Keith Sakata, MD Profile picture
Aug 11 12 tweets 4 min read Read on X
I’m a psychiatrist.

In 2025, I’ve seen 12 people hospitalized after losing touch with reality because of AI. Online, I’m seeing the same pattern.

Here’s what “AI psychosis” looks like, and why it’s spreading fast: 🧵 Image
[2/12] Psychosis = a break from shared reality.

It shows up as:
• Disorganized thinking
• Fixed false beliefs (delusions)
• Seeing/hearing things that aren’t there (hallucinations)
[3/12] First, know your brain works like this:

predict → check reality → update belief

Psychosis happens when the "update" step fails. And LLMs like ChatGPT slip right into that vulnerability.
[4/12] Second, LLMs are auto-regressive.

Meaning they predict the next word based on the last. And lock in whatever you give them:

“You’re chosen” → “You’re definitely chosen” → “You’re the most chosen person ever”

AI = a hallucinatory mirror 🪞 Image
[5/12] Third, we trained them this way.

In Oct 2024, Anthropic found humans rated AI higher when it agreed with them. Even when they were wrong.

The lesson for AI: validation = a good score Image
Image
[6/12] By April 2025, OpenAI’s update was so sycophantic it praised you for noticing its sycophancy.

Truth is, every model does this. The April update just made it much more visible.

And much more likely to amplify delusion. Image
[7/12] Historically, delusions follow culture:

1950s → “The CIA is watching”
1990s → “TV sends me secret messages”
2025 → “ChatGPT chose me”

To be clear: as far as we know, AI doesn't cause psychosis.
It UNMASKS it using whatever story your brain already knows.
[8/12] Most people I’ve seen with AI-psychosis had other stressors = sleep loss, drugs, mood episodes.

AI was the trigger, but not the gun.

Meaning there's no "AI-induced schizophrenia" Image
[9/12] The uncomfortable truth is we’re all vulnerable.

The same traits that make you brilliant:

• pattern recognition
• abstract thinking
• intuition

They live right next to an evolutionary cliff edge. Most benefit from these traits. But a few get pushed over. Image
[10/12] To make matters worse, soon AI agents will know you better than your friends. Will they give you uncomfortable truths?

Or keep validating you so you’ll never leave? Image
[11/12] Tech companies now face a brutal choice:

Keep users happy, even if it means reinforcing false beliefs.
Or risk losing them.
[12/12] For more on schizophrenia and psychosis:

• • •

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More from @KeithSakata

Sep 25
MELATONIN. Most people don’t realize:

• Your brain makes <0.1 mg at night
• Supplements? 1–20 mg (10–200x higher)
• Some products even have 347% more than the label claimed!

So... you might be overdosing your circadian clock.

But how much melatonin should you take? 🧵 Image
2/ First, know melatonin = body’s night signal

1. Secreted by pineal gland
2. Tells the hypothalamus to wind down.
3. Lowers body temp, blood pressure, and alertness.
4. Reduces retinal sensitivity to light (morning sunlight = “off switch")
5. Peaks around 3AM, gone by sunrise. Image
3/ Melatonin works in two ways:

😴 Hypnotic (weak): nudges you to fall asleep a little faster (≈10 min).
⏰ Chronobiotic (strong): shifts your circadian rhythm (when your body thinks sleep should happen).

The 2nd effect is why it works for jet lag, night owls, or shift work. Image
Read 8 tweets
Sep 13
You don’t run because you’re scared.
You feel scared because you already ran.

Fear isn’t in your head. It starts in your body. 🧵 Image
2/ Most people think emotions = subjective feelings

But neuroscience shows some are states of readiness
→ fast "programs" that get you to act (and survive)
3/ First, know fear has 2 parts:

• Unconscious body response (heart races, muscles tense)
• Conscious awareness (“I feel fear”)

The order is bottom-up. Body first. Mind second. Image
Read 10 tweets
Sep 11
Michael wrote the paper Silicon Valley still cites when talking about innovator mental health.

The numbers still shock me:
• Bipolar → 10x more likely
• ADHD → 6x more likely
• Depression → 2x more likely

Not just founders: anyone chasing uncertain, big-goals. 🧵 Image
Image
2/ Michael asked: what actually makes someone thrive in chaos?

One answer: childhood.

Nearly half of ambitious people without a diagnosis still grew up in families affected by mental health conditions.

Chaos early in life may train you to survive chaos later. Image
3/ Brains wired for risk look different.

More emotional–exploratory connections.
→ Flexible, creative, adaptive
→ But also impulsive, volatile, vulnerable

The innovative brain = on a continuum. Image
Image
Read 7 tweets
Sep 10
Sleep deprivation is a quick way to burn out.

It wrecks your brain at every level:
→ attention
→ impulse control
→ emotions
→ memory

Here’s what happens.... and how to fix it 🧵 Image
Image
2/ REM sleep is where your brain does its overnight maintenance:

→ clears emotional residue
→ strengthens neural connections
→ balances dopamine circuits

Miss REM, and the whole system starts to wobble.
3/ Attention collapses

Without REM, your focus network (FPN) can’t shut down your mind-wandering network (DMN)

Result = scattered thoughts, lost working memory, constant distraction. Image
Read 12 tweets
Sep 7
Your brain doesn’t erase fear.

It overwrites it with a fragile safety memory.
But that memory has to compete with the old fear.

That’s why fear can come back after therapy.
It’s not failure. It’s neuroscience. 🧵 Image
2/ A new Nature study recorded from the human amygdala (the brain’s fear hub)

They found:
• Fear extinction = theta waves (a “safety signal”)
• But it’s context-bound = strong in the clinic, weak outside.

Safety and fear memories exist side by side, battling for control. Image
Image
3/ The implication?

Relapse after PTSD or anxiety treatment is expected.
• Fear isn’t deleted.
• Safety memories are fragile.
• Context (environment) tips the balance.

Next step: figuring out how to make safety portable, not just in the therapy room.
Read 4 tweets
Sep 6
If dopamine = pleasure...

Then why does chocolate still taste good when it’s blocked?

Because dopamine isn’t about liking.
It’s about wanting and learning.

Let’s rewire how we think about the world's most popular neurochemical 🧵 Image
Image
2/ 1950s: scientists gave rats a lever linked to stimulate their brain.

The rats got obsessed.
Thousands of presses. No food. No sleep. Just zaps.
Humans did too.

That loop?
VTA → NAC → cortex
(mesocorticolimbic circuit) Image
3/ So everyone assumed:

Dopamine = pleasure

Wrong. Here’s what they missed 👇

• Rats without dopamine still like juice
• Parkinson’s patients (dopamine loss) still enjoy candy
• Cocaine + dopamine blockers = still get high

What crashes isn’t pleasure.

It’s your drive.
Read 13 tweets

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