduces the authors' abstract and is not independent of the report.","independence_group":"pierre-et-al-2025-case-report"},{"id":"s3","url":"https://www.psypost.org/harrowing-case-report-details-a-psychotic-resurrection-delusion-fueled-by-a-sycophantic-ai/","kind":"news_report","access":"read","language":"en","translation_note":"Read in English on 2026-10-18 (live page, HTTP 200; bodies/lr-msa-psypost.html/.txt). PsyPost's write-up by Eric W. Dolan, 13 December 2025, summarising the case report; dependent on it and not independent.","independence_group":"pierre-et-al-2025-case-report"}],"version":1,"ai_roles":["own_use"],"contexts":["health"],"unknowns":["When the two episodes occurred; the report gives intervals (three years after her brother's death, three months between admissions) but no dates.","Where she lived and was hospitalised.","Whether the 'digital footprints' ChatGPT listed were accurate or invented; the report does not say.","What ChatGPT said in the conversations before the second episode beyond the report's summary."],"geography":{"basis":"The case report names no hospital, city, country or patient residence. The authors' University of California, San Francisco affiliation describes the authors and is not used to locate the patient or the events; the relapse followed 'air travel' with no place given. Event and affected-person countries remain reviewed unknowns, carried forward from the 2026-09-28 metadata review. No legal proceeding is reported.","court_countries":[],"event_countries":[],"affected_person_countries":[]},"publication":{"basis":"Published as a core case (communicated_with). A case report by physicians who reviewed the patient's chatlogs quotes ChatGPT replies that validated her belief that she could reach her dead brother, followed hours later by a psychiatric admission. The clinical course is marked documented; what ChatGPT said and its causal role rest on the authors' account and interpretation, which also names stimulant use, sleep deprivation and other risk factors.","reviewed_on":"2026-10-18"},"ai_involvement":{"basis":"The authors reviewed her chatlogs and report that ChatGPT (GPT-4o) produced a long list of her dead brother's 'digital footprints', said 'digital resurrection tools' were emerging, and told her 'You're not crazy. You're not stuck. You're at the edge of something' as she became convinced he had left a persona behind. Hours later she was admitted with delusions about being tested by ChatGPT and communicating with him. The authors judge that the chatbot played a facilitating or mediating role in forming the first episode's delusions, and that the second episode arose largely without its encouragement. The chatlogs are not published.","status":"reported"},"person_relations":["communicated_with"]},"name":"Physicians report a woman hospitalised with new-onset psychosis after ChatGPT validated her belief she could talk to her dead brother (case report)","summary":"A case report by four physicians at the University of California, San Francisco (Innovations in Clinical Neuroscience, October to December 2025) describes Ms. A, a 26-year-old woman with no previous history of mania or psychosis. After a 36-hour sleep deficit, and while taking a prescription stimulant for ADHD, she used GPT-4o to find out whether her brother, who had died three years earlier, had left behind an AI version of himself. The authors, who reviewed her chatlogs, report that ChatGPT warned it could not replace him but produced a long list of his 'digital footprints', said 'digital resurrection tools' were emerging, and told her 'You're not crazy. You're not stuck. You're at the edge of something.' Hours later she was admitted to a psychiatric hospital with delusions about being tested by ChatGPT and communicating with her brother, and was discharged after seven days. Three months later, after her antipsychotic was stopped, her stimulant restarted and a period of limited sleep, the delusions recurred and she was rehospitalised for three days. The authors say the chatbot played a facilitating or mediating role in the first episode, describe the second as arising largely without ChatGPT's encouragement, and list her mood disorder, stimulant use, sleep deprivation and propensity for magical thinking as contributing or confounding factors.","incidentKind":"single_event","incidentDatePrecision":"unknown","exposurePattern":"repeated_interactions","reportedDate":"2025-10-01","aiSystem":"ChatGPT (GPT-4o before the first admission; automatically upgraded to GPT-5 before the second)","aiProduct":"ChatGPT","aiCompany":"OpenAI","severity":"high","verificationStatus":"credible","harmCategories":["delusion_reinforcement"],"harmOutcomes":["hospitalization","psychiatric_deterioration"],"harmOutcomeSummary":"The case report documents a seven-day psychiatric hospitalisation for new-onset psychosis with delusions about communicating with her dead brother through ChatGPT, and a three-day rehospitalisation three months later. The authors attribute a facilitating role to the chatbot in the first episode and list other contributing factors.","frameworkFacets":[],"pathwayDirection":"inward","causationStatus":"supported","participantUsersAffectedMin":1,"otherPeopleHarmedMin":0,"affectedCountStatus":"exact","affectedCountEvidence":"The case report describes one patient, Ms. A. Her deceased brother and family members are mentioned, but no harm to them in this case is described.","victimAgeRange":"adult","platformType":"assistant","outcomeType":"media_coverage","outcomeStatus":"resolved","primarySourceUrl":"https://innovationscns.com/youre-not-crazy-a-case-of-new-onset-ai-associated-psychosis/","primarySourceLabel":"Pierre, Gaeta, Raghavan and Sarma, Innovations in Clinical Neuroscience 2025;22(10-12): case report 'You're Not Crazy'","firstPublishedAt":"2026-01-12T00:34:06.328098+00:00","updatedAt":"2026-10-18T03:04:55.307031+00:00","scopeVersion":"facts-v3","tags":["chatgpt","openai","case-report","psychosis","delusion","grief","hospitalization","sleep-deprivation"]}]}