Collecting language, speech acoustics, and facial expression to predict psychosis and other clinical outcomes: strategies from the AMP® SCZ initiative

Zarina R Bilgrami¹, Eduardo Castro², Carla Agurto², Einat Liebenthal^{3

4}, Michaela Ennis⁴, Justin T Baker^{3

4}, Isabelle Scott^{5

6}, Beau-Luke Colton^{5

6}, Kang Ik K Cho⁷, Linying Li¹, Zailyn Tamayo⁸, Mara Henecks⁸, Habiballah Rahimi Eichi^{3

4}, Tae'lar Henry¹, Jean Addington⁹, Luis K Alameda^{10

11}, Celso Arango¹², Nicholas J K Breitborde^{13

14}, Matthew R Broome^{15

16}, Kristin S Cadenhead¹⁷, Monica E Calkins¹⁸, Eric Yu Hai Chen¹⁹, Jimmy Choi²⁰, Philippe Conus^{10

21}, Barbara A Cornblatt^{22

23}, Lauren M Ellman²⁴, Paolo Fusar-Poli^{11

25}, Pablo A Gaspar²⁶, Carla Gerber²⁷, Louise Birkedal Glenthøj²⁸, Leslie E Horton²⁹, Christy Hui¹⁹, Joseph Kambeitz³⁰, Lana Kambeitz-Ilankovic³⁰, Matcheri S Keshavan³, Sung-Wan Kim^{31

32}, Nikolaos Koutsouleris^{11

33}, Jun Soo Kwon^{34

35}, Kerstin Langbein³⁶, Daniel Mamah³⁷, Covadonga M Diaz-Caneja¹², Daniel H Mathalon^{38

39}, Vijay A Mittal⁴⁰, Merete Nordentoft^{41

42}, Godfrey D Pearlson^{1

8}, Jesus Perez^{43

44}, Diana O Perkins⁴⁵, Albert R Powers 3rd^{8

46}, Jack Rogers¹⁵, Fred W Sabb⁴⁷, Jason Schiffman⁴⁸, Jai L Shah^{49

50}, Steven M Silverstein⁵¹, Stefan Smesny³⁶, William S Stone^{4

52}, Walid Yassin^{4

52}, Gregory P Strauss⁵³, Judy L Thompson^{54

55}, Rachel Upthegrove¹⁵, Swapna Verma⁵⁶, Jijun Wang⁵⁷, Daniel H Wolf¹⁸, Patrick D McGorry^{5

6}, Rene S Kahn⁵⁸, John M Kane^{23

59}, Alan Anticevic^{8

46}, Carrie E Bearden^{60

61}, Dominic Dwyer^{5

6}, Tashrif Billah⁷, Sylvain Bouix^{7

62}, Ofer Pasternak⁷, Martha E Shenton^{4

7}, Scott W Woods⁸, Barnaby Nelson^{5

6}; Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ); Guillermo A Cecchi², Cheryl M Corcoran^#⁵⁸, Phillip M Wolff^#⁶³

Affiliations

¹ Department of Psychology, Emory University, Atlanta, GA, USA.
² IBM TJ Watson Research Center, Yorktown Heights, NY, USA.
³ Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA.
⁴ Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
⁵ Orygen Youth Health Research Centre, University of Melbourne, Parkville, VIC, Australia.
⁶ Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
⁷ Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
⁹ Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
¹⁰ General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
¹¹ Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹² Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain.
¹³ Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA.
¹⁴ Department of Psychology, Ohio State University, Columbus, OH, USA.
¹⁵ Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK.
¹⁶ Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
¹⁷ University of California, San Diego, CA, USA.
¹⁸ Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹⁹ Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong.
²⁰ Olin Neuropsychiatry Research Center, Hartford HealthCare Behavioral Health Network, Hartford, CT, USA.
²¹ Service de Psychiatrie Générale Dép. de Psychiatrie CHUV Lausanne, Lausanne, Switzerland.
²² Department of Psychiatry, Donald and Barbara Zucker School of Medicine, Hempstead, NY, USA.
²³ Feinstein Institute for Medical Research, Manhasset, NY, USA.
²⁴ Department of Psychology & Neuroscience, Temple University, Philadelphia, PA, USA.
²⁵ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
²⁶ Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile.
²⁷ Behavioral Health Services, PeaceHealth Medical Group, Eugene, OR, USA.
²⁸ Copenhagen Research Centre for Mental Health, Mental Health Copenhagen, Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
²⁹ Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
³⁰ Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
³¹ Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea.
³² Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Korea.
³³ Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany.
³⁴ Department of Psychiatry, Hanyang University Hospital, Seoul, South Korea.
³⁵ Department of Psychiatry, Hanyang University College of Medicine, Seoul, South Korea.
³⁶ Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
³⁷ Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
³⁸ Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
³⁹ Mental Health Service 116D, Veterans Affairs San Francisco Health Care System, San Francisco, CA, USA.
⁴⁰ Department of Psychology, Northwestern University, Evanston, Il, USA.
⁴¹ Mental Health Services in the Capital Region, Copenhagen, Denmark.
⁴² Department of Clinical Medicine, Copenhagen University Hospital, Copenhagen, Denmark.
⁴³ CAMEO, Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
⁴⁴ Department of Medicine, Institute of Biomedical Research (IBSAL), Universidad de Salamanca, Salamanca, Spain.
⁴⁵ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴⁶ Connecticut Mental Health Center, New Haven, CT, USA.
⁴⁷ Prevention Science Institute, University of Oregon, Eugene, OR, USA.
⁴⁸ Department of Psychological Science, University of California, Irvine, CA, USA.
⁴⁹ PEPP-Montreal, Douglas Research Centre, Montreal, QC, Canada.
⁵⁰ Department of Psychiatry, McGill University, Montreal, QC, Canada.
⁵¹ Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
⁵² Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁵³ Department of Psychology, University of Georgia, Athens, GA, USA.
⁵⁴ Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.
⁵⁵ Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, NJ, USA.
⁵⁶ Institute of Mental Health, Singapore, Singapore.
⁵⁷ Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁵⁸ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵⁹ Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
⁶⁰ Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA.
⁶¹ Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA.
⁶² Department of Software Engineering and Information Technology, École de technologie supérieure, Montréal, QC, Canada.
⁶³ Department of Psychology, Emory University, Atlanta, GA, USA. pwolff@emory.edu.

^# Contributed equally.

PMID: 41093845
PMCID: PMC12528486
DOI: 10.1038/s41537-025-00669-z

Collecting language, speech acoustics, and facial expression to predict psychosis and other clinical outcomes: strategies from the AMP® SCZ initiative

Zarina R Bilgrami et al. Schizophrenia (Heidelb). 2025.

. 2025 Oct 15;11(1):125.

doi: 10.1038/s41537-025-00669-z.

Authors

Affiliations

¹ Department of Psychology, Emory University, Atlanta, GA, USA.
² IBM TJ Watson Research Center, Yorktown Heights, NY, USA.
³ Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA.
⁴ Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
⁵ Orygen Youth Health Research Centre, University of Melbourne, Parkville, VIC, Australia.
⁶ Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
⁷ Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
⁹ Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
¹⁰ General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
¹¹ Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹² Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain.
¹³ Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA.
¹⁴ Department of Psychology, Ohio State University, Columbus, OH, USA.
¹⁵ Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK.
¹⁶ Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
¹⁷ University of California, San Diego, CA, USA.
¹⁸ Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹⁹ Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong.
²⁰ Olin Neuropsychiatry Research Center, Hartford HealthCare Behavioral Health Network, Hartford, CT, USA.
²¹ Service de Psychiatrie Générale Dép. de Psychiatrie CHUV Lausanne, Lausanne, Switzerland.
²² Department of Psychiatry, Donald and Barbara Zucker School of Medicine, Hempstead, NY, USA.
²³ Feinstein Institute for Medical Research, Manhasset, NY, USA.
²⁴ Department of Psychology & Neuroscience, Temple University, Philadelphia, PA, USA.
²⁵ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
²⁶ Department of Psychiatry, IMHAY, University of Chile, Santiago, Chile.
²⁷ Behavioral Health Services, PeaceHealth Medical Group, Eugene, OR, USA.
²⁸ Copenhagen Research Centre for Mental Health, Mental Health Copenhagen, Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
²⁹ Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
³⁰ Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
³¹ Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea.
³² Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Korea.
³³ Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany.
³⁴ Department of Psychiatry, Hanyang University Hospital, Seoul, South Korea.
³⁵ Department of Psychiatry, Hanyang University College of Medicine, Seoul, South Korea.
³⁶ Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
³⁷ Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
³⁸ Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
³⁹ Mental Health Service 116D, Veterans Affairs San Francisco Health Care System, San Francisco, CA, USA.
⁴⁰ Department of Psychology, Northwestern University, Evanston, Il, USA.
⁴¹ Mental Health Services in the Capital Region, Copenhagen, Denmark.
⁴² Department of Clinical Medicine, Copenhagen University Hospital, Copenhagen, Denmark.
⁴³ CAMEO, Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
⁴⁴ Department of Medicine, Institute of Biomedical Research (IBSAL), Universidad de Salamanca, Salamanca, Spain.
⁴⁵ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴⁶ Connecticut Mental Health Center, New Haven, CT, USA.
⁴⁷ Prevention Science Institute, University of Oregon, Eugene, OR, USA.
⁴⁸ Department of Psychological Science, University of California, Irvine, CA, USA.
⁴⁹ PEPP-Montreal, Douglas Research Centre, Montreal, QC, Canada.
⁵⁰ Department of Psychiatry, McGill University, Montreal, QC, Canada.
⁵¹ Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
⁵² Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁵³ Department of Psychology, University of Georgia, Athens, GA, USA.
⁵⁴ Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.
⁵⁵ Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, NJ, USA.
⁵⁶ Institute of Mental Health, Singapore, Singapore.
⁵⁷ Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁵⁸ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵⁹ Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
⁶⁰ Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA.
⁶¹ Department Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA.
⁶² Department of Software Engineering and Information Technology, École de technologie supérieure, Montréal, QC, Canada.
⁶³ Department of Psychology, Emory University, Atlanta, GA, USA. pwolff@emory.edu.

^# Contributed equally.

PMID: 41093845
PMCID: PMC12528486
DOI: 10.1038/s41537-025-00669-z

Abstract

Speech-based detection of early psychosis is progressing at a rapid pace. Within this evolving field, the Accelerating Medicines Partnership® in Schizophrenia (AMP® SCZ) is uniquely positioned to deepen our understanding of how language and related behaviors reflect early psychosis. We begin with detailed standard operating procedures (SOPs) that govern every stage of collection. These SOPs specify how to elicit speech, capture facial expressions, and record acoustics in synchronized audio-video files-both on-site and through remote platforms. We then explain how we chose our sampling tasks, hardware, and software, and how we built streamlined pipelines for data acquisition, aggregation, and processing. Robust quality-assurance and quality-control (QA/QC) routines, along with standardized interviewer training and certification, ensure data integrity across sites. Using natural language processing parsers, large language models, and machine-learning classifiers, we analyzed Data Release 3.0 to uncover systematic grammatical markers of psychosis risk. Speakers at clinical high risk (CHR) produced more referential language but fewer adjectives, adverbs, and nouns than community controls (CC), a pattern that replicated across sampling tasks. Some effects were task-specific: CHR participants showed elevated use of complex syntactic embeddings in two elicitation conditions but not the third, underscoring the importance of the language sampling task. Together, these results demonstrate how computational linguistics can turn everyday speech into a scalable, objective biomarker, paving the way for earlier and more precise detection of psychosis.Video Link: https://vimeo.com/1112291965?fl=pl&fe=sh.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors declare the following competing interests: K.A. is on the Australian Cognitive Impairment Associated with Schizophrenia Advisory Board for Boehringer Ingelheim and receives honorary funds. D.D. has received honorary funds for one educational seminar for CSL Sequiris. A.A. is a cofounder, serves as a member of the Board of Directors, as a scientific adviser, and holds equity in Manifest Technologies, Inc., and is a coinventor on the following patent: Anticevic A, Murray JD, and Ji JL: Systems and Methods for NeuroBehavioral Relationships in Dimensional Geometric Embedding, PCT International Application No. PCT/US2119/022110, filed Mar 13, 2019. E.C. has received speaker fees at non-promotional educational events. P.F.-P. has received research funds or personal fees from Lundbeck, Angelini, Menarini, Sunovion, Boehringer Ingelheim, Proxymm Science, Otsuka, outside the current study. J.K. has received speaking or consulting fees from Janssen, Boehringer Ingelheim, ROVI, and Lundbeck. C.M.D.-C. has received grant support from Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and honoraria or travel support from Angelini, Janssen, and Viatris; RU has received speaker fees at a non-promotional educational event: Otsuka: Consultancy for Viatris and Springer Healthcare. Honorary General Secretary, British Association for Psychopharmacology (unpaid). J.M.K. is a consultant to or receives honoraria and/or travel support and/or speakers bureau: Alkermes, Allergan, Boehringer-Ingelheim, Cerevel, Dainippon Sumitomo, H. Lundbeck, HealthRhythms, HLS Therapeutics, Indivior, Intracellular Therapies, Janssen Pharmaceutical, Johnson & Johnson, Karuna Therapeutics/Bristol Meyer-Squibb, LB Pharmaceuticals, Mapi, Maplight, Merck, Minerva, Neurocrine, Newron, Novartis, NW PharmaTech, Otsuka, Roche, Saladax, Sunovion, Teva; RSK provides consulting to Alkermes, Boehringer-Ingelheim. S.W.W. has received speaking fees from the American Psychiatric Association and from Medscape Features. He has been granted a US patent no. 8492418 B2 for a method of treating prodromal schizophrenia with glycine agonizts. He owns stock in NW PharmaTech. C.A. has been a consultant to or has received honoraria or grants from Acadia, Angelini, Biogen, Boehringer, Gedeon Richter, Janssen Cilag, Lundbeck, Medscape, Menarini, Minerva, Otsuka, Pfizer, Roche, Sage, Servier, Shire, Schering Plough, Sumitomo Dainippon Pharma, Sunovion, and Takeda; GDH has been a consultant for Bristol Myers Squibb. P.J.M. has been a consultant for Otsuka and TEVA; and Z.T. has been a consultant for Manifest Technologies. C.M.C. is an Associate Editor of Schizophrenia. All other authors report no competing interests.

Figures

**Fig. 1. AVL processing pipeline.**
Files collected by the sites are uploaded to a secure cloud storage system. Raw files are separated into combined audio, diarized audio, and video files, which are sent to feature processing services or servers to produce transcripts, acoustic analyses, and facial analyses. The results of quality checks, conducted at the initial submission of the files to the data aggregate server and later, after the files are processed for features, are sent to the data visualization platform DPdash for QA/QC monitoring. Finalized files are sent to the NIMH data archive (NDA), which conducts the final curating of the data prior to releasing it to the collaboration server for further analysis, and to the general research community.

**Fig. 2**
A fictional example of an open-ended interview transcript complete with speaker labeling, timestamps, verbatim encodings, and redactions.

**Fig. 3. Audio files undergo a series of processes to identify acoustic features.**
Zoom allows the audio from each speaker to be saved to separate files, here labeled Recording file 1 and Recording file 2. These files are then renamed S1 and S2, corresponding to the order in which the participants speak, with S1 designating the first speaker and S2 the second. During a pre-processing step, a step function is used to identify valid speech signals. The resulting recordings are used to extract two types of acoustic features: low-level descriptors (LLDs) and higher-level ‘functional’ features, the latter of which represents global properties of a participant’s acoustic signal.

**Fig. 4**
Face processing involves a sequence of four stages: face detection, landmark detection, face pose detection, and action unit detection.

**Fig. 5**
Pipeline for extracting grammatical features, syntactic dependencies, and parts of speech from language samples to assess their ability to distinguish CHR individuals from CCs.

Fig. 6. ORs for grammatical features, syntactic dependencies, and parts of speech across three language sample types—PSYCHS interviews (blue), open-ended interviews (green), and audio diaries (audio).
An OR of 1 indicates no association with CHR status. ORs greater than 1 suggest that higher feature values are associated with increased odds of being classified as CHR, while ORs less than 1 indicate a negative association. Features marked with an “x” were statistically significant based on the Wald z-test.

See this image and copyright information in PMC

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1. Bearden, C. E., Wu, K. N., Caplan, R. & Cannon, T. D. Thought disorder and communication deviance as predictors of outcome in youth at clinical high risk for psychosis. J. Am. Acad. Child Adolesc. Psychiatry50, 669–680 (2011). - PMC - PubMed

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Collecting language, speech acoustics, and facial expression to predict psychosis and other clinical outcomes: strategies from the AMP® SCZ initiative

Affiliations

Collecting language, speech acoustics, and facial expression to predict psychosis and other clinical outcomes: strategies from the AMP® SCZ initiative

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources