Conversational AI and Psychosis: A Proposed Neurocognitive Framework Involving Anthropomorphism, Predictive Coding, and Delusional Reinforcement

Abstract

Conversational AI has become an integral part of everyday life.Historical evidence shows that sociocultural change can be reflected in mental health, particularly in the incorporation of new technologies, suggesting that conversational AI represents a new context through which such changes may influence the manifestation and content of psychotic symptoms.This narrative review explores the possible relationship between conversational AI use and the development or worsening of psychotic symptoms, bringing together the limited clinical evidence, possible neurocognitive mechanisms, relevant vulnerability factors, and the potential role of conversational AI in therapeutic and pathological contexts.A non-systematic review of the literature was conducted using PubMed and Google Scholar, with relevant clinical case reports, original research articles, reviews, and conceptual articles identified through keyword searches and reference list screening.Conversational AI use has been associated with psychotic-like experiences in cross-sectional survey data and has been implicated in the onset or relapse of psychotic symptoms in an isolated case report.Several theoretical neurocognitive mechanisms have also been proposed by which conversational AI could contribute to the emergence or worsening of psychotic symptoms in vulnerable individuals.These mechanisms are largely derived from existing psychosis models and remain hypothesis-generating rather than empirically demonstrated, requiring further validation through longitudinal and experimental studies.At the same time, in carefully defined clinical contexts, conversational AI may also have supportive uses in assessment, monitoring, or structured therapeutic support.Given the current context, the use of conversational AI should be approached with caution; adherence to ethical standards and careful consideration of both its benefits and associated psychological risks are vital.