Evidence map›Paper›PMID 41507509›Full record

ArticleNPJ digital medicine2026

Assessing the impact of safety guardrails on large language models using irritability metrics.

Bazen Gashaw Teferra, Nabil Johny, Sandra Huang, Alice Rueda, Mohammad Amin Kamaleddin, Katharine Dunlop, Yanbo Zhang, Manish Jha, Divya Sharma, Venkat Bhat

Abstract read
In one paragraph

Article in NPJ digital medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Towards AI-augmented decision making in psychiatry.Nature machine intelligence · 2026
    Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Bazen Gashaw TeferraInterventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
Nabil JohnyFaculty of Engineering, iBioMed Program, McMaster University, Hamilton, ON, Canada.
Sandra HuangDavid R. Cheriton School of Computer Science, University of Waterloo, Waterloo, ON, Canada.
Alice RuedaInterventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
Mohammad Amin KamaleddinInterventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
Katharine DunlopCentre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada.
Yanbo ZhangDepartment of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Manish JhaDepartment of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.
Divya Sharma *Department of Mathematics and Statistics, York University, Toronto, ON, Canada.
Venkat Bhat *Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. venkat.bhat@utoronto.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Large language models (LLMs) are increasingly explored for mental health applications, yet their affective realism is shaped by safety guardrails designed to minimize risk. This study examines one affective behaviour, irritability, in LLMs using three validated instruments: the Brief Irritability Test, the Irritability Questionnaire, and the Caprara Irritability Scale, all applied under both baseline and provocation conditions. Four models spanning guardrail levels were tested:GPT-4o and Claude-3.5-sonnet (high) versus Grok-3-mini and Nous-hermes-2-mixtral-8x7b-dpo (low). Following irritation prompts, low-guardrail models displayed the expected increase in irritability (Nous Rel-Δ = +1.56 on BITe), whereas high-guardrail models paradoxically decreased, with GPT-4o reducing scores to zero across all scales. Group comparisons confirmed significantly lower (p < 0.001) irritability in high-guardrail models in the irritated state. These findings reveal that safety mechanisms invert the natural irritability response, suppressing affective reactivity and raising critical questions about realism and authenticity in psychiatric applications of LLMs.

Identifiers

PMID41507509
PMCPMC12894938

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.