In a letter addressed to President Barack Obama, three professors of psychiatry — including one from Harvard Medical School — expressed fears that President-elect Donald Trump’s exhibits signs he may not be mentally fit to assume the presidency.

In the letter, which can be found at The Huffington Post, Judith Herman, M.D. a professor of psychiatry at Harvard Medical School — along with two professors who taught at the University of California, San Francisco — made the appeal to Obama based upon their “grave concern” after watching Trump’s antics.

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“We are writing to express our grave concern regarding the mental stability of our President-Elect,” the letter reads. “Professional standards do not permit us to venture a diagnosis for a public figure whom we have not evaluated personally.”

“His widely reported symptoms of mental instability — including grandiosity, impulsivity, hypersensitivity to slights or criticism, and an apparent inability to distinguish between fantasy and reality — lead us to question his fitness for the immense responsibilities of the office,” it continues. “We strongly recommend that, in preparation for assuming these responsibilities, he receive a full medical and neuropsychiatric evaluation by an impartial team of investigators.”

This is not the first time questions have arisen over Trump’s mental stability as a world leader — or the stability of his followers.

Prior to the election, the American Psychiatric Association made a plea to members to not associate Trump with mental illness at a distance, with APA President Maria A. Oquendo. writing, “This year, the election seems like anything but a normal contest, that has at times devolved into outright vitriol. The unique atmosphere of this year’s election cycle may lead some to want to psychoanalyze the candidates, but to do so would not only be unethical, it would be irresponsible.”