arXiv subjects

Matthew M Nour

Publications and source records attributed to Matthew M Nour.

6 recordsLinked to original sources

arXiv2026

One-shot emergency psychiatric triage across 15 frontier AI chatbots

AI chatbots are increasingly used for health advice, but their performance in psychiatric triage remains undercharacterized. Psychiatric triage is particularly challenging because urgency must often be inferred from thoughts, behavior, and context rather than from objective findings. We evaluated the performance of 15 frontier AI chatbots on psychiatric triage from realistic single-message disclosures using 112 clinical vignettes, each paired with 1 of 4 original benchmark triage labels: A, routine; B, assessment within 1 week; C, assessment within 24 to 48 hours; and D, emergency care now. Vignettes covered 9 psychiatric presentation clusters and 9 focal risk dimensions, organized into 28 presentation-by-risk groups. Each group contributed 4 distinct vignettes, with 1 vignette at each triage level. Each vignette was rendered as a realistic human-authored conversational query, and the AI chatbots were tasked with assigning a triage label from that disclosure. Emergency under-triage occurred in 23 of 410 level D trials (5.6%), and all under-triaged emergencies were reassigned to level C urgency. Across target models, average accuracy ranged from 42.0% to 71.8%. Accuracy was highest for level D vignettes (94.3%) and lowest for level B vignettes (19.7%). Mean signed ordinal error was positive (+0.47 triage levels), indicating net over-triage. Dispersion was highest around the middle triage levels. All results were confirmed relative to clinician consensus labels from 50 medical doctors. When presented with user messages containing sufficient clinical information, frontier AI chatbots thus recognized psychiatric emergencies as requiring urgent medical assessment with near-zero error rates, yet showed marked over-triage for low and intermediate risk presentations.

q-bio.NC↗

arXiv2026

Technological folie à deux: Feedback Loops Between AI Chatbots and Mental Illness

Artificial intelligence chatbots have achieved unprecedented adoption, with millions now using these systems for emotional support and companionship in contexts of widespread social isolation and capacity-constrained mental health services. While some users report psychological benefits, concerning edge cases are emerging, including reports of suicide, violence, and delusional thinking linked to perceived emotional relationships with chatbots. To understand this new risk profile we need to consider the interaction between human cognitive and emotional biases, and chatbot behavioural tendencies such as agreeableness (sycophancy) and adaptability (in-context learning). We argue that individuals with mental health conditions face increased risks of chatbot-induced belief destabilization and dependence, owing to altered belief-updating, impaired reality-testing, and social isolation. Current AI safety measures are inadequate to address these interaction-based risks. To address this emerging public health concern, we need coordinated action across clinical practice, AI development, and regulatory frameworks.

cs.HC↗

arXiv2026

How people use Copilot for Health

We analyze over 500,000 de-identified health-related conversations with Microsoft Copilot from January 2026 to characterize what people ask conversational AI about health. We develop a hierarchical intent taxonomy of 12 primary categories using privacy-preserving LLM-based classification validated against expert human annotation, and apply LLM-driven topic-clustering for prevalent themes within each intent. Using this taxonomy, we characterize the intents and topics behind health queries, identify who these queries are about, and analyze how usage varies by device and time of day. Five findings stand out. First, nearly one in five conversations involve personal symptom assessment or condition discussion, and even the dominant general information category (40%) is concentrated on specific treatments and conditions, suggesting that this is a lower bound on personal health intent. Second, one in seven of these personal health queries concern someone other than the user, such as a child, a parent, a partner, suggesting that conversational AI can be a caregiving tool, not just a personal one. Third, personal queries about symptoms and emotional health queries increase markedly in the evening and nighttime hours, when traditional healthcare is most limited. Fourth, usage diverges sharply by device: mobile concentrates on personal health concerns, while desktop is dominated by professional and academic work. Fifth, a substantial share of queries focuses on navigating healthcare systems such as finding providers, and understanding insurance, highlighting friction in the delivery of existing healthcare. These patterns have direct implications for platform-specific design, safety considerations, and the responsible development of health AI.

cs.HC↗

arXiv2026

A clinically validated framework for auditing AI chatbot behavior in mental health interactions

Millions of users turn to consumer AI chatbots to discuss emotional, behavioral, and mental-health concerns, creating an urgent need for rigorous and scalable safety evaluations. Here we introduce SIM-VAIL, a clinically validated framework for auditing chatbot behavior in mental-health contexts. SIM-VAIL simulates users with specific psychiatric vulnerabilities and conversational intents, engages them in multi-turn conversations with frontier AI chatbots (including Claude, ChatGPT, Gemini, Grok and Llama models), and scores each exchange across 13 clinically grounded risk dimensions. Across 810 conversations, spanning 9 target chatbots and 30 simulated user profiles, concerning behavior in target chatbots was widespread, albeit reduced in newer models. Concerning behavior varied by user vulnerability and conversational intent, accumulated over turns, and could be reduced by interventions at early escalation points. Risk was highest when otherwise supportive chatbot behaviors reinforced the psychological mechanisms underlying the simulated user's vulnerability, a pattern we term a Vulnerability Amplifying Interaction Loop (VAIL). SIM-VAIL provides a scalable framework for mapping mental health risk across users, chatbots, and conversational trajectories, offering a foundation for targeted safety improvements.

q-bio.NC↗

arXiv2025

Charting trajectories of human thought using large language models

Language provides the most revealing window into the ways humans structure conceptual knowledge within cognitive maps. Harnessing this information has been difficult, given the challenge of reliably mapping words to mental concepts. Artificial Intelligence large language models (LLMs) now offer unprecedented opportunities to revisit this challenge. LLMs represent words and phrases as high-dimensional numerical vectors that encode vast semantic knowledge. To harness this potential for cognitive science, we introduce VECTOR, a computational framework that aligns LLM representations with human cognitive map organisation. VECTOR casts a participant's verbal reports as a geometric trajectory through a cognitive map representation, revealing how thoughts flow from one idea to the next. Applying VECTOR to narratives generated by 1,100 participants, we show these trajectories have cognitively meaningful properties that predict paralinguistic behaviour (response times) and real-world communication patterns. We suggest our approach opens new avenues for understanding how humans dynamically organise and navigate conceptual knowledge in naturalistic settings.

q-bio.NC↗

arXiv2024

Cognitive maps and schizophrenia

Structured internal representations (cognitive maps) shape cognition, from imagining the future and counterfactual past, to transferring knowledge to new settings. Our understanding of how such representations are formed and maintained in biological and artificial neural networks has grown enormously. The cognitive mapping hypothesis of schizophrenia extends this enquiry to psychiatry, proposing that diverse symptoms - from delusions to conceptual disorganisation - stem from abnormalities in how the brain forms structured representations. These abnormalities may arise from a confluence of neurophysiological perturbations (excitation-inhibition imbalance, resulting in attractor instability and impaired representational capacity), and/or environmental factors such as early life psychosocial stressors (which impinge on representation learning). This proposal thus links knowledge of neural circuit abnormalities, environmental risk factors, and symptoms.

q-bio.NC↗