Evaluating Generative Video AI for Standardized Psychiatric Patient Simulation With Graded Hygiene Deterioration.

Abstract Introduction: A clinician's initial assessment during the mental status examination (MSE) places substantial weight on a patient's general appearance, grooming, and hygiene. However, the logistical difficulty of producing simulated or standardized patient (SP) videos that systematically manipulate these characteristics limits the development of clinical AI tools and training curricula. This pilot study investigates the technical feasibility of using a video-generation diffusion model to re-animate modified reference images onto driving videos, enabling the creation of diverse patient presentations without the need for repeated filming. Methods: Utilizing an established publicly available dataset, we extracted reference images of three SPs and applied a text-to-image AI model to generate five appearance conditions: the unmodified baseline and four escalating hygiene-deterioration levels: mild, moderate, marked, and severe. We then used the Wan2.2-Animate-14B animate video generation AI model to re-animate these modified portraits onto the original driving footage. This factorial design varied several model parameters including; pose retargeting, classifier-free guidance scales, and generation modes, resulting in 180 unique videos. Quality was measured through Frechet Video Distance (FVD) for distributional fidelity and a physics-aware assessment performed by a multimodal large language model to evaluate physical plausibility. Results: Our analysis yielded two primary observations. First, compositing through replacement-mode achieved significantly higher temporal fidelity than animation-mode (mean FVD 8.6 vs. 19.4; Cohen's d = 1.84). Second, while distributional fidelity showed a monotonic decline as hygiene perturbation increased (Spearman rho = 0.48, p < 0.001), physics-aware scores did not follow a similar trend. This pattern is consistent with fine-motor artifacts arising from model-level generative constraints rather than from the severity of the appearance modification alone. Conclusions: These findings demonstrate that generating appearance-modulated clinical video libraries is technically achievable. Nevertheless, the persistence of fine-motor artifacts underscores the necessity of expert human oversight before these materials can be safely deployed in educational and translational settings. Keywords: Generative artificial intelligence; Standardized patients; Video diffusion models; Psychiatric simulation; Mental status examination; AI-generated video; Medical education; Digital psychiatry