Despite advancements in psychiatry, individuals with serious mental illness (SMI), such as schizophrenia, major depressive disorder, and bipolar disorder, experience long-term and severe impairment in their social and occupational functioning, low rates of recovery, and mortality rates significantly higher than the general population. Current therapeutic and pharmacological treatments are vital but limited in their efficacy, highlighting a need for adjunctive recovery-oriented approaches, such as arts-based interventions. However, the impact of drama therapy on mental health recovery for individuals with SMI remains not well understood. Our pilot study assessed the feasibility and acceptability of a virtual drama therapy program using the Co-active Therapeutic Theater Model in individuals with SMI who are members of a local clubhouse. Across three iterations, a total of 23 participants participated in a 12-week drama therapy program on Zoom that included an online performance open to the public, centered on a theme developed by the participants across weekly sessions. Quantitative rating scales were administered before and after the program to assess changes in psychiatric symptoms, perceived stress, quality of life, creative immersion, and social connectedness. Focus groups were conducted one week after the final performance. Quantitative results were overall non-significant. Qualitative results indicated that the program enhanced self-esteem and fostered a sense of connection among participants and with the broader clubhouse community. Our findings support the feasibility and acceptability of a virtual drama therapy program for patients with SMI and suggest potential benefits of implementing such a program in a clubhouse setting.

Objective: This proof-of-concept study examined the effects of brexpiprazole treatment on substance use, psychiatric symptoms, and quality of life in patients with co-occurring schizophrenia and substance use disorder. Methods: In this 12-week study, patients diagnosed with schizophrenia and substance use disorder using DSM-5 criteria were randomly assigned to switch from their current antipsychotic medication to brexpiprazole (up to 4 mg/day) or remain on their current antipsychotic treatment (treatment as usual [TAU]). Substance use was assessed by the number of days of substance use and the dollars spent on substance in the past week, and substance craving was assessed using the Visual Analog Scale (VAS). Quality of life was assessed using the Heinrichs-Carpenter Quality of Life Scale (QOL). In addition, psychiatric symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale-Severity of Illness. Results: Thirty-nine patients were randomized (21 in the brexpiprazole group,18 in the TAU group). Mixed models for repeated measures showed that, despite the lack of statistical significance, a consistent pattern of decrease in the brexpiprazole group was observed for the number of days of substance use and the dollars spent, as well as substance craving; the brexpiprazole group had a 15.5 points greater decrease in VAS (P= .157) and a $33.3 greater decrease in the dollars spent (P = .108) from baseline to week 12 compared with the TAU group. The brexpiprazole group did show a statistically significant 8.9 points greater increase in QOL compared with the TAU group (P = .020). Even though it was not statistically significant, the brexpiprazole group had a 2.4-point greater decrease in the PANSS General Psychopathology subscale score (P= .150) and a 1.9-point greater decrease in the PANSS Negative Symptom subscale score (P= .126) compared with the TAU group. Conclusion: This study suggests that brexpiprazole might be beneficial in reducing substance craving and use in patients with schizophrenia and cooccurring substance use disorder; this potential benefit may help improve quality of life and overall psychiatric symptoms in a difficult-to-treat patient population. Trial Registration: ClinicalTrials.gov identifier: NCT03526354.

Cognitive impairments in patients with schizophrenia (SCZ) is associated with poor social functioning and long-term prognosis. Our previous work suggests that some key fungal markers including Purpureocillium, are linked to SCZ. We present a case-control study that includes 136 first-episode, drug-naïve patients with SCZ and 92 healthy controls (HCs). Untargeted liquid chromatography/mass spectrometry (LC/MS) was utilized to measure serum metabolite levels. The abundance of Purpureocillium was assessed using the internal transcribed spacer (ITS) analysis. Cognitive function was measured using the MATRICS Consensus Cognitive Battery. The present study demonstrated significant declines in attention and alertness (AV), speed of processing (SOP) in individuals with SCZ. The abundance of Purpureocillium was found to have a negative correlation with multiple domains of cognitive function. Additionally, SCZ-related metabolic markers 2-Oxoarginine, N-Acetyl-serotonin, Ergothioneine, Isobutyric acid and Biotin were significantly associated with both the abundance of Purpureocillium and cognitive scores (SOP and AV). Mediation analyses revealed that the abundance of Purpureocillium in patients with SCZ had significant direct and indirect effects on SOP and AV) through metabolic markers (2-Oxoarginine, N-Acetyl-serotonin, Ergothioneine). Further, Purpureocillium and the metabolic markers were found to be correlated with inflammation and oxidative stress, both of which have been associated with pathogenesis of SCZ. Our findings suggest that Purpureocillium might be associated with cognitive impairments through its regulation on the metabolism of specific amino acids involved in inflammation and oxidative stress. A better understanding about the fungal-immune-metabolites association may lead to novel treatment approaches to improve cognitive function in patients with SCZ.

Objective: This proof-of-concept study examined the effects of brexpiprazole treatment on substance use, psychiatric symptoms, and quality of life in patients with co-occurring schizophrenia and substance use disorder. Methods: In this 12-week study, patients diagnosed with schizophrenia and substance use disorder using DSM-5 criteria were randomly assigned to switch from their current antipsychotic medication to brexpiprazole (up to 4 mg/day) or remain on their current antipsychotic treatment (treatment as usual [TAU]). Substance use was assessed by the number of days of substance use and the dollars spent on substance in the past week, and substance craving was assessed using the Visual Analog Scale (VAS). Quality of life was assessed using the Heinrichs-Carpenter Quality of Life Scale (QOL). In addition, psychiatric symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale-Severity of Illness. Results: Thirty-nine patients were randomized (21 in the brexpiprazole group, 18 in the TAU group). Mixed models for repeated measures showed that, despite the lack of statistical significance, a consistent pattern of decrease in the brexpiprazole group was observed for the number of days of substance use and the dollars spent, as well as substance craving; the brexpiprazole group had a 15.5 points greater decrease in VAS (P=.157) and a $33.3 greater decrease in the dollars spent (P=.108) from baseline to week 12 compared with the TAU group. The brexpiprazole group did show a statistically significant 8.9 points greater increase in QOL compared with the TAU group (P =.020). Even though it was not statistically significant, the brexpiprazole group had a 2.4-point greater decrease in the PANSS General Psychopathology subscale score (P=.150) and a 1.9-point greater decrease in the PANSS Negative Symptom subscale score (P=.126) compared with the TAU group. Conclusion: This study suggests that brexpiprazole might be beneficial in reducing substance craving and use in patients with schizophrenia and co-occurring substance use disorder; this potential benefit may help improve quality of life and overall psychiatric symptoms in a difficult-to-treat patient population. Trial Registration: ClinicalTrials.gov identifier: NCT03526354.

Studies have reported that white matter hyperintensities (WMHs) are associated with disturbances in immune function, and the relationship between WMHs and cognitive impairments have been documented in various clinical populations. The present study was to examine the relationship between WMHs, immune function, and cognitive impairments in patients with schizophrenia (SCH) remains unknown. A sample of 127 drug-naïve first episode SCH and 72 healthy controls (HCs) were included in this study. Serum levels of cytokines and oxidative stress indices were measured using enzyme-linked immunosorbent assay and microtiter plate method. WMHs were assessed using T2-weighted magnetic resonance imaging scanning, and cognitive performance was evaluated using the MATRICS Consensus Cognitive Battery. We found patients with SCH are more likely to present with WMHs compared with HCs (OR = 2.076, 95

BACKGROUND AND HYPOTHESIS Schizophrenia (SCZ) is associated with complex crosstalk between the gut microbiota and host metabolism, but the underlying mechanism remains elusive. Investigating the aberrant neurotransmitter processes reflected by alterations identified using multiomics analysis is valuable to fully explain the pathogenesis of SCZ. STUDY DESIGN We conducted an integrative analysis of multiomics data, including the serum metabolome, fecal metagenome, single nucleotide polymorphism data, and neuroimaging data obtained from a cohort of 127 drug-naïve, first-episode SCZ patients and 92 healthy controls to characterize the microbiome-gut-brain axis in SCZ patients. We used pathway-based polygenic risk score (PRS) analyses to determine the biological pathways contributing to genetic risk and mediation effect analyses to determine the important neuroimaging features. Additionally, a random forest model was generated for effective SCZ diagnosis. STUDY RESULTS We found that the altered metabolome and dysregulated microbiome were associated with neuroactive metabolites, including gamma-aminobutyric acid (GABA), tryptophan, and short-chain fatty acids. Further structural and functional magnetic resonance imaging analyses highlighted that gray matter volume and functional connectivity disturbances mediate the relationships between Ruminococcus_torgues and Collinsella_aerofaciens and symptom severity and the relationships between species Lactobacillus_ruminis and differential metabolites l-2,4-diaminobutyric acid and N-acetylserotonin and cognitive function. Moreover, analyses of the Polygenic Risk Score (PRS) support that alterations in GABA and tryptophan neurotransmitter pathways are associated with SCZ risk, and GABA might be a more dominant contributor. CONCLUSIONS This study provides new insights into systematic relationships among genes, metabolism, and the gut microbiota that affect brain functional connectivity, thereby affecting SCZ pathogenesis.

IntroductionZentangle is an emerging art intervention that incorporates mindfulness into creative drawing. This pilot study explored Zentangle as a novel adjunct treatment for people with serious mental illness (SMI).MethodsSix participants with SMI completed an 8-week Zentangle program. Psychiatric outcomes were evaluated using the Brief Psychiatric Rating Scale (BPRS), Mindful Attention Awareness Scale (MAAS), Perceived Stress Scale (PSS), and Quality of Life Enjoyment and Satisfaction Scale (Q-LES-Q-SF). A focus group was conducted to better understand the experiences of the participants.ResultsA significant reduction in psychiatric symptoms was observed as measured by the total score on the BPRS between baseline and 5-week post-intervention (40.7 ± 9.1 vs. 33.7 ± 8.9, mean ± SD, p = 0.02). Participants also showed a significant increase in mindful attention using the average score on the MAAS between 1- and 5-week post-intervention (3.5 ± 0.4 vs. 4.2 ± 0.7, mean ± SD, p = 0.04). Four themes were generated from the focus group: (1) approaching mindfulness through Zentangle; (2) power of uncomplicated art creation; (3) understanding the value of self-appreciation; and (4) fostering a positive environment.DiscussionOur preliminary data suggest that the use of Zentangle for participants with SMI may have a positive impact on overall psychiatric symptoms and mindfulness. Moreover, the Zentangle Method encourages positive emotions like gratitude and self-accomplishment to counteract negative feelings of self-criticism and failure in participants.

OBJECTIVE:Many studies have reported the important role of serum levels of short-chain fatty acids (SCFAs) in lipid metabolism and cognitive dysfunction. This study investigated the role of plasma lipids and SCFAs on cognitive functioning in drug- naïve first episode schizophrenia.METHODS:This study recruited 44 schizophrenia inpatients and 35 healthy controls. Plasma lipid metabolism was characterized using standard enzymatic methods and an automated analyzer. Serum levels of SCFAs were measured by Gas chromatography mass spectrometry (GC-MS). Cognitive performance was evaluated by the MATRICS Consensus Cognitive Battery (MCCB).RESULTS:The patient group showed significantly higher serum levels of total SCFAs, acetic acid, acetic acid/ propionic acid ratio, and poorer cognitive scores compared with the control group (p's < 0.05). Within the patient group, the lipid levels were positively associated with acetic acid/ propionic acid ratio (p's < 0.05). Furthermore, multiple regression analysis revealed that the interactions of LDL level × acetic acid/ propionic acid ratio was a significant predictor of the MCCB working memory, and processing speed subscale scores within the patient group.CONCLUSIONS:Cognitive dysfunction and abnormal serum levels of SCFAs occur in the early phase of schizophrenia. Lipid metabolism and serum levels of SCFAs might be, both independently or interactively, associated with cognitive dysfunction in schizophrenia.

Bacterial dysbiosis has been demonstrated in patients with schizophrenia (SCH). The aim of the present study was to investigate alterations in mycobiota composition and fungi-bacteria correlation network in drug-naive, first episode SCH. We recruited 205 SCH patients and 125 healthy controls (HCs), whose gut bacterial and fungal compositions were characterized by 16S and 18S ribosomal RNA gene amplicon sequencing, respectively. Fungal-bacterial relative correlation network analysis was performed using the Spearman's test and distance correlation. We also computed relative networks connectedness, which represents the ratio of significant in-teractions (edges) and taxa (nodes) in the network. SCH patients showed lower fungal alpha-diversity compared with that of HCs. Furthermore, we identified 29 differential fungal markers at multiple taxonomies between SCH patients and HCs. SCH patients also showed a significantly lower fungi-to-bacteria alpha-diversity ratio compared with that of HCs (p = 1.81 x 10-8). In risk prediction models, we observed that combining bacterial and fungal markers achieved higher accuracy than that of bacterial markers alone (AUC = 0.847 vs AUC = 0.739; p = 0.043). Fungal-bacterial correlation network was denser in HCs than in SCH patients and was characterized by a high number of neighbors (p < 0.05). In addition, an increased abundance of Purpureocillium was associated with more severe psychiatric symptoms and poorer cognitive function in SCH patients (p < 0.05). Our study demonstrated a disrupted and weakened fungi-bacteria network in SCH patients, which might be associated with their clinical manifestations. Future research on fungal-bacterial correlation network is warranted to advance our understanding about the role of mycobiota in the etiology of SCH and to explore novel intervention approaches.

The upregulation of immune and inflammatory response may play a role in the negative symptoms of schizophrenia. Berberine is an effective drug with anti-inflammatory property, and may be beneficial for the treatment of negative symptoms. The aim of this study is to test this hypothesis through a randomized, double-blind, placebo-controlled, clinical trial. Eligible patients with schizophrenia were randomized to receive placebo or berberine (900 mg/day) for 8 weeks as adjunctive treatment to single atypical antipsychotic drug. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate clinical symptoms at three time points (baseline, 4th and 8th week). Blood samples were collected at the above three time points to determine the concentrations of inflammatory markers including interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP). 59 patients with intention-to-treat were analyzed, 32 in the berberine group and 27 in the placebo group. From the baseline to the 8th week, berberine treatment significantly improved the negative symptom subscale of PANSS (F = 18.981; p < 0.001). From the baseline to the 8th week, the plasma CRP concentration decreased in the berberine group, while increased in the placebo group (F = 5.373; p = 0.024). Furthermore, in the berberine group, the change of CRP concentration was significantly positively correlated with the change of PANSS negative symptom subscale within 8 weeks (r = 0.56; p = 0.002). There was no significant difference in adverse events between the two groups (p’s > 0.05). Our study suggests that berberine treatment is well tolerated in patients with schizophrenia. Berberine may improve negative symptoms through anti-inflammatory effect. Trial registration: Clinicaltrials.gov identifier: NCT 03548155.

White matter abnormality has been widely reported in patients with schizophrenia (Sz). However, few studies have focused on the relationship between the white matter deficit and formal thought disorder (FTD). Moreover, the role of genetic high risk in FTD-related white matter deficit remains unclear. The present study recruited 46 Sz patients, 18 unaffected first-degree relatives of Sz patients, and 29 healthy controls. There was a widespread fractional anisotropy (FA) reduction in Sz. In addition, reduced FA in the left anterior corona radiata was related to more severe FTD symptoms in Sz. However, the genetic high-risk group only showed lower mean FA in the left anterior limb of the internal capsule than healthy controls. Our findings suggest that abnormality in the left anterior corona radiata may only occur in Sz but not in the genetic high-risk group. Such an abnormality might be associated with the severity of FTD symptoms. Meanwhile, genetic vulnerability may contribute to the abnormality in the left anterior limb of the internal capsule. Better analytical methods are needed to validate our results.

The impact of drama therapy on mental health recovery remains poorly understood. We examined the effects of a pilot remote drama therapy program for community members living with serious mental illness. The entire intervention was delivered remotely. Participants with serious mental illness completed a 12-week drama therapy program which included an online performance open to the public. Four quantitative scales were administered pre- and post-program. A focus group was conducted 1 week after the performance. Six participants completed the program and crafted a public performance themed around hope. No significant differences were identified in the quantitative measures. Five themes were identified in the post-performance focus group. Drama therapy presents an opportunity for individuals with serious mental illness to process and share their journeys with their diagnoses and re-create a healthy sense of self with increased community awareness.

IMPORTANCE Duration of untreated psychosis (DUP) has been associated with poor outcomes in schizophrenia, but the mechanism responsible for this association is not known. OBJECTIVES To determine whether hippocampal volume loss occurs during the initial 8 weeks of antipsychotic treatment and whether it is associated with DUP, and to examine molecular biomarkers in association with hippocampal volume loss and DUP. DESIGN, SETTING, AND PARTICIPANTS A naturalistic longitudinal study with matched healthy controls was conducted at Shanghai Mental Health Center. Between March 5, 2013, and October 8, 2014, 71 medication-naive individuals with nonaffective first-episode psychosis (FEP) and 73 age- and sex-matched healthy controls were recruited. After approximately 8 weeks, 31 participants with FEP and 32 controls were reassessed. EXPOSURES The participants with FEP were treated according to standard clinical practice with second-generation antipsychotics. standardized hippocampal of DUP, 13 peripheral molecular biomarkers, and 14 single-nucleotide polymorphisms from 12 candidate were determined. −0.029 to −0.010]; P = .001). During approximately 8 weeks of antipsychotic treatment, left HVI decreased in 24 participants with FEP at a median annualized rate of −.03791 (–4.1% annualized change from baseline) compared with an increase of 0.00115 (0.13% annualized change from baseline) in 31 controls (difference in point estimate, −0.0424 [95% CI, −0.0707 to −0.0164]; P = .001). The change in left HVI was inversely associated with DUP ( r = −0.61; P = .002). Similar results were found for right HVI, although the association between change in right HVI and DUP did not achieve statistical significance ( r = −0.35; P = .10). Exploratory analyses restricted to the left HVI revealed an association between left HVI and markers of inflammation, oxidative stress, brain-derived neurotrophic factor, glial injury, and markers reflecting dopaminergic and glutamatergic transmission. CONCLUSIONS AND RELEVANCE An association between longer DUP and accelerated hippocampal atrophy during initial treatment suggests that psychosis may have persistent, possibly deleterious, effects on brain structure. Additional studies are needed to replicate these exploratory findings of molecular mechanisms by which untreated psychosis may affect hippocampal volume and to determine whether these effects account for the known association between longer DUP and poor outcome.

Background: Butyric acid, a major short-chain fatty acid (SCFA), has an important role in the microbiota–gut–brain axis and brain function. This study investigated the role of butyric acid in treatment response in drug-naïve first episode schizophrenia.Methods: The study recruited 56 Chinese Han schizophrenia inpatients with normal body weight and 35 healthy controls. Serum levels of butyric acid were measured using Gas Chromatography-Mass Spectrometer (GC-MS) analysis at baseline (for all participants) and 24 weeks after risperidone treatment (for patients). Clinical symptoms were measured using the Positive and Negative Syndrome Scale (PANSS) for patients at both time points.Results: At baseline, there was no significant difference in serum levels of butyric acid between patients and healthy controls (p = 0.206). However, there was a significant increase in serum levels of butyric acid in schizophrenia patients after 24-week risperidone treatment (p = 0.030). The PANSS total and subscale scores were decreased significantly after 24-week risperidone treatment (p's < 0.001). There were positive associations between baseline serum levels of butyric acid and the reduction ratio of the PANSS total and subscale scores after controlling for age, sex, education, and duration of illness (p's < 0.05). Further, there was a positive association between the increase in serum levels of butyric acid and the reduction of the PANSS positive symptoms subscale scores (r = 0.38, p = 0.019) after controlling for potential confounding factors.Conclusions: Increased serum levels of butyric acid might be associated with a favorable treatment response in drug-naïve, first episode schizophrenia. The clinical implications of our findings were discussed.

Purpose/Background Hippocampal volume loss in early schizophrenia has been linked with markers of inflammation and oxidative stress, and with less response of negative symptoms. Aripiprazole has been reported to preserve hippocampal volume and to reduce inflammation. Methods/Procedures Study 1 was a 12-month multicenter randomized placebo-controlled trial of citalopram added to clinician-determined second-generation antipsychotic medication in 95 patients with first-episode schizophrenia (FES), 19 of whom received aripiprazole. We compared participants taking aripiprazole with those on other antipsychotics to determine whether those on aripiprazole had less hippocampal volume loss. We also examined peripheral biomarker data from medication-naive patients with schizophrenia receiving 8 weeks of antipsychotic treatment (n = 24) to see whether markers of inflammation and oxidative stress that previously predicted hippocampal volume differed between aripiprazole (n = 9) and other antipsychotics (study 2). Findings/Results Aripiprazole was associated with a mean increase in hippocampal volume of 0.35% (SD, 0.80%) compared with a 0.53% decrease (SD, 1.2%) with other antipsychotics during the first year of maintenance treatment in patients with FES. This difference was significant after adjusting for age, sex, citalopram treatment, and baseline Brief Psychiatric Rating Scale score (B = 0.0079, P = 0.03). Aripiprazole was also associated with reduced concentrations of the inflammatory cytokines interleukin-8 and tumor necrosis factor (P < 0.01) during the first 8 weeks of treatment in medication-naive patients with FES. Implications/Conclusions These results suggest that aripiprazole may protect against hippocampal atrophy via an anti-inflammatory mechanism, but these results require replication in larger, randomized trials, and the clinical relevance of hippocampal volume loss is not established.

Background: Lack of normal asymmetry in the brain has been reported in patients with schizophrenia. However, itremainsunclearwhetherdisruptedasymmetryoriginatesfrominter-hemisphericfunctionalconnectivity(FC) and/or intra-hemispheric FC in this patient population. Methods: Forty-fourpatientswith drug-naive, fi rst-episode schizophrenia, 42unaffectedsiblings,and 44 healthy controls underwent resting-state functional magnetic resonance imaging (fMRI) scan. The parameter of asym- metry (PAS) and support vector machine (SVM) were used to analyze the data. Patients were treated with olanzapine for 8 weeks. Findings: Compared with healthy controls, patients showed lower PAS scores in the left middle temporal gyrus (MTG)/inferior temporal gyrus (ITG), left posterior cingulate cortex (PCC)/precuneus and left angular gyrus, and higher PAS scores in the left precentral gyrus/postcentral gyrus. Unaffected siblings also showed lower PASscoresintheleftMTG/ITGandleftPCC/precuneusrelativetohealthycontrols.Further,SVManalysisshowed that a combination of the PAS scores in these two clusters in patients at baseline was able to predict clinical response after 8 weeks of olanzapine treatment with 77.27% sensitivity, 72.73% speci fi city, and 75.00% accuracy. Interpretation: Thepresentstudysuggestsdisruptedasymmetryofinter-andintra-hemisphericFCindrug-naive, fi rst-episode schizophrenia; in addition, a reduced asymmetry of inter-hemispheric FC in the left MTG/ITG and leftPCC/precuneusmayserveasan endophenotypefor schizophrenia,andmay haveclinicalutility topredictre-sponse to olanzapine treatment.

Preclinical studies have shown that the gut microbiota can play a role in schizophrenia (SCH) pathogenesis via the gut-brain axis. However, its role in the antipsychotic treatment response is unclear. Here, we present a 24-week follow-up study to identify gut microbial biomarkers for SCH diagnosis and treatment response, using a sample of 107 first-episode, drug-naïve SCH patients, and 107 healthy controls (HCs). We collected biological samples at baseline (all participants) and follow-up time points after risperidone treatment (SCH patients). Treatment response was assessed using the Positive and Negative Symptoms Scale total (PANSS-T) score. False discovery rate was used to correct for multiple testing. We found that SCH patients showed lower α-diversity (the Shannon and Simpson’s indices) compared to HCs at baseline ( p = 1.21 × 10 −9 , 1.23 × 10 −8 , respectively). We also found a significant difference in β-diversity between SCH patients and HCs ( p = 0.001). At baseline, using microbes that showed different abundance between patients and controls as predictors, a prediction model can distinguish patients from HCs with an area under the curve (AUC) of 0.867. In SCH patients, after 24 weeks of risperidone treatment, we observed an increase of α-diversity toward the basal level of HCs. At the genus level, we observed decreased abundance of Lachnoclostridium ( p = 0.019) and increased abundance Romboutsia ( p = 0.067). Moreover, the treatment response in SCH patients was significantly associated with the basal levels of Lachnoclostridium and Romboutsia ( p = 0.005 and 0.006, respectively). Our results suggest that SCH patients may present characteristic microbiota, and certain microbiota biomarkers may predict treatment response in this patient population.

Modifiable risk factors related to lifestyle choices contribute to the disproportionate impact of poor physical health among individuals with serious mental illness (SMI). This mixed methods study sought to elucidate factors that promote and challenge healthy lifestyle engagement. Focus groups were conducted to assess the lived perspectives of twelve individuals with SMI living independently in the community or utilizing group housing about their dietary and exercise habits. A survey was administered pre-focus group to explore participant views on and motivations for healthier living. Three major themes emerged based on focus group discussion: Meaning of Healthy Living, Obstacles to Maintaining Good Health, and Importance of Community. Overall, participants demonstrated positive attitudes and readiness for healthy lifestyle changes. Healthy lifestyle interventions with careful consideration of determinants related to health disparities and existing community resources to support such activities are recommended to improve physical health in people with SMI.