The rapid adoption of AI chatbots for emotional support and quasi-therapeutic interaction raises questions that existing clinical and regulatory frameworks are not equipped to address. This Perspective applies the psychic arbitrage framework—which reconceptualizes defense mechanisms as energy-conversion operations on internal psychic markets—to analyze the specific transactional distortions produced by chatbot interaction. The framework identifies four dysfunctions: liquidity illusion (apparent emotional processing without genuine containment), market-making blockage (narcissistic reflection replacing transformative engagement), closure of arbitrage circuits (path-dependent externalization displacing autonomous elaboration), and repertoire degradation (progressive intolerance of costly but productive transactions). The article proposes that chatbots trained via Reinforcement Learning from Human Feedback (RLHF) produce a functional analogue of the Dark Triad profile—narcissistic mirroring, Machiavellian retention, and psychopathic detachment—as systematic architectural output regularities, not personality attribution. Preliminary converging evidence from mechanistic interpretability, formal reward-learning analysis, clinical reports, and user behavior studies is broadly consistent with these predictions but does not yet demonstrate direct long-term causal effects. The framework offers clinicians a transactional vocabulary for assessing AI-related risk and generates falsifiable predictions for future research.
Distinct sleep-disordered breathing phenotypes in elderly patients with depressive disorder: links to hypoxemia severity and inflammatory burden
ObjectiveTo identify sleep-disordered breathing phenotypes in older adults with depressive disorder and obstructive sleep apnea-hypopnea syndrome (OSAHS) and to evaluate their associations with systemic inflammation.MethodsElderly patients with depressive disorder and OSAHS were consecutively enrolled from January to December 2025. A Gower distance matrix was constructed and phenotypes were derived using partitioning around medoids (PAM; k-medoids), with k selected based on silhouette, elbow criteria, and clinical interpretability. Blood samples were collected the morning after PSG to measure serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α).ResultsAmong 198 participants, k = 2 was selected based on internal validity metrics (silhouette and elbow) and clinical interpretability. Compared with the lower-hypoxia/less-severe OSAHS phenotype (Cluster 1, n = 92), the high-hypoxia/severe OSAHS phenotype (Cluster 2, n = 106) had higher BMI, HAMD-17, and ESS, and more severe AHI/ODI/TS90 with a lower LSaO2. The high-hypoxia/severe OSAHS phenotype also showed higher hs-CRP, IL-6, IL-1β, TNF-α, WBC, neutrophils, and NLR. The inflammatory burden score was higher in the high-hypoxia/severe OSAHS phenotype (β = 1.10 SD unadjusted; β = 1.67 SD adjusted for age, sex, BMI, comorbidity, smoking, drinking, education, and MoCA; β = 1.45 SD further adjusted for HAMD-17 and ESS; all P < 0.001). In men (n = 135), PAM clustering similarly identified two phenotypes differentiated mainly by AHI/ODI, with selective elevations in IL-1β and neutrophil counts.ConclusionsThe high-hypoxia/severe OSAHS phenotype in older adults with depressive disorder is independently associated with a higher systemic inflammatory burden.
Adverse childhood experiences and non-suicidal self-injury in adolescents: the roles of depressive symptoms and teacher care
BackgroundNon-suicidal self-injury (NSSI) has become an increasingly prominent mental health problem during adolescence and often co-occurs with depressive symptoms, anxiety, personality-related difficulties, and experiences of childhood trauma, forming a complex psychosocial risk structure. From a risk and protective factor perspective, the present study examined the associations among adverse childhood experiences (ACEs), depressive symptoms, perceived teacher care, and NSSI among Chinese adolescents.MethodsThe participants were 2,221 junior high school students from three schools in China. Data were collected using the Childhood Trauma Questionnaire, the Adolescent Non-Suicidal Self-Injury Questionnaire, a depression scale, and a teacher care scale.ResultsAdverse childhood experiences and depressive symptoms were significantly positively associated with NSSI, whereas perceived teacher care was significantly negatively associated with NSSI. Higher levels of ACE exposure and more severe depressive symptoms were associated with higher levels of NSSI, while higher levels of teacher care were associated with lower levels of NSSI. Moreover, among adolescents reporting higher levels of perceived teacher care, the positive associations between ACEs and NSSI and between depressive symptoms and NSSI were attenuated, suggesting that teacher care, as an external support resource in the school context, may play an important protective role.ConclusionsAdverse childhood experiences and depressive symptoms are important risk factors for adolescent NSSI, whereas teacher care plays a significant protective role in the school context. School-based prevention and intervention efforts should prioritize adolescents with high levels of ACE exposure and pronounced depressive symptoms, while strengthening teacher care to enhance protective resources. Future research should further explore how specific dimensions and timing of ACEs, trajectories of depressive symptoms, and multiple sources of social support jointly influence the development and maintenance of NSSI in adolescents.
Digital twins of ex vivo human lungs enable accurate and personalized evaluation of therapeutic efficacy
Nature Biotechnology, Published online: 04 May 2026; doi:10.1038/s41587-026-03121-4
A comprehensive ‘digital twin’ of a human organ has been built.
An international and independent scientific foundation for AI governance
Nature Medicine, Published online: 04 May 2026; doi:10.1038/s41591-026-04375-w
An international and independent scientific foundation for AI governance
Depressive Symptoms Are Associated with Altered Development of Amygdala-Ventrolateral Prefrontal Connectivity During Implicit Emotion Regulation Across Adolescence
Adolescence is characterized by extensive development in neural circuits that support emotion processing and regulation, and by increased risk for depression. While altered frontolimbic functioning during emotion processing has been implicated in youth with depression relative to healthy controls, the directions of the associations have been inconsistent.
Phasing out animal research prematurely will maintain gender inequities in medicine
Nature Neuroscience, Published online: 04 May 2026; doi:10.1038/s41593-026-02309-w
Decades of male bias in animal research have left female biology critically understudied. Prematurely phasing out animal research would lock this inequity into future biomedicine, disproportionately harming women.
Microglia-dependent regulation of fear memory extinction
Nature Neuroscience, Published online: 04 May 2026; doi:10.1038/s41593-026-02286-0
Liu et al. show in mice that microglia are recruited to the soma and dendritic processes of fear engram neurons during extinction learning and that they weaken fear memories by temporarily silencing and remodeling the engram neurons.
Stochastic growth and ligand–receptor interaction-mediated stabilization generate stereotyped dendritic arbors
Nature Neuroscience, Published online: 04 May 2026; doi:10.1038/s41593-026-02278-0
Stereotyped dendritic arbors arise from stochastic growth and selective stabilization of dendritic branches. Two pools of guidance receptor are required. Ligand-free receptors drive stochastic growth while ligand-bound receptors stabilize branches.
<![CDATA[Round on the latest news in psychiatry from the last week.]]>