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Large language models and chatbots are widely accessible, and often framed as supportive, empathic or even therapeutic. For most users, these systems are helpful or, at worst, benign. But as of late, a number of media reports have described people experiencing psychotic symptoms in which ChatGPT features prominently. For a small but significant group — people with psychotic disorders or those at high risk — their interactions with genAI may be far more complicated and dangerous, which raises urgent questions for clinicians.