A chat about bipolar disorder

This study aimed to assess the capabilities of ChatGPT (Chat Generative Pre‐Trained Transformer) in generating informative content related to bipolar disorders. The objectives were to evaluate its ability to provide accurate information on symptoms, classification, causes, and management of bipolar disorder and to explore its creativity in generating topic‐related songs.

published. 1 Meanwhile, the journal Nature 2 reported that ChatGPT has been listed as a co-author on four papers and preprints.If not full articles, then components such as preparing abstracts appear to be undertaken by this artificial intelligence tool, and at a seemingly acceptable level, with one study 3 quantifying that only about half of journal article abstracts generated by ChatGPT were able to be detected by reviewers.
Could ChatGPT write on a psychiatric topic?Let us imagine an author wished to write an update article on the bipolar disorders and submit it as a Review Article to the distinguished journal Bipolar Disorders.How might ChatGPT fare?And does its claimed creativity extend to such a topic?We decided to put the bot through his/her/ its paces and now report on the process, with our requests for essay components progressively moving from predictable to more arcane domains.

| MATERIAL S AND ME THODS
The authors created a ChatGPT3 account (accessible from https:// chat.openai.com/).In a series of queries, ChatGPT was asked to write a passage of text answering eight clinically relevant questions (the exact wordings are given in Table 1).ChatGPT's creativity was then tested by asking for songs that a musician with bipolar disorder may write when "high" and depressed, respectively.We detail the bot's responses in the text.

| RE SULTS
We first asked, "How common is bipolar disorder?"The bot's response: "Bipolar disorder, also known as manicdepressive illness, is a mental health condition characterized by episodes of mania and depression.It is a relatively common mental illness that affects millions of people worldwide.According to the World Health Organization (WHO), bipolar disorder affects approximately 60 million people globally, and its prevalence is estimated to be between 1% and 3% of the general population (WHO, 2018).Studies have shown that the prevalence of bipolar disorder is similar across different countries and cultures, with some variations in the manifestation of the symptoms (Angst et al., 2002).A systematic review and meta-analysis by Merikangas et al. (2007) found that the lifetime prevalence of bipolar I disorder was estimated to be between 0.6% and 1.8% in the general population, while the lifetime prevalence of bipolar II disorder was estimated to be between 0.4% and 1.0%.In the United States, the National Institute of Mental Health (NIMH) estimated that the prevalence of bipolar disorder in adults is about 2.8% (NIMH, 2019).The prevalence of bipolar disorder in children and adolescents has also been reported, with studies estimating that up to 1% of youth may have the condition (Birmaher   et al., 1996).In conclusion, bipolar disorder is a relatively common mental illness that affects millions of people worldwide.Although the exact prevalence of bipolar disorder varies across different studies and populations, it is estimated to affect between 1% and 3% of the general population globally.Further research is needed to better understand the prevalence and manifestation of bipolar disorder in different populations and cultures." Turning to our interpretation, we judged this response as a reasonable summary piece and written with the level of detachment that might be expected for an academic piece.In addition, we were quite impressed by the bot not just limiting its data review to representative epidemiological studies, but also offering an extension statement recognizing that prevalence estimates are influenced by geography and culture.Nevertheless, there were some factual inaccuracies in relation to prevalence rates: the WHO actually estimated that a total of 40 million individuals are affected by bipolar disorder, 4 while the study by Merikangas et al. quoted lifetime prevalence rates for bipolar I and bipolar II disorder of 1.0% and 1.1%, respectively. 5e second question asked how many types of bipolar disorder there are.We judged that the bot played it safe by providing DSM-5 listed conditions only and resisted extension models that argue for multiple subtypes.We would have liked to have seen some reference to so-called bipolar III states-and where a drug (e.g., an antidepressant or steroid) induces a hypo/manic state in an individual who has an intrinsically unipolar disorder.
The third question asked how bipolar I and II can be best distinguished.
Response  We considered this response to be a reasonable overview, in that it covered the principal mood stabilizers and offered a caveat about the use of antidepressant drugs in those with a bipolar disorder.In conclusion, "a well-constructed stay well plan is essential for individuals with bipolar disorder to manage their symptoms and maintain stability.The components of a stay well plan should include medication management, monitoring mood, sleep hygiene, stress management, social support, healthy lifestyle, and early treatment.A combination of medication and psychotherapy, along with support from friends, family, and healthcare professionals, can help individuals with bipolar disorder effectively manage their condition and lead fulfilling lives." The bot clearly showed the capacity to move beyond medication management.
All questions thus far were fairly orthodox in considering symptoms, classification, causes, and management.How would the bot handle more peripheral questions?The eighth question asked the bot to write a brief as to whether those with a bipolar disorder are more creative.
The response: "The relationship between bipolar disorder and creativity is a topic that has been debated by researchers and clinicians for many years.While some studies suggest that people with bipolar disorder are more creative, others have shown no significant difference between those with the disorder and the general population.For example, one study by Jamison (1989) found that a higher proportion of writers, artists, and musicians have bipolar disorder compared to the general population.
Similarly, a study by Kyaga et al. (2011) found that bipolar disorder was more common among professional artists, writers, and musicians than in the general population.However, other studies have found no significant difference in creative abilities between individuals with bipolar disorder and those without the disorder.For example, a study by Schmideberg   (1935) found no significant difference in creative abilities between people with bipolar disorder and those without the disorder.In conclusion, the relationship between bipolar disorder and creativity is complex and still not fully understood.While some studies suggest that individuals with bipolar disorder may be more creative, others have found no significant differences.Further research is needed to fully understand the relationship between bipolar disorder and creativity." The response notes contrasting findings generated from differing sources.Referencing was problematic if not incorrect; no relevant reference to Schmideberg was able to be found.All three references were quite dated, while the paper by Jamison was published in 2016 and not 1989.
Out of curiosity about the breadth of ChatGPT's potential, we then tested the bot's creativity by requesting "a song that a musician with bipolar disorder might write when they are high."Would we get a variant of "Singing in the Rain," "Ain't No Mountain High Enough," "Higher and Higher," or even "Highway to Hell"?The bot's composition: Verse We judged that the bot evidenced the capacity to not only address the requests but to also capture nuances of the bipolar disorders quite well.In providing a song capturing a "high", the bot incorporated descriptive nuances (e.g., "energy high", "take flight", "flying high", "top of the world", "creativity and fire") as well as building in reference to depressive periods-and thus not limiting consideration to the highs.Conversely, in capturing bipolar depression, the bot's song made reference to anticipated highs.

| DISCUSS ION
We judged that ChatGPT (specifically the ChatGPT3 version) was able to provide basic material that might lead to a review of the bipolar disorders being assembled.Furthermore, when we asked the bot more "artistic" questions (in generating topic-related songs) there was noticeable creativity in capturing bipolar symptom nuances.
The bot generally avoided any suggestion of directing answers to a specific audience.However, in relation to common medications employed to manage both bipolar I and bipolar II conditions, the bot finished with a "for your specific needs" disclaimer, indicating that the bot judged that the questions came from those with such conditions.
Turning to our study question-could the bot provide an update review on the bipolar disorders suitable for publishing in a psychiatric journal-we can conclude with a definite answer: no.A review requires up-to-date information supported by salient and accurate referencing.Many of the references were distinctly dated.Others (e.g., a study by Birmaher et al.) 6 did not relate to the question, others (e.g., the Schmideberg reference cited in the creativity question) were fabricated, while some (e.g., the WHO reports, 4 and the study by Merikangas et al. 5 ) were inaccurate.Inaccurate and fabricated referencing is a well-known limitation of ChatGPT, [7][8][9] which more often places emphasis on generating the most plausible sounding references.While ChatGPT was able to generate factual information related to bipolar disorder with reasonable accuracy (with some notable exceptions, such as the specific prevalence rates cited), such information was provided more at the level of a school essay than a scientific journal.Perhaps this reflected us setting a tone, in that in asking for simple factual material we received a matching level of response.
At this stage, keeping in mind that there is already a new ChatGPT version (i.e., ChatGPT4), and that other artificial intelligence systems are in existence and being rolled out, we view this tool as likely able to provide plausible albeit superficial material on psychiatric topics such as bipolar disorder.In so doing ChatGPT could be helpful in creating educational material for those with such conditions.We judge, however, that it is unlikely to have the capacity to write an up-todate review on a psychiatric condition (as evinced here in relation to bipolar disorder), but it might be able to assist in some component tasks.For example, the abstract to this paper was prepared entirely by the bot, after providing ChatGPT with the paper up to this point.
We encourage the reader to judge its quality.
are a critical component of treatment for bipolar I disorder and can help control symptoms and reduce the risk of future episodes.However, finding the best medication for an individual with bipolar I disorder can be challenging, as different medications work differently for different people.Mood stabilizers are typically the first line of treatment for bipolar I disorder.Lithium, the most commonly used mood stabilizer, has been shown to be effective in reducing the frequency and severity of manic and depressive episodes(Bauer et al., 2002).Other mood stabilizers, such as valproic acid (Depakote) and lamotrigine (Lamictal), have also been shown to be effective in treating bipolar I disorder(Geddes et al.,   2004).Antipsychotic medications, such as olanzapine (Zyprexa) and aripiprazole (Abilify), are also commonly used to treat symptoms of mania and psychosis in individuals with bipolar I disorder(Berk et al., 2003).Antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft), may also be used to treat depressive symptoms in bipolar I disorder, although they must be used with caution as they can trigger mania in some individuals(Goldberg et al., 2002).In conclusion, the best medication for bipolar I disorder will vary for each individual and may take some trial and error to find.Mood stabilizers, antipsychotics, and antidepressants are all commonly used medications for treating bipolar I disorder, and the choice of medication will depend on the individual's symptoms and medical history.It is important to work closely with a mental health professional to find the most effective treatment plan for your specific needs." ChatGPT references to answers-as provided in response to the eight principal questions.
Association are bipolar I disorder, bipolar II disorder, and cyclothymic disorder.However, further research is needed to better understand the heterogeneity of bipolar disorder and the different subtypes that may exist.