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Abstract Thought disorder may be associated with subtle language abnormalities. Binomials are pairs of words of the same grammatical type that are joined by a conjunction that often have a preferred order (for example, “up and down” is more common than “down and up”). We analyzed speech transcripts from patients with first-episode psychosis and found that atypical ordering of binomial pairs was associated with thought disorder but not with other psychosis symptoms. These results illustrate the potential to generate objective, quantifiable measures of disorganized speech.