{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:05:18Z","timestamp":1791270318730,"version":"4.1.0"},"reference-count":17,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Speech carries subtle indicators of current mental state, a phenomenon routinely used in psychiatric assessment. Despite its potential, quantitative speech analysis is not yet integrated into clinical care.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To identify which features of naturalistic speech are associated with concurrent variation in symptom severity in patients with psychotic disorders.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This longitudinal, multicenter cohort study was conducted in the Netherlands (June 7, 2017, to July 31, 2025) in adult patients (aged \u226518 years) with schizophrenia spectrum disorders who completed repeated clinical and speech assessments for up to 8 years. Findings were replicated in a longitudinal cohort from the US (March 1, 2021, to December 1, 2022).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n Individual symptom severity was measured using the Positive and Negative Syndrome Scale (PANSS) (Dutch cohort) or the Brief Psychiatric Rating Scale (US cohort). Speech samples were converted into interpretable artificial intelligence\u2013derived voice and text features, reduced using principal component analysis. Associations were estimated using linear mixed models adjusted for demographic characteristics and time point. Estimative accuracy was quantified using mean absolute error (MAE) and\n R<\/jats:italic>\n 2<\/jats:sup>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In the Dutch cohort, 773 speech recordings from 356 participants (mean [SD] age, 30.4 [10.3] years; 257 male [72.2%]) were analyzed, and in the US cohort, 165 speech recordings from 72 participants (mean [SD] age, 26.4 [5.2] years; 46 male [64.8%]) were analyzed. In the Dutch cohort, speech-based models detected individual psychotic symptoms with clinically meaningful accuracy, with an item-level MAE of less than 1 point (scale, 1-7), comparable to the 1-point agreement margin used in PANSS rater training. Models were associated with PANSS positive and negative subscale scores, with MAE of 2.85 and 3.22, explaining 13.4% and 17.8% of the variance, respectively, and well below the 20% threshold used to flag unreliable PANSS ratings. In the US replication cohort, Brief Psychiatric Rating Scale thought disturbance and withdrawal scores were associated with similar MAEs (3.0 and 2.4, respectively), explaining 31.0% and 21.5% of the variance. In the Dutch cohort, negative symptoms were associated with more reduced speech output (estimate, 2.46 [95% CI, 1.05-3.88]) and flatter acoustic profiles (estimate, 0.29 [95% CI, 0.10-0.48]), whereas positive symptoms were marked by longer utterances (estimate, 1.18 [95% CI, 0.08-2.29]) and altered discourse organization (estimate, \u22120.25 [95% CI, \u22120.48 to \u22120.02]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This cohort study of individuals with schizophrenia found that psychotic symptoms left specific, interpretable signatures in naturalistic speech that could be quantified, tracked longitudinally, and replicated across cohorts. Speech-based modeling achieved clinically meaningful, symptom-level estimations, providing a solid basis for scalable, low-burden tools for real-time monitoring in psychosis.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.20239","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T15:30:24Z","timestamp":1782401424000},"page":"e2620239","source":"Crossref","is-referenced-by-count":3,"title":["Automated Speech-Based Modeling of Item-Level Symptom Severity in Schizophrenia"],"prefix":"10.1001","volume":"9","author":[{"given":"Silvia","family":"Ciampelli","sequence":"first","affiliation":[{"name":"Center for Clinical Neuroscience and Cognition, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janna N.","family":"de Boer","sequence":"additional","affiliation":[{"name":"Center for Clinical Neuroscience and Cognition, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands"},{"name":"Karakter, Child and Adolescent Psychiatry, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanne","family":"Koops","sequence":"additional","affiliation":[{"name":"Center for Clinical Neuroscience and Cognition, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Troelstra","sequence":"additional","affiliation":[{"name":"Center for Clinical Neuroscience and Cognition, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almut","family":"Jebens","sequence":"additional","affiliation":[{"name":"Center for Clinical Neuroscience and Cognition, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Bernard C.","family":"Marsman","sequence":"additional","affiliation":[{"name":"Center for Clinical Neuroscience and Cognition, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnout C.","family":"Smit","sequence":"additional","affiliation":[{"name":"University Center of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Hossein Nikzad","sequence":"additional","affiliation":[{"name":"Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Partlan","sequence":"additional","affiliation":[{"name":"Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Homan","sequence":"additional","affiliation":[{"name":"Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland"},{"name":"Department of Adult Psychiatry and Psychotherapy, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram","family":"Hinzen","sequence":"additional","affiliation":[{"name":"Department of Translation and Language Sciences, Universit\u00e4t Pompeu Fabra, Barcelona, Spain"},{"name":"Instituci\u00f3 Catalana de Recerca i Estudis Avan\u00e7ats, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunny X.","family":"Tang","sequence":"additional","affiliation":[{"name":"Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris E. C.","family":"Sommer","sequence":"additional","affiliation":[{"name":"Center for Clinical Neuroscience and Cognition, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"zoi260564r1","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.schres.2022.06.011","article-title":"Syntactic complexity of spoken language in the diagnosis of schizophrenia: a probabilistic Bayes network model.","volume":"259","author":"Silva","year":"2023","journal-title":"Schizophr Res"},{"issue":"1","key":"zoi260564r2","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1038\/s41537-021-00172-1","article-title":"More than a biomarker: could language be a biosocial marker of psychosis?","volume":"7","author":"Palaniyappan","year":"2021","journal-title":"NPJ Schizophr"},{"issue":"2","key":"zoi260564r3","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1002\/wps.21192","article-title":"Anomalies of language in schizophrenia: a trajectory of mathematical and computational analyses.","volume":"23","author":"Corcoran","year":"2024","journal-title":"World Psychiatry"},{"key":"zoi260564r4","doi-asserted-by":"publisher","first-page":"3691","DOI":"10.1038\/srep03691","article-title":"Graph analysis of dream reports is especially informative about psychosis.","volume":"4","author":"Mota","year":"2014","journal-title":"Sci Rep"},{"issue":"1","key":"zoi260564r6","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1002\/wps.20491","article-title":"Prediction of psychosis across protocols and risk cohorts using automated language analysis.","volume":"17","author":"Corcoran","year":"2018","journal-title":"World Psychiatry"},{"issue":"1","key":"zoi260564r7","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1038\/s44277-025-00034-z","article-title":"Automated speech and language markers of longitudinal changes in psychosis symptoms.","volume":"3","author":"Tang","year":"2025","journal-title":"NPP Digit Psychiatry Neurosci"},{"key":"zoi260564r8","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2025.1571647","article-title":"Measurement of schizophrenia symptoms through speech analysis from PANSS interview recordings.","volume":"16","author":"Worthington","year":"2025","journal-title":"Front Psychiatry"},{"issue":"1","key":"zoi260564r9","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1038\/s41537-020-00114-3","article-title":"Language disturbances in schizophrenia: the relation with antipsychotic medication.","volume":"6","author":"de Boer","year":"2020","journal-title":"NPJ Schizophr"},{"issue":"3","key":"zoi260564r10","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1037\/1040-3590.17.3.324","article-title":"Meta-analysis of the Brief Psychiatric Rating Scale factor structure.","volume":"17","author":"Shafer","year":"2005","journal-title":"Psychol Assess"},{"issue":"4","key":"zoi260564r11","doi-asserted-by":"publisher","first-page":"1302","DOI":"10.1017\/S0033291721002804","article-title":"Acoustic speech markers for schizophrenia-spectrum disorders: a diagnostic and symptom-recognition tool.","volume":"53","author":"de Boer","year":"2023","journal-title":"Psychol Med"},{"key":"zoi260564r12","doi-asserted-by":"publisher","first-page":"S172","DOI":"10.1093\/schbul\/sbac194","article-title":"Syntactic network analysis in schizophrenia-spectrum disorders.","volume":"49","author":"Ciampelli","year":"2023","journal-title":"Schizophr Bull"},{"issue":"1","key":"zoi260564r13","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1038\/s41537-025-00693-z","article-title":"Syntactic network analysis in first-episode psychosis: toward generalizability.","volume":"11","author":"Ciampelli","year":"2025","journal-title":"Schizophrenia (Heidelb)"},{"key":"zoi260564r14","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2024.115752","article-title":"Navigating the semantic space: unraveling the structure of meaning in psychosis using different computational language models.","volume":"333","author":"He","year":"2024","journal-title":"Psychiatry Res"},{"issue":"1","key":"zoi260564r16","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1093\/schbul\/sbaa065","article-title":"Digital phenotyping of negative symptoms: the relationship to clinician ratings.","volume":"47","author":"Cohen","year":"2021","journal-title":"Schizophr Bull"},{"issue":"1","key":"zoi260564r17","doi-asserted-by":"publisher","DOI":"10.1093\/schizbullopen\/sgac054","article-title":"A longitudinal study of semantic networks in schizophrenia and other psychotic disorders using the word association task.","volume":"3","author":"Pintos","year":"2022","journal-title":"Schizophr Bull Open"},{"key":"zoi260564r15","author":"Eyben","year":"2013"},{"key":"zoi260564r5","doi-asserted-by":"crossref","unstructured":"H\u00fcppi? 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