Gut Microbiome in AP Naive

Patients will collect fecal samples at home using our well-established protocol at baseline, 6 weeks, and 12 weeks. Participants will be provided a kit containing a sterile specimen container and a cooling pad, as well as a stool collection tube for DNA analyses (OMNIgene•GUT, DNA Genotek Ottawa, ON). Patients will be instructed to transfer several grams of the feces into the specimen container and place the sample in the 2 bioharzard bags and then store in the freezer. On the day of their appointment they will transport the sample on the cooling pad (previously placed in the freezer) to their appointment. When the patient delivers the sample to the research staff, it will be immediately placed in a -80ºC freezer prior to being analyzed. These analyses with fecal samples will be conducted at McMaster University at the Farncombe Family Institute.

Following collection of baseline samples, a standard glucose drink (75mg) is given orally, and a blood sample of insulin and glucose is obtained exactly 1 hour and 2 hours after the standard glucose drink is administered. Blood will be drawn at a total of 4 time points. Serums which will be collected during this procedure include fasting glucose; fasting insulin; leptin, fasting free fatty-acids, c-peptide, cortisol; Glucagon-like polypeptide-1 (GLP-1), glucagon inhibitory peptide (GIP),cytokines, ghrelin related to weight gain and glucose metabolism.

Height (cm) will be collected at the initial study visit

Weight (kg) will be collected at each study visit

Blood pressure will be measured at each study visit (sys/dia)

Heart rate will be measured at each study visit (BPM)

Waist circumference (cm) will be measured at each study visit

BMI (kg/m^2) will be calculated at each study visit

Prolactin levels will be collected via blood work.

Liver enzymes including ALT (unit/L), ALP (unit/L), and AST (unit/L) will be collected via bloodwork.

Bilirubin (mcmol/L) values will be collected via bloodwork.

GGT (unit/L) values will be collected via bloodwork.

Albumin (g/L) values will be collected via bloodwork.

HbA1c will be collected via bloodwork.

Fasting bloodwork values including lipids (mmol/L), glucose (mmol/L), AAP serum levels (mmol/L), and electrolytes (mmol/L) will be collected via bloodwork.

CBC values will be collected via blood work.

TSH (mIU/L) values will be collected via blood work.

Insulin (pmol/L) values will be collected via blood work.

Leptin values will be collected via blood work.

FFA values will be collected via blood work.

C-peptide (ng/mL) values will be collected via blood work.

Cortisol (mcg/dL) values will be collected via blood work.

DNA will be collected via blood work.

The BPRS is a rater administered interview evaluating psychiatric symptoms. Total scores range between 18 and 126, with higher scores indicating greater severity of symptoms. Total scores are calculated by adding all individual item scores.

The SANS is a rater administered interview evaluating positive and negative symptoms in psychosis. Total scores range from 0 to 110, with higher scores indicating greater severity of symptoms.Total scores are calculated by adding all individual item scores.

The CGI is a rater-observed measure which evaluates overall mental illness severity. The score ranges from 1 to 7, with a higher score indicating greater severity of symptoms.

The CDSS is a rater administered interview evaluating the presence and severity of depressive symptoms in schizophrenia. The total score ranges from 0 to 27, with higher scores indicating a greater severity. Total scores are calculated by adding all individual item scores.

The QLS is a questionnaire measuring the functioning of outpatient schizophrenia patients and measures the quality of relationships, occupational roles, and personal experiences. Subscale scores include Interpersonal Relations (range 0-72), Instrumental Role (range 0-36), Intrapsychic Function (range 0-63), Common Objects and Activities (range 0-18). The total score is then calculated by adding all the individual items together for a total score range of between 0-189. Higher scores across all variables indicate poorer quality of life. Total scores are calculated by adding all individual item scores.

The BSFS is a scale used to measure quality of social functioning. Subscales include Social Engagement/Withdrawal (range 0-15), Interpersonal Communication (range 0-9), Independence-Performance (range 0-39), Recreation (range 0-45), Prosocial (range 0-66), Independence-Competence (range 0-39), and Occupation/Employment (range 0-10). Higher scores indicate better social functioning. Scores are calculated by adding all individual item scores.

A rater-administered evaluation of side-effects related to psychopharmacological drugs. Ratings are given on a scale of 0-3, with higher scores indicating greater severity. An overall score, assigned by rater impression, is given to indicate overall incapacity due to side-effects.

A rater-administered evaluation of tardive dyskinesia. Scores are assigned across 3 categories including facial and oral movement, extremity movement, and trunk movement. There are no subscale scores however a global rating is given from a range of 0-4 based on the average of the categorical ratings, with higher scores indicated greater severity.

A rater-administered evaluation of akathisia. A rating of 0-3 is given for objective and subjective awareness of fidgeting, respectively, as well as for distress related to movement. A global score, as calculated on the average of all individual scores, is assigned on a scale of 0-5.

A rater-administered evaluation of extrapyramidal symptoms. Scores range from normal (score 0-3), minimal degree of movement disorder (score 3-5), clinically significant degree of movement disorder (score 6-11), and severe degree of movement disorder (score 12-17). Items are rated individually (i.e. no composite score).

A self-administered rating of food cravings and eating behaviours, both trait and state. A total score is calculated by adding all scores together. Higher scores indicate heightened trait and or state behaviour.

A self-administered rating of food cravings where participants mark on a continuum . The location of the mark is then measured (cm) for each item. Some items are reverse scored so individual items need to be reviewed for context. Only individual item scores are assigned (i.e. no total score assigned).

A self-administered food frequency questionnaire designed for older children and adolescents. Individuals scores are evaluated for nutritional breakdown. This is a qualitative self-report assessment.

A rater administered questionnaire evaluating health-related physical activity. A composite score is calculated by combining subscale scores of walking, moderate and vigorous physical activity, and the score is categorized into "low", "medium", or "high" physical activity category.

An evaluation of key cognitive domains relevant to individuals with schizophrenia

An evaluation of the ability of participants to take perspective from an egocentric or allocentric point of view and to rotate mentally the stimulus or their point of view. Participants are rated on accuracy and reaction time.