Core schema instability in youth at clinical high risk for psychosis: within-person variability as an index of self-belief precision
Year: 2026
Type: preprint
Abstract: Aim Core schemas are considered stable traits in clinical high risk (CHR) research. However, unexamined fluctuation may conceal belief changes that precede psychosis emergence. We examined whether schemas possess considerable within-person variability in CHR, and whether that variability exceeds that of controls. Methods In NAPLS-2, 411 CHR and 194 control participants completed the Brief Core Schema Scales (BCSS) at least three times across 24 months. Random-intercept models identified intraclass correlations in CHR. Bayesian censored location-scale models, correcting for floor scores and mean level differences, compared within-person SD between groups. Results Within-person variance accounted for 41.3%–50.6% of BCSS variance in CHR. Latent within-person SD was greater in CHR on all four subscales, most for negative-self (ratio 1.71, 95% CrI [1.50, 1.94]). This variability was largely independent of shared improvement and psychotropic medication effects. Conclusions Core schemas fluctuate substantially in CHR compared to controls, particularly in negative self-beliefs. Single baseline scores may understate schema–outcome associations.
Source: medRxiv
Institutions: Yale University, Connecticut Mental Health Center, University of Calgary, Hotchkiss Brain Institute, University of California, Los Angeles, University of California San Diego, San Francisco VA Medical Center, University of California, San Francisco, University of North Carolina at Chapel Hill, Emory University
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1853164733, Vulnerability Markers in the Prodrome and First Episode of Schizophrenia, G2559930976, G2988724381, 3/9- Predictors and Mechanisms of Conversion to Psychosis, "1/9-Predictors and Mechanisms of Conversion to Psychosis, 8/9 Predictors and Mechanisms of Conversion to Psychosis, Vulnerability Markers in Prodromal Schizophrenia, "7/9" Predictors and Mechanisms of Conversion to Psychosis, 4/9-Predictors and Mechanisms of Conversion to Psychosis, 5/9 Predictors and Mechanisms of Conversion to Psychosis, 2/9 - Predictors and Mechanisms of Conversion to Psychosis, G8774197883
OpenAlex ID: W7224435643