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