The medical adoption of NLP tools requires interpretability by end users, yet traditional explainable AI (XAI) methods are misaligned with clinical reasoning and lack clinician input. We introduce CHiRPE (Clinical High-Risk Prediction with Explainability), an NLP pipeline that takes transcribed semi-structured clinical interviews to: (i) predict psychosis risk; and (ii) generate novel SHAP explanation formats co-developed with clinicians. Trained on 944 semi-structured interview transcripts across 24 international clinics of the AMP-SCZ study, the CHiRPE pipeline integrates symptom-domain mapping, LLM summarisation, and BERT classification. CHiRPE achieved over 90% accuracy across three BERT variants and outperformed baseline models. Explanation formats were evaluated by 28 clinical experts who indicated a strong preference for our novel concept-guided explanations, especially hybrid graph-and-text summary formats. CHiRPE demonstrates that clinically-guided model development produces both accurate and interpretable results. Our next step is focused on real-world testing across our 24 international sites.

Concept Bottleneck Models (CBMs) decompose image classification into a process governed by interpretable, human-readable concepts. Recent advances in CBMs have used Large Language Models (LLMs) to generate candidate concepts. However, a critical question remains: What is the optimal number of concepts to use? Current concept banks suffer from redundancy or insufficient coverage. To address this issue, we introduce a dynamic, agent-based approach that adjusts the concept bank in response to environmental feedback, optimizing the number of concepts for sufficiency yet concise coverage. Moreover, we propose Conditional Concept Bottleneck Models (CoCoBMs) to overcome the limitations in traditional CBMs’ concept scoring mechanisms. It enhances the accuracy of assessing each concept’s contribution to classification tasks and feature an editable matrix that allows LLMs to correct concept scores that conflict with their internal knowledge. Our evaluations across 6 datasets show that our method not only improves classification accuracy by 6% but also enhances interpretability assessments by 30%.

Multimodal Large Language Models (MLLMs) have shown promise in visual-textual reasoning, with Multimodal Chain-of-Thought (MCoT) prompting significantly enhancing interpretability. However, existing MCoT methods rely on rationale-rich datasets and largely focus on inter-object reasoning, overlooking the intra-object understanding crucial for image classification. To address this gap, we propose WISE, a Weak-supervision-guided Step-by-step Explanation method that augments any image classification dataset with MCoTs by reformulating the concept-based representations from Concept Bottleneck Models (CBMs) into concise, interpretable reasoning chains under weak supervision. Experiments across ten datasets show that our generated MCoTs not only improve interpretability by 37% but also lead to gains in classification accuracy when used to fine-tune MLLMs. Our work bridges concept-based interpretability and generative MCoT reasoning, providing a generalizable framework for enhancing MLLMs in fine-grained visual understanding.