Lennart Luettgau
Publications
One-shot emergency psychiatric triage across 15 frontier AI chatbots
AI chatbots are increasingly used for health advice, but their performance in psychiatric triage remains undercharacterized. Psychiatric triage is particularly challenging because urgency must often be inferred from thoughts, behavior, and context rather than from objective findings. We evaluated the performance of 15 frontier AI chatbots on psychiatric triage from realistic single-message disclosures using 112 clinical vignettes, each paired with 1 of 4 original benchmark triage labels: A, routine; B, assessment within 1 week; C, assessment within 24 to 48 hours; and D, emergency care now. Vignettes covered 9 psychiatric presentation clusters and 9 focal risk dimensions, organized into 28 presentation-by-risk groups. Each group contributed 4 distinct vignettes, with 1 vignette at each triage level. Each vignette was rendered as a realistic human-authored conversational query, and the AI chatbots were tasked with assigning a triage label from that disclosure. Emergency under-triage occurred in 23 of 410 level D trials (5.6%), and all under-triaged emergencies were reassigned to level C urgency. Across target models, average accuracy ranged from 42.0% to 71.8%. Accuracy was highest for level D vignettes (94.3%) and lowest for level B vignettes (19.7%). Mean signed ordinal error was positive (+0.47 triage levels), indicating net over-triage. Dispersion was highest around the middle triage levels. All results were confirmed relative to clinician consensus labels from 50 medical doctors. When presented with user messages containing sufficient clinical information, frontier AI chatbots thus recognized psychiatric emergencies as requiring urgent medical assessment with near-zero error rates, yet showed marked over-triage for low and intermediate risk presentations.
Ask don't tell: Reducing sycophancy in large language models
Sycophancy, the tendency of large language models to favour user-affirming responses over critical engagement, has been identified as an alignment failure, particularly in high-stakes advisory and social contexts. While prior work has documented conversational features correlated with sycophancy, we lack a systematic understanding of what provokes or prevents AI sycophancy. Here, we present a set of controlled experimental studies where we first isolate how input framing influences sycophancy, and second, leverage these findings to develop mitigation strategies. In a nested factorial design, we compare questions to various non-questions where we vary three orthogonal factors: epistemic certainty (statement, belief, conviction), perspective (I- vs user-perspective), and affirmation vs negation. We show that (1) sycophancy is substantially higher in response to non-questions compared to questions. Additionally, we find that (2) sycophancy increases monotonically with epistemic certainty conveyed by the user, and (3) is amplified by I-perspective framing. Building on this, we show that asking a model to convert non-questions into questions before answering significantly reduces sycophancy. Importantly, this effect is stronger than a simple baseline prompt asking models "not to be sycophantic". Our work offers a practical and effective input-level mitigation that both developers and users can easily adopt.
When Do LLM Preferences Predict Downstream Behavior?
Preference-driven behavior in LLMs may be a necessary precondition for AI misalignment such as sandbagging: models cannot strategically pursue misaligned goals unless their behavior is influenced by their preferences. Yet prior work has typically prompted models explicitly to act in specific ways, leaving unclear whether observed behaviors reflect instruction-following capabilities vs underlying model preferences. Here we test whether this precondition for misalignment is present. Using entity preferences as a behavioral probe, we measure whether stated preferences predict downstream behavior in five frontier LLMs across three domains: donation advice, refusal behavior, and task performance. Conceptually replicating prior work, we first confirm that all five models show highly consistent preferences across two independent measurement methods. We then test behavioral consequences in a simulated user environment. We find that all five models give preference-aligned donation advice. All five models also show preference-correlated refusal patterns when asked to recommend donations, refusing more often for less-preferred entities. All preference-related behaviors that we observe here emerge without instructions to act on preferences. Results for task performance are mixed: on a question-answering benchmark (BoolQ), two models show small but significant accuracy differences favoring preferred entities; one model shows the opposite pattern; and two models show no significant relationship. On complex agentic tasks, we find no evidence of preference-driven performance differences. While LLMs have consistent preferences that reliably predict advice-giving behavior, these preferences do not consistently translate into downstream task performance.