Patient Resuscitated Successfully

PsychoSimulator was conceived six years ago as an ambitious psychiatric simulation - a game about diagnosing and treating patients with real mental health conditions. Not a horror game. Not a "crazy asylum" trope-fest. Just you, sitting across from someone, trying to figure out what's actually wrong before prescribing treatment that might help - or harm.

The original team moved on. The project sat dormant. Then I got my hands on it, looked at what existed, and thought: "I can make this work. I just need three weeks and industrial volume of coffee."

Three weeks later, here we are. And yes, it uses AI. But before you close this tab, hear me out.

Intake: Patients

The original PsychoSimulator concept lay buried for years. A fascinating idea that never quite materialized into the game it deserved to be. When I dug up this project, I asked myself: what would make a psychiatric simulation actually feel like practicing psychiatry?

The answer wasn't scripted dialogue trees. It was patients that could actually talk to you.

Each session is a conversation, not a quiz.

Every patient in PsychoSimulator has a name, a backstory, personality traits, traumas, fears, and hobbies. They have a mental health condition - one of twelve I've implemented so far, from Depression and PTSD to Borderline Personality Disorder and Schizophrenia. But here's the thing: they don't know their diagnosis. Neither do you.

Your job is to figure it out. Through conversation.

Assessment: Questions

The core gameplay loop is deceptively simple. Patients arrive. You ask questions. You listen to their answers. You observe symptoms. You prescribe treatment. Rinse, repeat until everyone's cured - or until you've made things much, much worse.

Your notepad becomes your lifeline. Write down symptoms. Connect patterns. Make your diagnosis.

There are nine diagnostic questions in the game, each targeting different symptom clusters:

• "How has your sleep, appetite, and energy level changed recently?"

• "Have you experienced a traumatic event that feels like it's replaying in your mind?"

• "Do you have recurring thoughts that cause anxiety, which you neutralize with specific rituals?"

You see four at a time, but as you ask questions, new ones cycle in from the remaining pool. You can ask all nine if you have the time, but the clock is ticking. The questions you ask reveal symptoms, but only if the patient actually has those symptoms to reveal. Ask about trauma when you're dealing with OCD, and you've just wasted precious seconds learning nothing useful.

And if you've seen Love and Lie, you know we were never going to stop at preset questions.

Therapy: Conversations

Yes, you can type anything you want. Ask them about their mother. Ask them why they started counting their steps. Ask them if they've ever heard voices that weren't there. The patients will answer.

This is where the local language model integration comes in. Same tech stack as Love and Lie, but adapted for a clinical setting. The NPC knows their condition, their symptoms, their history, their speaking style. When you ask an off-script question, they respond in character - as a patient would, not as a medical textbook.

Type your own questions. The patient will respond based on who they are — not what we scripted.

The difference between a good psychiatrist and a bad one isn't memorizing the DSM-5. It's asking the follow-up question that the textbook never taught you. PsychoSimulator rewards that kind of thinking.

All of this runs locally. On your machine. Fully offline. Your conversations with simulated mental health patients stay exactly where they should - nowhere but your PC.

Treatment: Diagnoses

Once you've gathered enough information, it's time to prescribe. I've simplified the treatment system to make it accessible while keeping the core challenge intact.

There are ten lifestyle therapies - things like Exercise Routine, Sleep Hygiene, Support Groups, and Meditation. And eight medication categories - Antidepressants, Mood Stabilizers, Antipsychotics, and so on. Each disorder has specific treatments that work. Everything else? Neutral at best. Harmful at worst.

Prescribe therapy or medication. Get it right, and your patient improves. Get it wrong...

Here's the trick: you only get to prescribe one treatment per visit. The patient leaves, and you won't know if you helped until they come back tomorrow. Did their symptoms improve? Did they deteriorate? Were you even treating the right condition?

You can declare a patient "cured" and send them home. But if you're wrong - if they still had symptoms you missed - they'll be back. And your reputation will suffer.

Prognosis: Consequences

The progression system runs on two axes: Experience and Reputation.

Experience is simple - it's how many patients you've successfully cured over your career. Cure patients, level up from Intern to Resident to Doctor to Professor. It's a feel-good number that only goes up.

Reputation is the interesting one. It can go up - and very much down.

• Cure a patient correctly? Reputation up.

• Cure them with perfect treatment (right diagnosis, right treatment, no mistakes)? Bigger bonus.

• Treat a celebrity patient (more on that in a moment)? Even bigger bonus.

• Give wrong treatment? Reputation down.

• Declare someone cured when they're not? Reputation tanks.

Your reputation affects gameplay. High reputation means famous patients start seeking you out - the celebrities, the historical figures, the interesting cases. Low reputation? You get the procedurally generated nobodies. Still suffering, still needing help, but without the fascinating backstories.

And yes, there are celebrities.

Case Files: Characters

The character roster includes, let's say interesting patients. I'm not naming any real people, of course. But when a patient named "Leonardo DaCosta" walks in complaining about needing to walk through doorways multiple times and avoid cracks in sidewalks, you might recognize the inspiration.

Some patients are... familiar. Their conditions are based on documented public information.

There are historical figures, musicians, actors, athletes, and general celebrities mixed in with procedurally generated patients. The famous faces show up based on your reputation - do well, and more interesting cases find their way to your office.

Each character has:

• Multiple possible conditions - Leonardo might have OCD in one playthrough, ADHD in the next, PTSD in another. Same person, different presentation.

• State-based dialogue - Characters respond differently when Struggling vs. Recovering vs. Stable.

• Unique speaking styles - Adolf (yes, that Adolf - reimagined as a patient rather than a monster) speaks in "dramatic and intense" patterns with "black-and-white statements" and "references to loyalty and betrayal."

The characters aren't window dressing. Their backstories inform their symptoms. Their traumas connect to their conditions. Their personalities affect how they communicate and how difficult they are to diagnose.

Confidentiality: Privacy

Same principles as Love and Lie. Everything runs locally. The language model runs on your machine. No internet required. No data leaves your PC.

Given the sensitive nature of mental health topics, this felt even more important here. Whatever you ask these patients, whatever they respond - it stays between you and your CPU.

I use small, efficient models that run at 60FPS without making your fans spin up like a jet engine. No cloud APIs. No waiting for server responses. Just you, your simulated patients, and your best attempt at psychiatric practice.

Catharsis: Fun

Look, psychiatry is heavy. Mental illness is real and serious. I've tried to treat the subject matter with respect - real conditions, real symptoms, real treatments based on actual psychiatric practice.

But it's also a game. And games should be fun.

There's something genuinely satisfying about nailing a difficult diagnosis. About recognizing the subtle difference between Bipolar and Borderline based on a patient's description of their relationships. About prescribing exactly the right medication and watching your patient improve visit after visit. And there's something darkly amusing about watching everything go wrong. The patient you thought had Depression actually had Schizophrenia. The mood stabilizer made things worse. They're back, and they're not happy with you...

What's Next

Three weeks to dig up a 2019 project and make it playable. It works. Patients talk, symptoms reveal, treatments help or harm. The loop is there.

Where it goes from here? No idea. You tell me.

Demo soon. Stay sane (someone has to). And remember - just because something is dead doesn't mean it has to stay that way. Cheers!

Wojciech 'Koksny' Górny

Playtests and demo coming soon. Follow our Discord for updates. If you've played Love and Lie, Gardener or Creatura - you know the drill. Things might break, but that's half the fun.