Linguistic Markers in At-Risk Mental States Using Natural Language Processing: A Systematic Review

Background/Objectives: In recent years, research on psychosis has increasingly focused on prevention, aiming to implement early interventions that mitigate or reduce its impact. Within this framework, the analysis of linguistic markers in individuals with at-risk mental states (ARMS) has proven valuable for identifying those at risk and predicting psychosis onset. Artificial intelligence tools, particularly natural language processing (NLP), have emerged as effective resources for detecting these language-based indicators. This study aims to synthesize the existing scientific evidence on linguistic markers analyzed through NLP techniques in individuals with ARMS. Methods: A systematic review following the PRISMA 2020 protocol was conducted. Three databases (PubMed, PsycInfo, and Scopus) were searched for published articles from their inception to October 2025. Rayyan software was used to manage references and article downloads. Out of ninety initial search results, fifteen studies involving 1313 participants from diverse groups were included in the review. Results: The findings indicated that alterations in semantic coherence, syntactic complexity, referential cohesion, and speech/content poverty differentiated ARMS individuals from healthy controls. Several of these markers, analyzed with NLP methods, predicted the onset of psychosis with accuracy levels ranging from 79% to 100%, although these findings should be interpreted with caution due to the significant methodological heterogeneity and variability in sample sizes across the included studies. Conclusions: NLP techniques offer a powerful approach for detecting language alterations that distinguish ARMS individuals and provide meaningful predictions of psychosis onset, highlighting their potential as a complement to traditional clinical assessments for early identification and prevention.