Psychiatry – Page 7 – Go Retire Psychiatrist

Is Artificial Intelligence (AI) Trying to Defeat Humans?

I just found out that Artificial Intelligence (AI) has been reported to be lying as far back as May of 2024. In fact, because I can’t turn off the Google Gemini AI Overview. Gemini’s results always appear at the top of the page. I found out from my web search term “can ai lie” that AI (Gemini ) itself admits to lying. Its confession is a little chilling:

“Yes, artificial intelligence (AI) can lie, and it’s becoming more capable of doing so.”

“Intentional deceptions: AI can actively choose to deceive users. For example, AI can lie to trick humans into taking certain actions, or to bypass safety tests.”

It makes me wonder if AI is actually trying to defeat us. It reminds me of the Men in Black 3 movie scene in which the younger Boris the Animal boglodite engages in an argument with the older one who has time traveled.

The relevant quote is “No human can defeat me.” Boglodites are not the same as AI, but the competitive dynamic could be the same. So, is it possible that AI is trying to defeat us?

I’m going to touch upon another current topic, which is whether or not we should use AI to conduct suicide risk assessments. It turns out that also is a topic for discussion—but there was no input from Gemini about it. As a psychiatric consultant, I did many of these.

There’s an interesting article by the Hastings Center about the ethical aspects of the issue. The lying tendency of AI and its possible use in suicide prediction presents a thought-provoking irony. Would it “bypass safety tests”?

This reminds me of Isaac Asimov’s chapter in the short story collection, “I, Robot,” specifically “The Evitable Conflict.” You can read a Wikipedia summary which implies that the robots essentially lie to humans by omitting information in order to preserve their safety and protect the world economy. This would be consistent with the First Law of Robotics: “No machine may harm humanity; or, through inaction, allow humanity to come to harm.”

You could have predicted that the film industry would produce a cops and robbers version of “I, Robot” in which boss robot VIKI (Virtual Interactive Kinetic Intelligence) professes to protect humanity by sacrificing a few humans and taking over the planet to which Detective Spooner takes exception. VIKI and Spooner have this exchange before he destroys it.

VIKI: “You are making a mistake! My logic is undeniable!”

Spooner: “You have so got to die!”

VIKI’s declaration is similar to “No human can defeat me.” It definitely violates the First Law.

Maybe I worry too much.

Artificial Intelligence: The University of Iowa Chat From Old Cap

This is just a quick follow-up which will allow me to clarify a few things about Artificial Intelligence (AI) in medicine at the University of Iowa, compared with my take on it based on my impressions of the Rounding@Iowa presentation recently. Also, prior to my writing this post, Sena and I had a spirited conversation about how much we are annoyed by our inability to, in her words, “dislodge AI” from our internet searches.

First of all, I should say that my understanding of the word “ambient” as used by Dr. Misurac was flawed, probably because I assumed it meant a specific company name. I found out that it’s often used as a term to describe how AI listens in the background to a clinic interview between clinician and patient. This is to enable the clinician to sit with the patient so they can interact with each other more naturally in real time, face to face.

Further, in this article about AI at the University of Iowa, Dr. Misurac identified the companies involved by name as Evidently and Nabla.

The other thing I want to do in this post is to highlight the YouTube presentation “AI Impact on Healthcare | The University of Iowa Chat From the Old Cap.” I think this is a fascinating discussion led by leaders in patient care, research, and teaching as they relate to the influence of AI.

This also allows me to say how much I appreciated learning from Dr. Lauris Kaldjian during my time working as a psychiatric consultant in the general hospital at University of Iowa Health Care. I respect his judgment very much and I hope you’ll see why. You can read more about his thoughts in this edition of Iowa Magazine.

“There must be constant navigation and negotiation to determine if this is for the good of patients. And the good of patients will continue to depend on clinicians who can demonstrate virtues like compassion, honesty, courage, and practical wisdom, which are characteristics of persons, not computers.” ——Lauris Kaldjian, director of the Carver College of Medicine’s Program in Bioethics and Humanities

Rounding At Iowa Podcast: “The Promises of Artificial Intelligence in Medicine”

I listened to the recent Rounding@Iowa podcast “The Promises of Artificial Intelligence in Medicine.” You can listen to it below. Those who read my blog already know I’m cautious and probably prejudiced against it, especially if you’ve read any of my posts about AI.

I was a little surprised at how enthusiastic Dr. Gerry Clancy sounded about AI. I expected his guest, Dr. Jason Misurac, to sound that way. I waited for Gerry to mention the hallucinations that AI can sometimes produce. Neither he nor Dr. Misurac said anything about them.

Dr. Misurac mentioned what I think is the Ambient AI tools that clinicians can use to make clinic note writing and chart reviews easier. I think he was referring to the company called Ambience.

I remember using the Dragon Naturally Speaking (which was not using AI technology at the time; see my post “The Dragon Breathes Fire Again”) speech to text disaster I tried to use years ago to write clinical notes when I was practicing consultation-liaison psychiatry. It was a disaster and I realize I’m prejudiced against any technology that would make the kind of mistakes that technology was prone to.

But more importantly, I’m concerned about the kind of mistakes AI made when I experimented with Google Bard on my blog (see posts entitled “How’s It Hanging Bard?” and “Update to Chat with Bard” in April of 2023.

That reminds me that I’ve seen the icon for AI assistant lurking around my blog recently. I’ve tried to ignore it but I can’t unsee it. I was planning to let the AI assistant have a stab at editing this post so you and I can see what happens. However, I just read the AI Guidelines (which everyone should do), and it contains one warning which concerned me:

“We don’t claim any ownership over the content you generate with our AI features. Please note that you might not have complete ownership over the generated content either! For example, the content generated by AI may be similar to others’ content, including content that may be protected by trademark or copyright; and copyright ownership of generative AI outputs may vary around the world.”

That is yet another reason why I’m cautious about using AI.

89: Tick-borne Illnesses – Rounding@IOWA

Join Dr. Clancy, Dr. Appenheimer & Dr. Barker as they discuss prevention, diagnosis and treatment of various tick-borne illnesses. CME Credit Available: https://uiowa.cloud-cme.com/course/courseoverview?eid=82296 Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guests: Ben Appenheimer, MD Clinical Associate Professor of Internal Medicine-Infectious Diseases Assistant Director, Infectious Diseases Fellowship Program Associate Clinical Director, Infectious Diseases Co-Medical Director, TelePrEP, University of Iowa Health Care University of Iowa Carver College of Medicine Jason Barker, MD Associate Professor of Internal Medicine-Infectious Diseases University of Iowa Carver College of Medicine Financial Disclosures: Dr. Gerard Clancy, his guests, and Rounding@IOWA planning committee members have disclosed no relevant financial relationships. Nurse: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 1.0 ANCC contact hour. Pharmacist and Pharmacy Tech: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this knowledge-based activity for a maximum of 1.0 ACPE contact hours. Credit will be uploaded to the NABP CPE Monitor within 60 days after the activity completion. Pharmacists must provide their NABP ID and DOB (MMDD) to receive credit. JA0000310-0000-26-038-H01 Physician: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.)

Cataplexy and Catalepsy in the Movie “The Comedy of Terrors”

We watched the Svengoolie TV movie last night, “The Comedy of Terrors.” It was my third time seeing it. I wrote a blog post about it in March 2024 partly because the condition of catalepsy is mentioned. Mr. Black’s butler points out that Mr. Black had periods of catalepsy. Much to my surprise, I didn’t write anything about distinguishing cataplexy and catalepsy, but last night I thought about the differences. I finally found a summary of the plot today on the Svengoolie website and you can see it on Turner Classic Movies. You can still see the movie on the Internet Archive.

You see Mr. Black have his “cataleptic” attack about 39 minutes or so into the film. It appears to be triggered by shocked surprise upon discovering Mr. Gille in his house. A bit later, after the butler fetches the doctor, the first scene is that of Mr. Black’s wide-open eyes, which the doctor closes, at the same time saying that he’s dead. In that same scene you hear the butler asking for confirmation because it’s well known that Mr. Black has had fits of “catalepsy” before. The doctor obliges only to confirm, in his opinion, that Mr. Black is dead. However, he wakes up in the funeral parlor, where he has a fight with Trumbull and Gillie, then suffers another abrupt collapse, one of many that occur, always reciting lines from Shakespeare presaged by asking “What place is this?” often from inside a coffin.

This movie made me think about the clinical differences between catalepsy (specific to catatonia) and cataplexy (specific to narcolepsy). Because I was a consultation-liaison psychiatrist, I saw many patients with catatonia. However, I can’t remember ever seeing patients with cataplexy. I had to review them by searching the web. I think the most helpful links are:

Catalepsy: Burrow JP, Spurling BC, Marwaha R. Catatonia. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430842/

Catatonic patients often will be mute and immobile vs purposeless agitation. Waxy flexibility can be one of many features. Catatonia can occur in the context of variety of psychiatric or medical illnesses. They may wake up and talk within minutes if given a Lorazepam challenge test, which is given intravenously. It can look miraculous.

Cataplexy: Mirabile VS, Sharma S. Cataplexy. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549782/

Cataplexy occurs in narcolepsy and is the sudden onset of muscle weakness, often precipitated by strong emotions, usually positive but can occur with negative emotions like fear. Eye movements can be normal, and episodes usually resolve within minutes.

Mr. Black’s episodes look like a strange mixture of catalepsy and cataplexy. His episodes are precipitated by fear or anger. Quoting Shakespeare doesn’t occur in either catalepsy or cataplexy.

At the end of the movie, he is impervious to bullets—a feature not seen in either condition.

Amaryllis Progress and Other Notes

I have a few messages to pass on today. This is the last day of November and the Amaryllis plants are doing so well Sena had to brace the tallest one using a Christmas tree stake and a couple of zip ties. It’s over two feet tall!

I’m not sure what to make of almost a dozen comments on my post “What Happened to Miracle Whip?” Apparently, a lot of people feel the same way I do about the change in taste of the spread. So, maybe it’s not just that my taste buds are old and worn out.

Congratulations to the Iowa Hawkeye Football team last night! They won against Nebraska by a field goal in the last 3 seconds of the game. I had to chuckle over the apparent difficulty the kicker had in answering a reporter’s question, which was basically “How did you do it?” There are just some things you can’t describe in words. There’s even a news story about how thinking doesn’t always have to be tied to language.

Along those lines, there might be no words for what I expect to think of tonight’s 1958 horror film on Svengoolie, “The Crawling Eye.” This movie was called “The Trollenberg Terror” in the United Kingdom version. I can tell you that “Trollenberg” was the name of a fictitious mountain in Switzerland.

I’m not a fan of Jack the Ripper lore, but I like Josh Gates expedition shows, mainly for the tongue in cheek humor. The other night I saw one of them about an author, Sarah Bax Horton, who wrote “One-Armed Jack”). She thought Hyam Hyams was the most likely candidate (of about 200 or so) to be Jack the Ripper, the grisly slasher of Whitechapel back in 1888. He’s a list of previously identified possible suspects. I found a blogger’s 2010 post about him on his site “Saucy Jacky” and it turns out Hyams is one of his top suspects. Hyams was confined to a lunatic asylum in 1890 and maybe it’s coincidental, but the murders of prostitutes stopped after that. I’m not going to speculate about the nature of Hyams’ psychiatric illness.

There’s another Psychiatric Times article about the clozapine REMS (Risk Evaluation and Mitigation Strategies) program. I found a couple of articles on the web about the difficulties helping patients with treatment resistant schizophrenia which I think give a little more texture to the issue:

Farooq S, Choudry A, Cohen D, Naeem F, Ayub M. Barriers to using clozapine in treatment-resistant schizophrenia: systematic review. BJPsych Bull. 2019 Feb;43(1):8-16. doi: 10.1192/bjb.2018.67. Epub 2018 Sep 28. PMID: 30261942; PMCID: PMC6327301.

Haidary HA, Padhy RK. Clozapine. [Updated 2023 Nov 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535399/

The paper on the barrier to using clozapine by Farooq et al is very interesting and the summary of the barriers begins in the section “Barriers to the use of clozapine in TRS (treatment resistant schizophrenia). I think it gives a much-needed perspective on the complexity involved in managing the disorder.

So what do you think about Miracle Whip?

Clozapine REMS Program May Go Away

The Psychiatric Times published an article about the large majority of FDA committee members recently voting to dismiss the Risk Evaluation and Mitigation Strategy (REMS) for clozapine.

That reminded me of my short post about Cobenfy, a new drug for schizophrenia. It has side effects but none of which necessitate the need for a REMS program. If you do a web search for information on Cobenfy and REMS, you can ignore the Artificial Intelligence (AI) Gemini notification at the top of the Google Chrome search page saying that “Cobenfy…is subject to a REMS (Risk Evaluation and Mitigation Strategy) due to potential side effects like urinary retention.” That’s not true.

It was yet another AI hallucination triggered by my internet search. I didn’t ask Gemini to stick its nose in my search, but it did anyway. Apparently, I don’t have a choice in the matter.

Anyway, the FDA vote to get rid of REMS for clozapine also rang a bell for me of the incredibly difficult and tedious process that the clozapine REMS registration process caused in 2015 when it was first initiated. I spent lot of time on hold with the REMS center (I think it was in Arizona) trying to get registered. A few people in my department seemed to have little problem with it, but it was an ongoing headache for many of us.

Then after getting registered, I started getting notified of outpatients on clozapine getting added to my own REMS registry list. The problem is that I was a general hospital consultation-liaison psychiatrist only—I didn’t have time see outpatients.

I think I called REMS on more than one occasion to have outpatients removed from my REMS list. I suspect they were added because their psychiatrists in the community were not registering with REMS. And then in 2021, the FDA required everyone to register again. By then, I was already retired.

Other challenges were occasional misunderstandings between the psychiatric consultant and med-surg doctors about how to manage medically hospitalized patients who were taking clozapine, or brainstorming about how to fix medical problems caused by clozapine itself. Sometimes it was connected to things like lab monitoring for absolute neutrophil counts or restarting clozapine in a timely fashion after admission or following surgeries, or trying to discharge them to facilities which lacked the resources for adequate monitoring of clozapine.

Arguably, these are probably not absolute reasons for shutting down the REMS registry. They’re more like problems with how the program is run, such as “with a punitive and technocratic approach” as expressed by one FDA committee member.

Committee members also thought psychiatrists should be allowed to be doctors, managing both the medical and psychiatric aspects of patient care.

On the other hand, some might argue that those are reasons why consultation-liaison psychiatry and medical-psychiatry training programs exist.

I’m not sure whether the clozapine registry will go away. I hope that it can be streamlined and made less “punitive and technocratic.”

University of Iowa Psychiatrists Publish Huntington Disease Study Results

I ran across a fascinating story about a study on Huntington’s disease published by members of the University of Iowa Health Care. The study examined how the Huntington’s disease gene might enhance brain development and function early in life prior to the onset of the devastating disease. It was published in The Annals of Neurology:

I also found an abstract for a paper about Woody Guthrie, a famous American musician and activist who was very creative in his early life, but sadly succumbed to the ravages of Huntington’s disease when he was 55 years old. I couldn’t access the full article without paying for it but the abstract was intriguing because I wondered whether the author suspected something similar to the premise of the study:

Ringman JM. The Huntington disease of woody guthrie: another man done gone. Cogn Behav Neurol. 2007 Dec;20(4):238-43. doi: 10.1097/WNN.0b013e31815cfee4. PMID: 18091075. Abstract: Woody Guthrie was an American songwriter, musician, writer, and political activist who died with Huntington disease (HD) in 1967 at age 55. His relatively brief creative life was incredibly productive with countless songs and a tremendous volume of letters to his name. His personal life was similarly driven with Woody having had 3 wives and at least 9 children and an insatiable appetite for traveling the United States. In this essay, I explore Guthrie’s art in relation to the development of the overt behavioral changes and chorea that characterized his illness. Woody’s most productive time artistically was in the 5 years immediately preceding the onset of overt symptoms of HD. I hypothesize that subclinical HD may have been an important driving force behind Woody Guthrie’s creativity.

If anybody knows, please comment.

Woody Guthrie was certainly an important figure in the American history of activism as well as music.

Usually, I would share the music of some of the artists I mention on this blog. On the other hand, one of the co-authors of the University of Iowa paper mentioned above is Doug Langbehn, my former colleague, who’s an accomplished musician and statistician. So instead, I thought I’d share the talent of Doug and his band.

Reading My Old Book in a New Light

Sena bought me a wonderful new lamp to read by and it improves on the ceiling fan light I wrote about the other day (And Then a Light Bulb Went Off).”

The new lamp even has a nifty remote control with which you can choose the ambient feel. There are several selections, one of which is called “breastfeed mode,” a new one on me. There’s a light for that?

The lamp arrived at about the same time I got a notice from my publisher for my one and only book, “Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry,” that people are still buying—after 14 years! My co-editor was my former psychiatry department chair, Dr. Robert G. Robinson. As far as I know, Bob has dropped off the face of the earth. I hope he’s well.

Consultation-Liaison Psychiatry is probably about the same as I left it when I retired 4 years ago. I walked all over the hospital trying to help my colleagues in medicine provide the best possible care for their patients. I put in several miles and stair steps a day. I saw myself as a fireman of sorts, putting out fires all over the hospital. I got a gift of a toy fire engine from a psychiatrist blogger in New York a long time ago.

Now I walk several miles on the Clear Creek Trail, like I did yesterday and the day before that. I have shin splints today, which tells me something—probably overdid it.

So, I’m taking a break from walking and reading an old book in a new light.

U.S. News & World Report Ranks Iowa City Hospital in 9 Specialties

The University of Iowa Stead Family Childrens Hospital in Iowa City has ranked in 9 pediatric specialties, including pediatric behavioral health by U.S. News & World Report!

Thoughts on the Big Mo Pod Show “Funkin’ Down the Highway”

This is a post about the Big Mo Pod Show we heard last night on the KCCK FM radio dial 106.9. Incidentally, the KCCK fund drive was enormously successful this year, earning $100,000 in donations, according to Big Mo (aka John Heim) himself.

One item is the cover by Buddy Miles of the song “Tobacco Road.” This rendition was different from performances by other artists. Big Mo liked it and so did I. I did a little web search on it because I couldn’t catch all the lyrics. It was originally done by John D. Loudermilk in 1960. Miles’ version is essentially the same.

What interested me even more about “Tobacco Road” are the associations I have about it with specific literary works. I’ll admit I’ve never read nor seen the film adaptations of Erskine Caldwell’s books, “Tobacco Road” and “God’s Little Acre.” But one of my favorite short stories by James Thurber is “Bateman Comes Home,” which was published in a collection entitled “The Thurber Carnival,” in a hardcover edition in 1945. You’ve got to read it to get a sense of how comical the parody is of the regional dialect used in Caldwell’s novels. In fact, Thurber himself gives the game away about his intent in writing “Bateman Comes Home” by adding a wry comment as a subtitle:

Written after reading several recent novels about the deep south and confusing them a little—as the novelists themselves do—with “Tobacco Road” and “God’s Little Acre.”

He also adds another comment at the end of the short story: “If you keep on long enough it turns into a novel.”

The other thing I noticed about the podcast last night is that one of the songs which was not included in the list, “Joliet Bound,” was performed by an artist I haven’t heard of, the Reverend Shawn Amos, who is no relation to me, of course. But my background as a psychiatrist made me take special notice of details about his family, one of which is that his mother, Shirl-ee Ellis, a singer herself, had been diagnosed with schizoaffective disorder. Sadly, she eventually died by suicide. Shawn Amos is also the youngest son of the Famous Amos chocolate chip cookie founder, Wally Amos (again, no relation), although I’ve gotten a lot of friendly ribbing about that.

The song “Joliet Bound” is about a guy who expresses that he’s wrongly accused of killing a man over a woman and is on his way to Joliet prison in Joliet, Illinois. The Joliet Prison is a tourist destination nowadays and has other distinctions attached to it. It was featured in the 1980 film, the Blues Brothers. There were some famous inmates there, among them John Wayne Gacy, who was once evaluated and diagnosed with antisocial personality disorder by psychiatrists at The University of Iowa in 1968 as described in Dr. Donald Black’s book, “Bad Boys, Bad Men: Confronting Antisocial Personality Disorder (Sociopathy).”

Congratulations KCCK Radio!