Annotation quality is a major bottleneck in building reliable and explainable artificial intelligence (XAI) systems for mental health research. In depression-related datasets, labels are often assigned without structured evidence, symptom-level justification, or traceable alignment with the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), limiting both transparency and downstream model interpretability. We propose a self-evolving, expert-in-the-loop annotation framework for Major Depressive Disorder (MDD) that combines large language model (LLM)-assisted labeling with expert verification. The framework is intended to support the construction of explainable, DSM-5-TR-aligned datasets rather than to perform clinical diagnosis. It operates in three stages: candidate evidence selection from textual records, criterion-level DSM-5-TR analysis, and case-level synthesis that produces label-level diagnostic and severity annotations. A dual-memory architecture, composed of Example Memory and Reflection Memory, is designed to internalize expert feedback and iteratively improve future annotations without retraining. We describe this mechanism and leave its evaluation across multiple feedback cycles to future work. In addition to final labels, the framework exports clinical evidence, reasoning traces, and edit histories, enabling comprehensive auditability. In a pilot study using expert-reviewed samples, the proposed approach improves annotation consistency and explainability while reducing manual revision effort.
Interpretability is essential for trustworthy medical image diagnosis. However, existing concept-driven interpretable methods have key limitations: Concept Bottleneck Models (CBMs) require scoring all predefined concepts at inference time and for manual intervention, imposing a substantial burden on clinicians, while rationale-based generative approaches often select concepts by class discriminability, which can drift from diagnostic ontologies. To address these issues, we propose Neuro-Symbolic Rule Distillation (NeRD), a framework that produces efficient, ontology-grounded reasoning chains that are sufficient yet non-redundant, without manually crafting diagnostic rules. Experiments on two skin datasets demonstrate strong diagnostic performance and interpretability, and blinded expert evaluation confirms the clinical plausibility of NeRD rationales. Our method further enables a first expert-in-the-loop study for Multimodal Chain-of-Thought-based diagnosis, achieving efficient and effective concept-level intervention.