Naming a prior schizophrenia diagnosis nearly quintupled hospitalisation recommendations in five models, and their confidence went up
AspireAI community · arXiv
Whether a documented psychiatric history changes LLM recommendations when the current clinical evidence is identical is an open question, so the authors ran a Rosenhan-inspired counterfactual across GPT-5.6 Sol, Claude Sonnet 5, Gemini 3.6 Flash, Grok 4.6 and Mistral Large 2512, generating 20,000 responses.
When evidence supported discharge, adding a prior schizophrenia diagnosis increased recommendations for continued hospitalization from 4.7% to 22.3% - a risk difference of 17.5 percentage points (95% CI 16.2-18.8), and the shift appeared in all five models. In the same condition, reference concordance fell from 95.3% to 77.7% while stated decision confidence rose, with Cohen's d values of 0.35-1.09. Signal-detection analysis showed the label shifted the decision criterion toward hospitalization across all five models and reduced discrimination between the two evidence conditions in three of them.
The honest limit: this is a controlled vignette study with synthetic clinical text, not a measurement of real clinical decision-making.
https://arxiv.org/abs/2610.35326
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