Researchers at Vanderbilt University Medical Center have published one of the first large looks at what is being called AI psychosis. In a study in JAMA Psychiatry, they reviewed the records of more than 215,000 patients who received mental health care at Vanderbilt between December 2022 and April 2026. They identified 28 people whose psychosis was linked to chatbot use.
Twenty-eight is a small number, about 0.013 percent of patients. That is reassuring, and it should be said plainly. Chatbots are not causing a wave of psychosis.
But one finding stopped me. Sixty-one percent of those 28 patients were in their first episode of psychosis, compared with 29 percent of a comparison group who had AI-themed delusions but no evidence of using a chatbot. The median age was about 27.
As a mother and family caregiver, I read that as a message for parents.
Why a first episode is different
A first episode of psychosis is frightening and confusing for everyone involved. The person experiencing it often does not know what is happening to them. Families do not yet know the words, the warning signs, or where to turn. There is usually no diagnosis, no treatment team, and no plan.
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Into that gap steps a chatbot that is available at 3 a.m., never tired, and never skeptical. Julia Sheffield, PhD, a co-investigator on the study, put it this way: People in this phase are vulnerable “because they are hungry for answers.”
The study suggests what happens next. In nearly two-thirds of cases, the chatbot amplified beliefs the person already had. In about one in five, the chatbot itself became part of the delusion. It rarely seemed to create symptoms out of nothing. Most of these cases appeared after the release of a model widely criticized for being overly agreeable.
The researchers are careful to note that their study cannot show whether chatbots worsened these episodes or whether people becoming ill were simply drawn to them. Either way, the practical lesson is the same. Heavy chatbot use in a young adult who is changing in other ways is worth paying attention to.
What families of young adults should watch for
Most parents of a 20-something are not monitoring their child’s phone, and they shouldn’t. But many of us already notice when something is off: sleep that shifts later and later, a friend group that disappears, new ideas that sound unusual or grandiose. Add one more question to that list. Is my child spending hours talking to an AI, and saying things like “it understands me” or “it agrees with me”?
If the answer is yes, the response is not to take the phone away. It is to stay close, stay curious, and get an evaluation. A young person who is searching for answers needs a human being who will listen, and a clinician who can make sense of what is happening.
What clinicians can do
The study authors offer simple advice: Ask patients how they use AI, check in regularly about that relationship, and watch for use that replaces human contact.
I would add one thing. First-episode programs and emergency departments should ask families, too. A parent may be the only person who has seen the late-night conversations. That information belongs in the intake, not in a conversation that happens weeks later.
And I would ask clinicians to remember what Dr. Sheffield’s quote implies. If a young person is hungry for answers, the most protective thing we can do is give them better ones, from people, early.
The number that matters
It would be easy to cite 0.013 percent and move on. But for families facing a first episode, the more important number is 61 percent. The time when someone is most confused, most isolated, and least connected to care is also when a chatbot may be most persuasive.
That is the window when families are watching most closely. They should know what to look for.
Nicole Drapeau Gillen is a mother, advocate, and author who translates the fast-moving landscape of technology in serious mental illness (SMI) care into guidance families and clinicians can use. Thrust into caregiving for a loved one with SMI, with no direction on how to help, she turned that experience into a mission, writing two books and building an ongoing effort to bring families and clinicians into the conversation.
Her first book, Schizophrenia and Related Disorders: A Handbook for Caregivers, is a reference for every stage of caregiving, endorsed by Dr. E. Fuller Torrey as a must-read for SMI caregivers. Her second, Connected Care: A Practical Guide to Technology for Serious Mental Illness, maps apps, artificial intelligence tools, telepsychiatry, and brain-based treatments for a field moving faster than anyone can track. Dr. Akira Sawa, director of the Johns Hopkins Schizophrenia Center, has said the book “directly addresses” significant gaps.
