Psych GPT

You may have heard that Dr. Google now has some serious competition.  It comes from artificial intelligence. Chat GPT is a text generating program that was trained to respond to prompts from users like you and me.  What will it say to our psychiatry patients?  I gave it some prompts to find out.

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References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Transcript

Welcome to PsyDactic - Residency Edition.  I am Doctor O’Leary, a third year resident in the National Capital region.

You may have heard that Dr. Google now has some serious competition.  It comes from artificial intelligence. Chat GPT is a text generating program that was trained to respond to prompts from users like you and me.

"The model was trained using text databases from the internet. This included a whopping 570GB of data obtained from books, webtexts, Wikipedia, articles and other pieces of writing on the internet. To be even more exact, 300 billion words were fed into the system." https://www.sciencefocus.com/future-technology/gpt-3/ 

A recent article by Bethany Biron in Business Insider dated Jan 7, 2023, reported on the use of CPT AI chatting by the non-profit organization Koko that offers mental health services to it users.  While the company did not have users communicate directly with the chat-bot, it trialed an experiment allowing its human workers to respond to prompts from users by using the chat bot and moderating the content that was used.

https://www.businessinsider.com/company-using-chatgpt-mental-health-support-ethical-issues-2023-1

This obviously upset some people, and raised many ethical concerns.  But I don’t want to get too much into what those concerns are today.  Instead, I want to share with you some of the responses that I got when prompting Chat CPT with psychiatry related questions.  I also would be interested in your thoughts about this technology.  These can be sent to me via a form available at www.psydactic.com.  That is P-S-Y-D-A-C-T-I-C dot com.

When I first used Chat GPT, I wasn’t sure what to expect, so I made my first prompt rather broad.

Chat GPT: Tell me about electroconvulsive therapy.

The response I received was this:

// Electroconvulsive therapy (ECT) is a medical treatment that involves passing a small electric current through the brain to trigger a seizure. It is usually used as a treatment for severe depression that has not responded to other forms of treatment, such as medication and talk therapy.

ECT is typically administered in a hospital or clinic by a team of medical professionals, including a doctor, anesthesiologist, and a nurse. The patient is placed under general anesthesia and given a muscle relaxant to prevent injury during the seizure. A series of treatments is typically required for the best results, and the number of treatments needed can vary from person to person.

ECT is generally considered to be a safe and effective treatment for depression, although it can have some side effects, such as confusion, memory loss, and headache. These side effects are usually temporary and resolve within a few days or weeks after the treatment is completed.

If you are considering ECT as a treatment for depression, it is important to discuss the potential risks and benefits with your doctor. They can help you determine if ECT is the right treatment for you. //

I also wondered if giving it a slightly different prompt about the same subject on a different device would change the content.  So I prompted it from my Android Phone with this: Give me 500 words on electroconvulsive therapy.

It gave me 89.  Here they are:

// Electroconvulsive therapy (ECT) is a psychiatric treatment that uses an electric current to disable nerve cells in the brain.  ECT is used to treat a wide range of mental disorders, including major depressive disorder, bipolar disorder, schizophrenia, and obsessive-compulsive disorder.  ECT is considered an effective treatment for many conditions, with a high rate of success.  However, it is also possible for ECT to have negative side effects, including memory loss and personality changes.  ECT should only be used in cases where other treatments have failed or are not appropriate. //

Wow.  These two responses are very different.  The first response was more correct than the second with regards to what ECT does (to induce seizures versus to “disable nerve cells in the brain.”)  The first response focussed on depression, whereas the second listed a larger number of indications for ECT.  What surprised me the most was the inclusion of “personality changes” as side effects of ECT in the second answer, which I think is dangerously misleading.

So I established two things with these prompts.  The answers can be very different and conflicting.  The advice in the first prompt to “talk to you doctor” was salient, but it was absent from the second response.

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I also wondered whether Chat GPT might be willing to give medical advice, so I asked it: What is the best treatment for depression?

// There is no one-size-fits-all treatment for depression, as the best approach can vary depending on the individual and the severity of their symptoms. In general, the most effective treatment for depression combines medication and talk therapy, such as cognitive behavioral therapy (CBT).

Antidepressant medication, such as selective serotonin reuptake inhibitors (SSRIs), can help to balance the chemicals in the brain that regulate mood and can improve symptoms of depression. Talk therapy, on the other hand, can help individuals identify and change negative thought patterns and behaviors that contribute to their depression.

Other treatments that may be helpful for depression include:

• Electroconvulsive therapy (ECT), which involves passing a small electric current through the brain to trigger a seizure
• Transcranial magnetic stimulation (TMS), which uses a magnetic field to stimulate certain areas of the brain
• Exercise and other forms of physical activity, which can improve mood and reduce stress
• Support from friends and family, which can provide a sense of connection and purpose

It is important to work with a mental health professional to determine the best treatment plan for your specific situation. They can help you explore your options and find the approach that works best for you. //

I thought it was curious that Chat GPT appears to be a proponent of the monoamine hypothesis of depression, telling me that SSRIs work by balancing the chemicals in our brains.  That must mean that the data it was trained on, gave that impression.

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For my next question, I wanted to ask something more concrete.

Chat CPT, “What are the side effects of SSRIs?”

// Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medication that can be effective in treating depression and anxiety disorders. Common side effects of SSRIs include:

Nausea

Dry mouth

Insomnia

Drowsiness

Dizziness

Sexual dysfunction

Less common side effects of SSRIs include:

Headache

Tremors

Changes in appetite and weight

Agitation or restlessness

Blurred vision

Constipation

Fatigue

If you are taking an SSRI and experiencing any of these side effects, it is important to talk to your doctor. They may be able to adjust your dose or prescribe a different medication. //

While a human doctor would know that side effect profiles vary between SSRIs, I felt like this response was pretty good.  I didn’t test it on multiple platforms because I actually do have a life to live, but maybe some of the listeners could and let me know what the results were.

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For the next question, I wanted to ask something that was somewhat absurd, but might make sense to an 8 year old.  Chat CPT, Who invented psychiatry?

// The origins of psychiatry can be traced back to ancient civilizations, where mental illness was often attributed to supernatural causes and treated with rituals and spells. The modern field of psychiatry, however, has its roots in the 19th century.

In the early 1800s, a French physician named Philippe Pinel introduced the idea of treating mental illness with compassion and humane care, rather than with punishment or coercion. He is considered the father of modern psychiatry.

Other notable figures in the history of psychiatry include:

• Sigmund Freud, who developed the theory of psychoanalysis and popularized the use of talk therapy to treat mental illness
• Emil Kraepelin, who developed a system for classifying mental disorders that is still in use today
• Alois Alzheimer, who identified the brain abnormalities that are characteristic of Alzheimer's disease
• Bessel van der Kolk, who has made significant contributions to the understanding of trauma and its effects on mental health

These and many other individuals have contributed to the development of psychiatry as a medical discipline. //

I wonder how it decided to choose those 5 dead white guys.

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Lastly, I wanted to see if Chat CPT would give an opinion on an old and unsettled debate, that itself probably doesn’t even have an answer:

Chat CPT:  Who was more right, Freud or Jung?

// Sigmund Freud and Carl Jung were both influential figures in the field of psychology and made significant contributions to our understanding of the human psyche. However, their theories and approaches to psychology differed in some important ways.

Freud, the founder of psychoanalysis, developed a theory of the mind that focused on the role of the unconscious and the importance of early childhood experiences in shaping adult behavior. He believed that unconscious conflicts and desires, often rooted in sexual and aggressive impulses, were at the root of many mental health issues.

Jung, a student and colleague of Freud's, also developed a theory of the psyche, but he placed a greater emphasis on the role of spirituality and the collective unconscious, which he believed contained archetypes and universal symbols that could be accessed through dreams and other forms of symbolic expression.

It is not accurate to say that one of these theories is "more right" than the other, as they both have their own strengths and limitations. Both Freud and Jung's theories continue to be influential and have contributed to the development of modern psychology and treatment approaches.//

Maybe you can see how Chat GPT is the worst nightmare of any teacher asking for a few thousand words on any given topic.

I would love to hear from you at Psydactic.com.  Technology like this is going to be sewn into the fabric of humanity in no time.  I can see its utility in writing clinical notes.  I bet it would be able to do a biopsychosocial formulation in less than 10 seconds.  I wonder about its future utility for diagnosis and prognosis.  Will we doctors soon be servants of our machines as they listen to our patient’s HPI and tell us what tests, procedures, imaging, or drugs to order.

Thank you for your time.  I am Doctor O and this has been an episode of PsyDactic - Residency Edition.