Clinical NLP

NLP: Natural Language Processing

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9 papers in the last four weeks, up 50% on the four weeks before. 0.1% of all new papers.

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Jun 25, 2026cs.AI

Language-Based Digital Twins for Elderly Cognitive Assistance

Digital twins have emerged as a promising paradigm for personalized healthcare, enabling modeling of individual behavior and health trajectories. In cognitive health, early detection of Mild Cognitive Impairment (MCI) remains challenging, where language and conversational patterns serve as non-invasive biomarkers. In this work, we propose a language-based digital twin framework that leverages large language models (LLMs) to mimic the conversational behavior of elderly individuals by incorporating stylometric cues and contextual metadata. To evaluate fidelity and cognitive consistency, we introduce a multi-head conditional variational autoencoder (cVAE) that jointly measures reconstruction quality and predicts cognitive scores. Experiments on the I-CONECT dataset show that the digital twin preserves identity-specific characteristics and achieves reconstruction and MoCA prediction errors comparable to real data, while outperforming baseline GPT-generated responses. These results highlight the potential of language-based digital twins as a scalable and non-invasive approach for personalized and continuous cognitive health monitoring.

Mohammad Mehdi Hosseini, Mohammad H. Mahoor, Hiroko H. Dodge

Ritchie School of Engineering and Computer Science, University of Denver, Denver, CO 80208, USA · Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA

Digital Twins Clinical NLP

Jun 25, 2026cs.LG

RSPC: A Benchmark for Modeling Stress and Psychiatric Conditions in Digitally Mediated Relationships using Psychiatrist Annotations

In NLP, mental health conditions are often modeled as isolated phenomena, without interpersonal context. We use Reddit posts about long-distance relationships to capture both mental health distress and associated relational triggers. We introduce the Relational Stress and Psychiatry Corpus (RSPC) containing 1,799 Reddit posts annotated by psychiatrists for diagnostic categories, including the most prevalent mood disorders (anxiety and depression), relational stressor triggers, and indications of relationship phase. We benchmark seven fine-tuned transformer models and five large language models across multi-label disorder classification, relational trigger detection, and temporal phase prediction tasks. We find clear task-dependent differences between model families, with Claude-3-Haiku achieving the best disorder classification performance (Macro-F1 = 0.538) and GPT-4o obtaining the strongest relational trigger detection performance (Macro-F1 = 0.519), suggesting distinct model capabilities. We further find strong associations between anxiety disorders and chronic relational uncertainty. Overall, RSPC establishes a benchmark for NLP tasks that consider relational context and supports a shift from individual-centric to context-aware mental health modeling that captures the social and temporal dynamics of distress.

Parmitha Vangapandu, Sai Ganesh Mokkapati, Sathwik Narkedimilli +4

Indian Institute of Information Technology Dharwad · Keshav Memorial College of Engineering · National University of Singapore +4

Social Media Analysis LLM Evaluation Depression Detection Mental Health Clinical NLP

Jun 24, 2026cs.CL

MedGuards: Multi-Agent System for Reliable Medical Error Detection and Correction

As Large Language Models (LLMs) are increasingly deployed in healthcare settings, accurate error detection and correction in generated or existing text becomes critical, as even minor mistakes can pose risks to patient safety. Existing methods for error detection and correction, including automated checks and heuristic-based approaches, do not generalize well across unseen datasets. In this paper, we propose MedGuards as a medical safety guardrail, which is a new framework that treats medical error detection and correction as a multi-agent in-context learning task. Specialized agents separately detect, localize, and correct errors, while a confidence-guided arbitration mechanism resolves disagreements using reasoning traces and confidence scores. This design enhances interpretability, robustness, and adaptability, without requiring additional training of the base LLMs. Additionally, we introduce the Keyword-Prioritized Correction Score (KPCS), a new evaluation metric that considers whether critical keywords within the reference text are generated correctly, providing a more comprehensive assessment than conventional metrics. Experiments across four multilingual medical datasets consisting of clinical notes demonstrate significant improvements by the proposed framework across several metrics and models. Our aim is to enable safer deployment of LLMs in real-world healthcare applications. For reproducibility, we make our code publicly available at https://github.com/congboma/MedGuards.

Congbo Ma, Hu Wang, Yichun Zhang +1

New York University Abu Dhabi · Khalifa University · New York University

LLM Guardrails LLM Safety Clinical Language Model Evaluation Multi-Agent LLMs Clinical NLP

Jun 22, 2026cs.CL

Explanation-Guided Medical Named Entity Recognition with Stability and Boundary Awareness for Atopic Dermatitis

Objective: This study aims to improve the reliability and robustness of medical named entity recognition (NER) in Chinese atopic dermatitis (AD) clinical texts through explanation-guided learning. Methods: We propose a stability and boundary-aware explanation-guided NER framework. Perturbation-based analysis is used to evaluate explanation stability and entity boundary sensitivity. An adaptive fusion strategy dynamically combines local and global explanation to generate more reliable token-level explanations. The fused explanation signals are further incorporated into model training through stability, boundary-aware, and consistency constraints. Results: Experiments on Chinese AD NER datasets show that the proposed framework improves explanation robustness and achieves consistent performance gains across multiple NER models. The adaptive fusion strategy also provides more stable explanations and stronger boundary perception than individual explanation methods. Conclusion: The proposed method effectively integrates reliable explanation signals into medical NER training, improving both recognition performance and explanation reliability. The framework provides a practical and generalizable solution for explainable medical NER and offers reliable support for downstream clinical decision-making and medical knowledge applications.

Xueguang Li, Di Lin, Xue Jiang +2

School of Information and Software Engineering, University of Electronic Science and Technology of China, Sichuan, China · School of Information and Software Engineering, University of Electronic Science and Technology of China, Sichuan 610054, China · Department of Dermatology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China +3

Named Entity Recognition Explainability Evaluation Clinical NLP

Jun 20, 2026cs.CL

Where Does the Signal Live? A Web Data Recipe for Medical Encoder Pretraining

Web data curation has been widely studied for decoder Large Language Model (LLM) pretraining. Encoders for dense-terminology domains such as medicine, by contrast, are pretrained on small, manually-curated corpora that limit scalability and writing style diversity, a bottleneck even more severe in non-English clinical settings. Whether web-scale data curation also benefits encoder Masked Language Modeling (MLM) in a dense-terminology domain remains an open question. To address this, we introduce two complementary levers. Medical-term density filtering selects documents rich in medical terms. Signal-amplifying rephrasing uses an LLM to rewrite documents into denser variants with broader entity contexts. We instantiate the recipe on French medical NLP. The medical-term density filter outperforms the widely-used educational quality filter on downstream medical tasks, and the two complement each other. Signal-amplifying rephrasing alone improves on raw web data, and mixing it with filtered web data produces the largest gain. The recipe yields FineMed, a French medical pretraining corpus, and DoctoBERT, a state-of-the-art French medical encoder family evaluated on both the public benchmark DrBenchmark and a proprietary clinical Named Entity Recognition (NER) task.

Bofeng Huang, Jacques Sun, Diane Bouchacourt +2

Doctolib · Work done while at Doctolib.

Language Model Pretraining Masked Language Modeling Training Data Curation Domain-Adaptive Pretraining Clinical NLP

Jun 19, 2026cs.CL

Clinical Term Extraction using Open-Source Small Language Models

Clinical information for amyotrophic lateral sclerosis (ALS) care documented in unstructured clinical notes limits downstream analysis without extraction into structured formats. Open-source small language models with few-shot prompting for detecting the presence of ALS-relevant clinical terms in patient documentation were evaluated without task-specific training data. The detection task targeted 17 categories spanning functional scores, respiratory measures, medications, and related clinical and non-clinical attributes. Clinical note content was normalized from JSON-encoded discharge summaries and processed with a prompt template having structured JSON outputs. We compared 26 open-source models using aggregate, label-level, and manual-validation multilabel classification metrics. Manual validation showed that a regex rule baseline had higher overall micro-F1 and lower Hamming loss than any single SLM or TF-IDF baseline, while Qwen3-4B-Instruct-2507 was the highest-performing SLM by micro-F1. Model rankings varied by metric and label category, with the TF-IDF baseline showing high recall but low precision, some SLMs showing higher precision but lower recall, and Hammer2.1-7b showing strong performance for ALSFRS-R subscore detection. These findings support targeted hybrid extraction workflows rather than replacement of existing rule-based methods.

Noah Marchal, William E. Janes, Mihail Popescu +1

University of Missouri, Columbia, Missouri, USA · Department of Occupational Therapy; University of Missouri, Columbia, Missouri, USA

Small Language Models Clinical Information Extraction Classification Clinical NLP

Jun 19, 2026cs.CL

MedHal-Loc: Are "Explainable-by-Architecture" Medical Hallucination Detectors Faithful Localizers? A Localization Benchmark

Detecting hallucinations in clinical text is increasingly framed as an explainability problem: systems should not merely flag an unreliable response but point to the offending span. Architectures built around knowledge-graph (KG) triple decomposition are marketed for exactly this auditability, yet their localization ability is typically assumed rather than measured. We introduce MedHal-Loc, a benchmark and metric for localization faithfulness -- whether a detector's top-ranked error unit actually overlaps the erroneous span. The controlled subset comprises 300 PubMedQA-derived statements with single, span-level errors injected across four localizable types (entity substitution, relation error, mechanism misattribution, invention), yielding gold spans by construction; a complementary natural subset documents that real hallucinations are dominated by diffuse conclusion-flips that resist span localization (a human expert accepted 1/18 candidate spans). Evaluating four fine-grained paradigms, we find that NLI-per-clause, consistency-per-sentence, and the dedicated span detector FAVA all localize well above chance, whereas an elaborate KG-triple pipeline localizes no better than chance (+3.3pp, n.s.), bottlenecked by ~59% entity-extraction coverage -- despite competitive detection F1 (0.609). Detection competence does not imply faithful localization; architectural explainability must be validated, not presumed.

Minmin Chen, Daojian Lu, Yining Dai +2

Shanwei Institute of Technology, Shanwei, China · Guangdong Provincial People’s Hospital, Guangzhou, China

Hallucination Detection Clinical Language Model Evaluation Explainability Evaluation Clinical NLP

Jun 18, 2026cs.AI

Neurosymbolic Clinical Trial Matching via LLM-Driven Abduction and Logical Verification

Large Language Models (LLMs) offer a promising path to automate Clinical Trial Matching (CTM), but still struggle with the deterministic verification required for complex eligibility criteria. Conversely, purely symbolic methods provide formal rigour but break down when faced with incomplete patient records and noisy clinical evidence. To bridge this gap, we investigate a hybrid framework for CTM combining LLMs with logical verification. In particular, we introduce an abductive neurosymbolic CTM framework (αNeSy-CTM), which leverages the linguistic and world knowledge in LLMs to support reasoning over noisy and underspecified clinical text. Extensive evaluation demonstrates that αNeSy-CTM substantially outperforms standalone LLM baselines, achieving up to 30% relative improvement over zero-shot baselines. In addition, our analyses confirm the impact of abductive reasoning on CTM, with αNeSy-CTM exhibiting improved accuracy, specificity, and robustness over a non-abductive neurosymbolic setting. Furthermore, αNeSy-CTM and Chain-of-Thought (CoT) reasoning prove highly complementary, highlighting the potential for a hybrid routing policy. Ultimately, this paper demonstrates the impact of neurosymbolic methods for automating CTM, providing a path toward the next generation of auditable, LLM-driven clinical applications.

Baiyang Qu, Leonardo Ranaldi, Xi Wang +1

Department of Computer Science, University of Leicester, UK · School of Informatics, University of Edinburgh, UK · School of Computer Science, University of Sheffield, UK

Abductive Reasoning Neuro-Symbolic Reasoning Clinical NLP

Jun 17, 2026cs.CL

Before the Labels: How Dataset Construction Shapes Suicidality Detection in Clinical Text

Clinical NLP increasingly relies on electronic health record (EHR) data to detect suicidal behaviors, treating clinical documentation as more reliable ground truth than social media. We argue that this framing obscures how EHR-based suicidality datasets encode a particular operationalization of suicidality, shaped by who authors the data, how episodes are bounded, and how ambiguity is resolved. We ground this argument in a case study of the ScAN dataset, built over MIMIC-III clinical notes. We show how governance constraints, ICD-based cohort selection, single-annotator labeling, and hospital-stay-level aggregation produce labels that reflect clinician-documented judgments, treat suicidality as a bounded episode, and assume that intent can be reliably inferred from documentation. A linguistic analysis demonstrates that identical labels subsume heterogeneous clinical framings differing in temporality, negation, and uncertainty. We argue that clinical NLP should examine the assumptions embedded in suicidality datasets before interpreting their labels as ground truth.

Priyanshi Garg, Ishita Rao, Jieqiong Ding +1

Department of Linguistics, University of Washington, Seattle, WA, USA · Human Centered Design & Engineering, University of Washington, Seattle, WA, USA

Electronic Health Records Clinical NLP Clinical Risk Prediction

Jun 16, 2026eess.AS

Reading between the Lines: Leveraging Large Language Models for Global Dementia and Depression Assessment from Clinical Interviews

Dementia and depression are the most prevalent neuropsychiatric disorders in geriatric populations, and their overlapping symptoms pose major challenges for differential diagnosis. In this study, we investigate open-weights Large Language Models (LLMs) for predicting dementia and depression severity from speech samples collected during standardized history taking interviews with 154 German-speaking subjects. We introduce an observer-based Global Depression Scale (GDS-D) aligned with the established Global Deterioration Scale (GDS), enabling parallel global staging of affective and cognitive symptoms. We compare three LLMs (Mistral 3.1, DeepHermes, Qwen3) in two settings: (1) zero-shot prediction and (2) LLM-based feature extraction for Support Vector Regression, using human and pause-enriched transcripts. Results show that LLMs effectively predict depression severity in zero-shot settings (best MAE of 0.60), while dementia assessment benefits substantially from structured feature extraction (best MAE of 0.78), reducing errors by up to 35% over zero-shot baselines. Pause-enriched transcripts achieve competitive performance with human transcriptions, demonstrating the viability of fully automatic screening pipelines for differential neuropsychiatric assessment.

Franziska Braun, Alea Rüggeberg, Thomas Ranzenberger +4

1TH Nürnberg · 2FAU Erlangen · 3PMU Klinikum Nürnberg, Germany

Depression Detection Mental Health Speech-Based Dementia Detection Depression Severity Estimation Clinical Language Model Evaluation Clinical NLP

Jun 14, 2026cs.CL

In-Domain Supervised Pathology Report Classification: A Reproducible Pipeline from Data Curation to Production-Matched Evaluation

We introduce an in-domain supervised pipeline designed to counter the out-of-distribution performance drop that hampers supervised biomedical NLP models, a problem observed when models trained on pathology reports are moved across cancer registries. Our contribution is a reproducible recipe for training a supervised classifier from routinely collected cancer registry data. It describes how to build the in-domain training set and a production-matched holdout, and to choose operating points that keep the false-negative rate (FNR) very low while keeping reviewer workload manageable. The pipeline standardizes data curation with facility-stratified sampling and separate handling of reports linked to registry cases, and includes a blinded manual audit to estimate positive-case prevalence and label noise. On a 418k-report holdout set, the Kentucky model achieved FNR 0.003 and false-positive rate (FPR) 0.097, improving over the Seattle-trained MOSSAIC OncoID baseline (FNR 0.010, FPR 0.183) and raising F1 from 0.860 to 0.922. In a blinded manual review of 600 reports, estimated positive prevalence declined from 0.500 to 0.398, indicating substantial label noise with errors concentrated in rare primary sites.

Isaac Hands, Bin Huang, Adam Spannaus +4

Department of Computer Science, University of Kentucky, Lexington, KY, USA · UK Markey Cancer Center, Lexington, KY, USA · Kentucky Cancer Registry, Lexington, KY, USA +3

Computational Pathology Training Data Curation OOD Generalization Oncology Clinical NLP

Jun 10, 2026cs.CL

MentalMARBERT: Domain-Adaptive Pre-training and Two-Stage Fine-Tuning for Arabic Mental Health Disorders Detection

Detecting mental health disorders from Arabic social media text remains challenging due to dialectal variation, informal language, limited high-quality annotated resources, and severe class imbalance. While English mental health natural language processing (NLP) has progressed substantially, Arabic multi-class disorder classification remains insufficiently studied. This study proposes a two-phase framework for Arabic mental health text classification. In phase 1, three Arabic pre-trained language models, AraBERT, CAMeLBERT, and MARBERT, undergo Domain-Adaptive and Task-Adaptive Pretraining (DAPT and TAPT) using a large-scale corpus of unlabeled Arabic mental health tweets. The adapted models are evaluated under a unified protocol to identify the most effective backbone model. In phase 2, the selected model is assessed across four configurations combining single-stage and hierarchical two-stage classification architectures with full fine-tuning and Low-Rank Adaptation (LoRA). To support this study, we constructed a novel annotated Arabic mental health dataset comprising 50,670 tweets across six categories, with strong inter annotator agreement (Krippendorff's Alpha = 0.733, average pairwise agreement = 0.797). Experimental results show that the domain-adapted MARBERT (MentalMARBERT) achieves statistically significant improvements over baseline models in both accuracy and macro-F1. The hierarchical two-stage architecture combined with full fine-tuning achieves the best overall performance, reaching a macro-F1 of 0.861 and an accuracy of 0.877. These findings demonstrate the effectiveness of domain-specific adaptive pretraining and hierarchical classification for Arabic mental health disorder detection.

Fatimah Almalki, Areej Alhothali, Lulwah Alharigy +1

Department of Computer Science Faculty of Computing and Information Technology King Abdulaziz University Jeddah, Saudi Arabia · Department of Psychology College of Arts and Humanities King Abdulaziz University Jeddah, Saudi Arabia

Social Media Analysis Arabic NLP Mental Health Domain-Adaptive Pretraining Text Classification Clinical NLP

Jun 10, 2026cs.CL

eCREAM-MedCorpus A Large-Scale Corpus of Clinical Notes for Italian

We present eCREAM-MedCorpus, a new and unique large-scale dataset of clinical notes produced in Emergency Departments of Italian hospitals. The corpus, in its current version, is composed of approximately 4 million clinical notes fully anonymized, covering diverse phases of patient care during the stay in the emergency department. In addition, a subset of about six thousand notes has been manually annotated by clinical experts through a structured Case Report Form (CRF) containing 132 items relevant for two patient situations in emergency departments, dyspnea and loss of consciousness. Items may assume numerical values (e.g., for blood saturation), categorical (e.g., for level of consciousness ), binary (e.g., for presence of traumas), and mixed value types. The annotation process involved multiple clinicians and underwent iterative revision to resolve ambiguities in item formulation, resulting in a richly structured (although high imbalanced) resource. The dataset aims to fill a relevant gap of data able to support both the development and the use of Large Language Models in concrete medical applications. We describe the data collection protocol, the on-site anonymisation pipeline, corpus statistics, and the annotation scheme. Finally, we propose CRF-filling as a novel structured information extraction benchmark, and provide zero-shot baseline resulting from Gemma-27B and MedGemma-27B. To the best of our knowledge, eCREAM-MedCorpus is the largest freely available dataset of clinical notes existing for the Italian language.

Tiziano Labruna, Guido Bertolini, Pietro Ferrazzi +1

Fondazione Bruno Kessler, Trento, Italy · Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy · University of Padua, Padua, Italy

Document Information Extraction Clinical Information Extraction Electronic Health Records Clinical NLP Medical LLMs

Jun 9, 2026cs.IR

A PubMed-Scale Dataset of Structured Biomedical Abstracts

Structured abstracts are important for biomedical literature processing, by facilitating information retrieval, text mining, and knowledge synthesis. However, a vast portion of abstracts indexed in PubMed remain unstructured, presenting a significant bottleneck for downstream text-processing workflows and applications. To resolve this limitation, we introduce Structured PubMed, a comprehensive corpus of section-labeled biomedical abstracts compiled from the complete PubMed database, encompassing over 23.2 million research-article records. The corpus is divided into two distinct subsets: a collection of 5.9 million author-structured abstracts parsed from official XML files, and an automatically labeled collection of 17.2 million originally unstructured abstracts structured via a verbatim-extraction Large Language Model pipeline. Every record is harmonized under a unified five-section schema and mapped to its original PubMed identifier, publication type, and publication date. This dataset can be utilized to train sentence-classification models, benchmark text-segmentation architectures, and perform large-scale, section-specific information extraction at an unprecedented PubMed-wide scale.

Chia-Hsuan Chang, Haerin Song, Brian Ondov +1

Department of Biomedical Informatics & Data Science, School of Medicine, Yale University, New Haven, CT 06510, USA · Interdisciplinary Program in Artificial Intelligence, Seoul National University, 1, Gwanak-ro, 08826, Seoul, Republic of Korea

Jun 9, 2026cs.CL

Dep-LLM: Training-Free Depression Diagnosis via Evidence-Guided Structured Multi-factor with Reliable LLM Reasoning

Automatic Depression Detection (ADD) from clinical interviews is a pivotal task in computational mental health, yet it remains challenging due to two critical obstacles: 1) difficulty in modeling complex but sparsely distributed depression clues within lengthy, multi-topic clinical interviews, leading to superficial and unreliable reasoning; 2) scarcity of labeled data due to clinical privacy, together with high cost of training and fine-tuning, limiting the deployment of supervised ADD systems. To jointly address these challenges, we propose Dep-LLM, a training-free framework that mirrors the step-by-step reasoning of clinical psychiatrists and operates entirely on frozen off-the-shelf foundation LLMs. Dep-LLM comprises three stages. First, a Chain-of-Thought (CoT) Depression Multi-factor Analysis module structurally decomposes the long dialogue into five clinically aligned themes and produces evidence-grounded rationales, effectively handling long-context dependencies. Second, we introduce Confidence Analysis and Modulation module that quantifies the epistemic reliability from token-level entropy of each rationale and applies an intra-label and inter-theme modulation that amplifies trustworthy signals while suppressing uncertain ones without extra training. Third, a Collaborative Multi-factor Prediction module dynamically integrates multi-factor signals weighted by confidence into the final diagnosis. Extensive experiments on the DAIC-WOZ and E-DAIC datasets demonstrate the effectiveness and generalizability of Dep-LLM: it surpasses zero-shot baseline on nearly all 21 foundation LLMs across 9 metrics such as accuracy, macro F1 and weighted-average F1, and further outperforms state-of-the-art supervised domain-specific LLMs as well as the latest closed-source commercial LLMs, while requiring no extra training.

Yiqing Lyu, Xianbing Zhao, Buzhou Tang +1

LLM Inference Depression Detection Mental Health Clinical Reasoning Clinical NLP

Jun 7, 2026cs.CL

ClinicalAligner26AM: A Cross-Lingual Aligner for Dataset Translation; Evidences from the MultiClinCorpus Shared Task

Word-level cross-lingual alignment is central to annotation projection, translation auditing, and cross-lingual faithfulness estimation, yet existing neural aligners are rarely adapted to specialized domains. In this paper, we introduce ClinicalAligner26AM, a large-context multilingual aligner model for biomedical and clinical text initialized from ClinicalEncoder26AM. Our training recipe is inspired by AWESoME Align. We build our soft alignment target by sharpening with Sinkhorn-Knop optimal transport a cost matrix established for parallel clinical texts and conversations through the fusion of sentence-level, phrase-level, and token-level signals. We distill this sharpened alignment matrix directly into our student aligner, by encouraging its naive cosine-based token similarity scores to match this target. At inference time, we project source-span scores through the learned token alignment matrix and decode the longest valid high-scoring span in the target text, optionally supported by MultiClinNER predictions summarized in Appendix B. We evaluate CA26AM on the MultiClinCorpus shared task, which projects Spanish clinical entity annotations into six target languages. Our two submitted systems ranked respectively first and second across all languages and entity types, with character-weighted F1 scores above 0.95 in nearly all settings.

François Remy

Parallia Healthcare AI

Clinical NLP Cross-Lingual Transfer

Jun 2, 2026cs.CL

The Word and the Way: Strategies for Domain-Specific BERT Pre-Training in German Medical NLP

Digital healthcare generates vast amounts of clinical text that can support AI-assisted applications, yet German biomedical language models remain limited by older architectures or restricted training data. We present ChristBERT (Clinical- and Healthcare-Related Issues and Subjects Tuned BERT), a family of domain-specific German RoBERTa-based language models trained on a 13.5GB corpus of scientific publications, clinical texts, health-related web content, and translated clinical resources. To investigate the impact of domain adaptation strategies in German clinical NLP, we compare continued pre-training, training from scratch, and domain-specific vocabulary adaptation. The resulting models are evaluated on three medical named entity recognition tasks and two text classification tasks. ChristBERT consistently outperforms existing general-purpose and medical German language models on four of five benchmarks and establishes a new state of the art for German clinical language modeling. Our results show that the optimal adaptation strategy is task-dependent: in our evaluation, training from scratch is particularly effective for highly specialized clinical texts, whereas continued pre-training performs well on more commonly written medical texts. All models are publicly released to support future research and applications in German medical NLP.

Henry He, Johann Frei, Raphael Schmitt

School of Computation, Information and Technology, Technical University of Munich, Munich, Germany. · Chair of IT Infrastructure for Translational Medical Research, Faculty of Applied Computer Science, University of Augsburg, Augsburg, Germany. · Institute of General Practice, Faculty of Medicine and Medical Center, University of Freiburg, Germany.

Domain-Adaptive Pretraining Clinical NLP

Jun 1, 2026cs.CL

When Rating Scales Fall Short: LLM-Assisted Discovery of ADHD Signals in Turkish Teacher Narratives

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood, and its diagnosis relies on assessments combining clinician judgment with standardized rating scales and reports from parents and teachers. While structured instruments such as the Conners' Teacher Rating Scale-Revised Short Form (CTRS-R:S) quantify ADHD-related behaviors, teachers also provide open-ended narratives that may contain complementary signals not captured by structured assessments. However, it remains unclear to what extent teacher narratives encode signals overlooked by rating scales. In this study, we analyze de-identified Turkish teacher evaluation forms collected during clinical ADHD assessments, including both CTRS-R:S scores and open-ended teacher narratives. We compare predictive signals from structured scores and narrative text and identify cases where structured assessments fail to clearly distinguish ADHD from non-ADHD students while narrative-based models capture distinct behavioral patterns. Notably, these cases show minimal overlap with those missed by the narrative model, suggesting that structured and narrative information encode complementary signals. To interpret these differences, we apply a large language model (LLM)-assisted theme discovery pipeline that reveals distinct attention, behavioral, and family-related patterns, highlighting the potential of natural language processing (NLP) to uncover clinically relevant signals from teacher narratives and to complement traditional ADHD screening tools.

Baris Karacan, Irem Aktar Songur, Ahmet Ozaslan +1

Department of Computer Science, University of Illinois Chicago · Department of Child and Adolescent Psychiatry, Gazi University

Medical Diagnosis Clinical Information Extraction Clinical NLP

Jun 1, 2026cs.CL

KliniskVestBERT: BERT Model Specialised to Norwegian Clinical Texts

The increasing application of Natural Language Processing (NLP) in healthcare demands language models specifically attuned to the complexities of clinical language. This work introduces KliniskVestBERT, a suite of three BERT-based encoder models pre-trained on a substantial corpus of real-world, de-identified Norwegian clinical texts from Helse Vest. We continue pretraining existing language models Nb-BERT-large, NorBERT3-large, and ModernBERT on our specialized clinical dataset. This dataset is based on a representative population of Helse Vest patients. The included document types are carefully curated to encompass a broad clinical spectrum in bokmål and nynorsk including discharge summaries, surgical reports, nursing notes etc. ensuring comprehensive representation of the linguistic landscape within Norwegian healthcare settings. Evaluation on three synthtetic Norwegian clinical benchmark datasets and two real-world problems demonstrates that each of our clinically specialized models consistently outperforms their baseline counterparts, highlighting the significant benefit of domain-specific pre-training for NLP tasks within the clinical domain. The project was a joint effort by all Helse Vest entities (Helse Bergen, Helse Fonna, Helse Førde and Helse Stavanger) with DIPS under the project lead of Helse Vest ICT.

Christian Autenried, Cosimo Persia

Helse Vest ICT

Language Model Pretraining Domain-Adaptive Pretraining Clinical Language Model Evaluation Clinical NLP Medical LLMs

Jun 1, 2026cs.CL

Why Do Self-Harm Prediction Models Struggle to Generalise? Lexical and Semantic Variations in Emergency Department Triage Notes

Self-harm presentations to emergency departments (EDs) are strongly associated with higher suicide risk. NLP models have shown robust performance in detecting self-harm from triage notes within single hospitals, yet performance often declines across institutions. To examine potential causes, we compare ED triage notes from two hospitals by analyzing lexical characteristics, highly associated predictive features, and salient topics. Our results reveal variation in lexical expression and feature importance related to self-harm across hospitals, despite consistent core themes such as self-poisoning and self-injury. These documentation differences are associated with reduced cross-site performance. Our findings provide insight into how institutional variation affects the identification of self-harm in clinical text and highlight potential methods to improve model generalisability.

Liuliu Chen, Mike Conway, Jo Robinson +1

School of Computing and Information Systems, The University of Melbourne, Australia · Orygen, The National Centre of Excellence in Youth Mental Health, Australia · Centre for Youth Mental Health, The University of Melbourne, Australia +1

Distribution Shift Clinical Triage Mental Health Clinical Prediction Clinical NLP Clinical Risk Prediction

May 30, 2026cs.CL

LinguIUTics at PsyDefDetect: Iterative Imbalance-Aware Fine-tuning of Qwen3-8B for Psychological Defense Mechanism Classification

Detecting psychological defense mechanisms in conversational text remains a challenging clinical NLP problem. For the PsyDefDetect 2026 shared task (nine-class utterance classification evaluated via macro F1), our team LinguIUTics achieves a macro F1-score of 0.3917 on the official positive-class leaderboard, ranking 4th out of 21 registered teams and improving over the Ministral-8B task baseline (31.48 macro F1) by 7.7 absolute points (24.4 percent relative). BERT-family encoders and zero-shot LLMs proved ineffective on rare classes due to severe class imbalance, leading us to QLoRA fine-tuning of Qwen3-8B. We leverage three key strategies: grouped stratified cross-validation (preventing leakage), minority-class round-robin lexical augmentation, and a post-processing pipeline with logit bias tuning and ensemble blending. Together, these components close much of the validation-to-leaderboard gap and substantially improve minority-class recall, driving the critical "Unclear" class (Level 8) from near-zero performance to an F1 score of 0.797.

Shefayat E Shams Adib, Ahmed Alfey Sani, Md Hasibur Rahman Alif +1

Department of Computer Science and Engineering, Islamic University of Technology, Dhaka, Bangladesh

Class-Imbalanced Learning Quantization-Aware LoRA Language Model Post-Training Clinical NLP

May 29, 2026cs.CL

Reliable Multilingual Orthopedic Decision Support from Clinical Narratives: Language-Aware Adaptation and Verification-Guided Deferral

Multilingual orthopedic decision support remains challenging in low-resource healthcare settings, where clinical narratives contain specialized terminology, mixed scripts, incomplete evidence, label imbalance and language-dependent documentation patterns. This article presents a reliability-oriented framework for classifying free-text orthopedic notes in English, Hindi and Punjabi. We compare task-aligned multilingual transformer encoders, a task-fine-tuned DistilBERT baseline, zero-shot instruction-tuned large language models (LLMs) and a domain-adaptive encoder, IndicBERT-HPA. IndicBERT-HPA augments IndicBERT with language-aware orthopedic adapter heads to support clinically relevant multilingual representation learning. Evaluation extends beyond aggregate accuracy to per-class performance, ROC-AUC, AUPRC, expected calibration error, cross-language stability and robustness under controlled balanced and natural-prevalence distributions. The evaluated zero-shot LLMs remain substantially less effective than task-adapted encoders for closed-set classification, with language-dependent instability. Under natural clinical prevalence, IndicBERT-HPA achieves the strongest overall performance, reaching an averaged Macro-F1 of 0.8792, Macro-AUROC of 0.894 and AUPRC of 0.902. We further implement a deterministic selective-verification layer combining confidence gating, evidence-consistency checking and language-risk screening. On a randomly selected held-out 5,000-record subset, it achieves 84.4% selective accuracy and 0.76 selective Macro-F1 at 72.3% coverage, compared with 71.5% accuracy and 0.65 Macro-F1 for accept-all prediction. These results support reliability-oriented multilingual clinical decision support with explicit deferral.

Danish Ali, Li Xiaojian, Sundas Iqbal +1

School of Computer Science, Wuhan University, China · School of Software, Nanjing University of Information Science and Technology (NUIST), China · Department of Orthopedic, Bahawal Victoria Hospital, Pakistan

Multilingual Language Models Selective Prediction Clinical Decision Support Low-Resource Language Processing Clinical NLP

May 27, 2026cs.CL

ClinicalEncoder26AM: A Multlilingual Diagnosable ColBERT Model; Evidences from the MultiClinNER Shared Task

ClinicalEncoder26AM is a multilingual Diagnosable ColBERT for clinical and biomedical texts, which aligns at multiple levels its token-level semantic with ClinicalMap25, a clinical latent space inspired by BioLORD-2023 and enriched with synthetic and annotated supervision. The post-training recipe builds upon BGE-M3, and combines synthetic clinical notes, patient--doctor conversations, and annotated resources such as MedMentions, while considering both named-entity-level and sentence-level representations in a multi-adapter distillation, along with a ColBERT-style retrieval objective. In this system demonstration paper, we evaluate the model in the MultiClinNER shared task by finetuning it as a BIO tagger for patient symptoms, disorders, and procedure spans, using a lightweight two-layer CNN head to improve local boundary detection. The resulting system remains simple, processes most documents in a single 8192-token window, and achieves state-of-the-art multilingual entity recall, while achieving Top 5 overall across all entity types and languages in Character-weighted F1 scores. Training curves further show that ClinicalEncoder26AM is markedly more data-efficient than the base M3 model, supporting the usefulness of its clinical post-training for downstream information extraction. The model can be downloaded on https://huggingface.co/Parallia/ClinicalEncoder26AM-Diagnosable-Colbert-L2-for-multilingual-medical-texts

François Remy

Parallia AI

Named Entity Recognition Healthcare Clinical Information Extraction Multi-Vector Retrieval Text Embedding Models Clinical NLP

May 27, 2026cs.CL

PubMedCausal: A Span-Level Annotated Corpus for Causal Relation Extraction in Biomedical Text

Causal relation extraction (CRE) is central to biomedical text mining, but current resources often conflate causal relations with broader associations, restrict annotation to sentence-level examples, or focus mainly on explicit causal cues. This limits their usefulness for evaluating whether models can recover causal claims as they are actually expressed in biomedical text. We introduce PubMedCausal, a span-level annotated corpus for biomedical CRE built from PubMed abstracts. The corpus contains 30,000 paragraph-level rows, including 3,945 causal rows and 6,491 adjudicated cause--effect pairs. Each causal relation is annotated with full-text cause and effect spans, causality type, and sententiality, enabling evaluation of both causal detection and full-span causal extraction. We benchmark discriminative encoders and open-source generative models across detection and extraction settings. For causal detection, biomedical encoders are strongest, with PubMedBERT reaching an F

_1

score of 0.7391. For span-level extraction, the best generative baseline is DeepSeek-R1-32B with few-shot prompting, reaching a Cosine Pair F

_1

of 0.6765. We further test transfer learning by evaluating PubMedCausal-trained encoders on external causal relation datasets, showing that the resource supports cross-dataset evaluation. Our results show that biomedical CRE remains difficult under class imbalance, long causal spans, implicit causality, inter-sentential relations, and prompt sensitivity. Code and Data can be found here: https://github.com/josiahpaul07/PubMedCausal_Exp

Ifeoluwa Kunle-John, Josiah Paul, Oluwatosin Agbaakin +3

Edyah Limited1, University of Ibadan, NG2 · Indiana University, Indianapolis, IN3 · Creighton University, Omaha NE4

Relation Extraction Clinical NLP

May 27, 2026cs.CL

Challenges in Explaining Pretrained Clinical Text Classifiers

Explaining the predictions of neural models in clinical NLP remains a significant challenge, especially for complex tasks involving long, unstructured medical texts. While post-hoc methods like LIME and SHAP are widely used, they often fall short when applied to clinical narratives. In this paper, we identify core limitations of token-level and perturbation-based explanation techniques through targeted demonstra- tions on a hospital length-of-stay prediction task. Our findings reveal issues such as overemphasis on non-informative tokens, instability in at- tributions, and high-confidence predictions for incoherent input variants. These results underscore the need for explanation strategies that are clin- ically meaningful, semantically grounded, and robust to linguistic noise.

Kristian Miok, Matej Klemen, Blaz Škrlj +1

Faculty of Computer and Information Science, University of Ljubljana, Slovenia · ICAM - Advanced Environmental Research Institute, West University of Timisoara, Romania · Jožef Stefan Institute

Feature Attribution Neural Network Interpretability Explainability Evaluation Clinical NLP

May 25, 2026cs.CL

Forgotten Words: Benchmarking NeoBERT for Dementia Detection in Low-Resource Conversational Filipino and English Speech

Dementia detection from spontaneous speech offers a scalable approach to cognitive screening, yet NLP systems remain predominantly English-centric. This limitation is especially acute in the Philippines, where Filipino-English code-switching is pervasive and no prior work has addressed NLP-based dementia detection. We present the first systematic evaluation of transformer-based dementia detection in Filipino speech and the first assessment of NeoBERT in a clinical NLP setting. To separate language from domain effects, we construct a parallel bilingual dataset of 4,000 DementiaBank-derived transcripts, with Filipino translations produced manually to preserve discourse-level markers of cognitive decline. We evaluate five model families, TF-IDF + LogReg, BERT, NeoBERT, XLM-R, and RoBERTa-Tagalog, under monolingual, zero-shot cross-lingual, and bilingual fine-tuning settings. We find that in-domain performance does not transfer across languages, with English-trained BERT dropping to Macro-F1 = 0.455 on Filipino, and that architectural modernization alone does not improve robustness. Bilingual fine-tuning, however, eliminates cross-lingual degradation across all transformer models, converging to Macro-F1 = 0.969-0.973. These results suggest that multilingual clinical NLP performance is driven primarily by linguistic coverage during training rather than model scale or architecture.

Rez Samantha Z. Floresca, Edric Castel C. Hao, Hannah Grachiella Buñales +3

Ateneo de Manila Senior High School · Analog Devices, Inc.

Multilingual Language Model Evaluation Speech-Based Dementia Detection Low-Resource Language Processing Clinical NLP Cross-Lingual Transfer

May 24, 2026cs.CL

Overview of the PsyDefDetect Shared Task at BioNLP 2026: Detecting Levels of Psychological Defense Mechanisms in Supportive Conversations

We present an overview of PsyDefDetect, the shared task on detecting levels of psychological defense mechanisms in emotional support dialogues, co-located with BioNLP@ACL 2026. Grounded in the clinically validated Defense Mechanism Rating Scales (DMRS) framework, the task asks systems to classify a target seeker utterance, given its preceding dialogue context, into one of nine categories: seven hierarchical DMRS levels plus two auxiliary labels. Participants worked on PsyDefConv, a newly released corpus of 200 dialogues and 2336 help-seeker utterances annotated under DMRS with substantial inter-annotator agreement. The task attracted 172 participants on CodaBench who produced 563 submissions, with 21 teams officially registering their results for the final ranking. The best system achieved a macro F1-score of 0.420, surpassing the strongest fine-tuned baseline reported in the dataset paper by a notable margin, yet leaving clear headroom. Our analysis highlights (i) a persistent tendency to over-predict the majority High-Adaptive class, (ii) a widening gap between accuracy and macro-F1 that reveals class-imbalance sensitivity, and (iii) the value of theory-aware and LLM-based approaches for fine-grained defensive-function classification. We release all task materials and invite the community to continue work on this novel intersection of clinical psychology and NLP.

Hongbin Na, Zimu Wang, Zhaoming Chen +8

University of Technology Sydney · Xi’an Jiaotong-Liverpool University · University of Utah +5

Emotional Support Conversation Mental Health Clinical NLP

May 23, 2026cs.AI

Automated Detection and Classification of Delusion-related Content in Naturalistic Audio Diaries Using Multi-Agent Language Models

Speech monologues recorded in naturalistic settings provide opportunities to characterize mental illness phenomenology and detect symptom exacerbation. Large language models (LLMs) offer new possibilities for automating this process, as they require annotated data primarily for evaluation rather than training. In this paper, we present a novel automated, multi-agent LLM pipeline for the fine-grained, multi-label extraction of language suggestive of delusional beliefs, associated affective responses, and behavioral responses from transcripts of naturalistic audio diaries collected from people with moderate persecutory ideation. Evaluating an ensemble of three foundation models, we demonstrate that detailed diagnostic prompt instructions successfully reduce false positives for delusional theme classification, but also constrain the interpretation of affective or behavioral responses. Furthermore, comparing multi-agent adjudication frameworks shows that complex conversational debate between agents diminishes accuracy on clinically ambiguous text by inducing premature consensus. Instead, majority voting establishes robust performance (Micro F1 of 0.872 and 0.779 for delusion detection and classification respectively). This work provides a validated and scalable pipeline for the automated detection and characterization of content suggesting delusional beliefs in naturalistic speech.

Feng Chen, Justin Tauscher, Changye Li +7

Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA · Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA · Department of Psychology, Louisiana State University, Baton Rouge, LA, USA +1

LLM Evaluation Multi-Agent LLMs Clinical NLP

May 21, 2026cs.LG

EmoTrack: Clinical-Semantic Modeling for Text-Based Depression Severity Estimation

Text-based counseling provides a valuable source of information for assessing depression severity. We study prediction of the total score on the eight-item Patient Health Questionnaire (PHQ-8), a self-report measure of depression severity, from counseling transcripts. Clinical-based methods rely mainly on large language model (LLM) inference to obtain structured session-level assessments, but these assessments provide limited information about which utterances support each score. Training-based methods train predictors directly on sentences or their semantic embeddings and preserve local conversational detail, but must learn clinical structure from limited labeled transcripts. Integrating a small set of clinical feature scores with a long sequence of high-dimensional utterance representations is challenging, as simple fusion can overemphasize dialogue evidence and fail to link clinical features to supporting utterances. Combining structured clinical assessments with sentence-level semantics, we propose EmoTrack, which jointly encodes clinical feature scores and utterance representations to predict the total PHQ-8 score. For longitudinal assessment across successive sessions, the model can also incorporate a compressed representation of the preceding session as optional memory. On the real-world DAIC-WOZ benchmark, EmoTrack reduces mean absolute error from 2.8234 to 2.4708 relative to the strongest evaluated baseline. Across five settings covering single-session estimation, cross-dataset transfer without adaptation, and longitudinal assessment, it reduces normalized aggregate error by approximately 6.1% relative to the strongest baseline.

Zhaomin Wu, Jiayi Li, Bingsheng He

Department of Computer Science National University of Singapore

Mental Health Counseling Depression Detection Mental Health Clinical Outcome Prediction Depression Severity Estimation Clinical NLP

May 20, 2026cs.CL

Reliable Automated Triage in Spanish Clinical Notes: A Hybrid Framework for Risk-Aware HIV Suspicion Identification

Standard clinical Natural Language Processing (NLP) benchmarks often yield inflated metrics by forcing deterministic classification on ambiguous instances, thereby obscuring the clinical risks of overconfident predictions. To bridge this gap, we propose a risk-aware hybrid selective classification framework, evaluated on early Human Immunodeficiency Virus suspicion identification in Spanish clinical notes. Our dual-verification approach explicitly decouples aleatoric uncertainty through Mondrian conformal prediction and epistemic uncertainty using a Multi-Centroid Mahalanobis Distance veto. Empirical evaluations reveal that standard uncertainty metrics and baseline classifiers are structurally insufficient for safe medical triage, suffering severe coverage collapse when forced to operate under strict reliability constraints. In contrast, by demanding that clinical narratives pass both probabilistic and geometric safeguards, the proposed framework successfully isolates a highly trustworthy operational domain.

Rodrigo Morales-Sánchez, Soto Montalvo, Raquel Martínez

Dept. Lenguajes y Sistemas Informáticos, ETSI Informática, Universidad Nacional de Educación a Distancia (UNED) · Dept. Informática y Estadística, ETSI Informática, Universidad Rey Juan Carlos (URJC)

Selective Prediction Healthcare Clinical Triage Medical Diagnosis Clinical NLP Clinical Risk Prediction