81: Psychiatric Risk Associated With Large Language Model Chatbots: An Emerging Concern

Amandeep Jutla, M.D., joins Dr. Dixon and Dr. Berezin, with guest host Dr. Matt Hirschtritt, to discuss concerns surrounding the use of large language model chatbots and psychiatric risk. 01:08   Introduction 04:03   Language models in 2019 05:18   The appeal of chat-based AI for autistic adults 07:34   Do you use chat-based AI models personally? 09:44   Specific concerns of interacting with AI chat bots 11:07   The illusion of speaking with a person 13:34   Suggestions for clinicians and researchers 16:17   Questions a clinician should ask 18:29   Uses for AI models 20:11   Can chat bots get good at providing advice? 21:30   Regulations? 24:12   Motivational interviewing   Transcript   Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]  

Rachel Oblath, Ph.D., joins Dr. Dixon and Dr. Berezin, with guest host Dr. Matt Hirschtritt, to discuss repeated utilization of emergency psychiatric services among youths in both emergency department and alternative settings. Transcript 01:10   Emergency psychiatric services utilization 03:57   Previous studies and unanswered questions 07:01   Emergency room and urgent care 08:39   BEST program 10:53   Findings and considerations 13:46   Results 15:56   Repeat utilization 19:03   Effectiveness of inpatient care 20:06   Non-ED settings 21:46   Implications 25:52   If you could change one thing … 27:56   Stones left unturned 29:12   Variables Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]

Katherine Koh, M.D., M.Sc., joins Dr. Dixon and Dr. Berezin, along with guest host Dr. Matt Hirschtritt, to discuss street psychiatry: what it is, its history, and what it means for the treatment of unhoused patients in often adverse settings. Transcript 01:08     What is street psychiatry? 05:03     Path into street psychiatry 08:24     Purpose of the article 09:22     What makes street psychiatry unique 14:09     "A long walk" 15:45     When does a person become a patient? 18:36     Rewards and challenges 26:14     Recovery and relationships 30:37     A philosophy of working with highly complex cases 35:14     Uncertainty and instability Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]  

Ruth S. Shim, M.D., M.P.H., and Alex Shevrin Venet, M.Ed., join Dr. Dixon and Dr. Berezin, along with guest host Dr. Matt Hirschtritt to discuss equity-centered trauma-informed education (ECTIE), a model that can be applied across the educational spectrum. 04:15     Expanding equity-centered trauma-informed education (ECTIE) beyond K–12 05:59    Five core components 10:25    Reception from teachers and school administrators to ECTIE 12:41    Unconditional positive regard 14:22    How did your collaboration begin? 17:29    Medical school and TIE 19:42    Bidirectional nature of ECTIE 22:00    "Asset-based lens instead of a lens of saviorism" 24:45    Take home points on ECTIE Transcript Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]

Dr. Kathyrn Ridout (Kaiser Permanente Northern California) joins Dr. Dixon and Dr. Berezin to discuss implementing measurement-based care for solo and small-group practitioners. Transcript 00:33     Ridout interview 00:57     Background 02:56     Measurement-based care 04:32     Large integrated systems versus small group and solo practitioners 06:25     Evidence for the utility of measurement-based care 07:37     Communication and engagement between clinicians and patients 10:22     Edge cases that don't quite fit 13:44     Beyond just the PHQ-9 15:00     Moving beyond the measurement of just symptoms 16:04     What should providers be looking for in measurements? 17:27     Computerized adaptive testing 19:08     Artificial intelligence 22:23     When the measurement doesn't match 26:31     "Base truth" Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter.

Dr. Robert Drake (Columbia University, New York) joins Dr. Dixon and Dr. Berezin to discuss a personal reflection looking back at research conducted at Dartmouth in the 1990s looking at mental health, employment, individual placement, and support. Transcript 00:49     Dartmouth in the 1990s 01:59     Failures and successes 04:01     "This was really the greatest serendipity of my life" 07:05     Employment versus day centers 09:11     A pivot point 11:07     Assertive Community Treatment (ACT) 12:53     Finding a job, and a path 16:03     Too sick to work? 18:47     Individual Placement and Support (IPS) 21:00     Wanting to share this experience 22:36     Replicating this program in other environments 24:43     The reflection 29:36     Building relationships 31:17     Building IPS 33:35     Advice for employers Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]

Dr. Benjamin Brody (Weill Cornell Medicine, New York) joins Dr. Dixon and Dr. Berezin to discuss how Joint Commission accreditation can be evolved to ensure that it is aligned with best incentives to for high-quality behavioral health care. Transcript 00:52     Brody background 02:51     Inpatient work 03:42     The tension of inpatient psychiatric care 05:28     The Joint Commission 07:39     What the Joint Commission is doing well 09:04     Best practices 11:02     Who ordered what, when, and where 13:33     Including the patient as a stakeholder 20:23     Comprehensive treatment plans 22:25     What would you do if you were CEO? 24:34     Ensuring that the things the Joint Commission focuses on are the things that improve patients' lives. 25:14     A vision for quality improvement that engages stakeholders 30:12     Shared decision making Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]

Dr. Judith Cook (University of Illinois Chicago) joins Dr. Dixon and Dr. Berezin to discuss an intervention designed to help improve financial literacy and competency and reduce economic strain for people receiving services for psychiatric disorders. Transcript 00:57     Psychiatric services research 02:05     Clinical work and Thresholds 03:46     Current role 04:23     Why does financial wellness matter for this population? 06:43     Psych rehab 08:05     Spending triggers 10:59     A psych rehab framework 12:53     Financial wellness 14:10     Beyond trans-diagnostic 16:24     The curriculum 20:10     Receiving a good financial education 21:32     Top line findings of the trial 25:07     The emotional context of financial wellness 25:55     Trained peer instructors 27:34     Policymaker takeaways 30:30     Financial literacy does not imply financial wellness 32:07     Small goals towards financial wellness  Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]

Dr. Kevin Simon (Harvard Medical School and Boston Public Health Commission) joins Dr. Dixon and Dr. Berezin to discuss the processes behind and concerns surrounding involuntary psychiatric hospitalization. Transcript 01:03     Career path 03:42     Boston Public Health Commission 09:28     Collaborators 13:09     Section 12 16:14     Transportation 17:17     Rates of involuntary transport 22:29     Requests that don't end in transport 23:42     Police involvement Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]

Eunice Wong, Ph.D., (RAND, Santa Monica, Calif.) joins Dr. Dixon and Dr. Berezin to discuss a review taking a look at the interactions of faith communities and the mental health sector in the provision of mental health care. Transcript 00:56     How did you arrive at this field of study? 02:58     What is RAND and what do they do? 04:11     How are works for a think tank evaluated? 05:21     The interaction of faith communities and mental health service provision 07:38     Types of collaboration – PSFPTP Hankerson episode 09:57     Why look at the literature now? 11:12     What kinds of questions are you asking? 12:57     The complexity of different faiths, and different organizations 15:56     Topline findings 18:12     Does the research paradigm work in situations like this? 22:03     Discussing a patient and provider's religiosity 23:20     Assumptions and characterizations of faith-based organizations 24:55     Destigmatizing conversations about mental health and behavioral health in faith-based communities 27:39     The multilayered nature of faith-based community participation 28:53     Future research Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at [email protected]