New Tool Predicts Cardiometabolic Risk in Young People with Psychosis

A new tool, PsyMetRiC, offers a proactive approach to managing the physical health risks faced by young people experiencing psychosis. This web-based risk prediction tool is designed to forecast the likelihood of developing cardiometabolic disorders – including obesity, metabolic syndrome, and type 2 diabetes – in this vulnerable population. The development addresses a critical gap in healthcare, as individuals with severe mental illness, on average, die 15 years earlier than the general population, largely due to preventable physical health conditions.

PsyMetRiC’s algorithms are specifically calibrated for young people navigating the early stages of psychosis. The tool predicts clinically significant weight gain within a year, the onset of metabolic syndrome within six years, and the potential development of type 2 diabetes within ten years. These predictions are based on analysis of anonymized health data from over 25,000 young people with psychosis in the UK, tracked over more than two decades. The underlying science was recently published in The Lancet Psychiatry.

Understanding the Increased Risk

Traditionally, prediction tools used by general practitioners to assess cardiovascular risk – like those determining the need for statins – haven’t been effective for younger individuals or those with psychosis. This means that those who could benefit most from early intervention often aren’t receiving it. As Dr. Benjamin Perry, Associate Clinical Professor of Psychiatry at the University of Birmingham, explains, the onset of psychotic disorders, typically in late teens and early twenties, can profoundly impact lifestyle. Individuals may struggle with healthy eating, exercise, and may be more prone to smoking. Antipsychotic medications can sometimes lead to side effects like increased appetite or sedation, contributing to weight gain. These factors, combined with potential healthcare inequalities, create a complex landscape of risk.

Dr. Perry emphasizes that the factors predisposing individuals to obesity, diabetes, and heart disease are often detectable at the very beginning of psychosis – much earlier than they would typically appear in the broader population. This early detection is the core principle behind PsyMetRiC.

From PsyMetRiC1 to PsyMetRiC2: Refining Predictive Power

PsyMetRiC builds upon earlier function. The web application is an updated version of a prediction model initially developed and validated in the UK in 2021, known as PsyMetRiC1. That initial model demonstrated its ability to accurately predict the risk of metabolic syndrome up to six years out. Researchers have since expanded and refined the tool, creating PsyMetRiC2, by leveraging larger UK-based datasets. This refinement has improved the tool’s overall predictive power.

A key aspect of this evolution was incorporating feedback from a diverse range of stakeholders – clinicians, caregivers, and, crucially, young people with lived experience of psychosis. The McPin Foundation, working with The Centre for Mental Health and Equally Well, facilitated this collaboration to ensure the app delivers outcomes that are both clinically meaningful and patient-centered. This focus on patient needs shaped the development of risk communication guides designed to be accessible and motivating.

The tool is designed for ease of use in both primary and secondary care settings, requiring only routinely collected health information to generate predictions. It provides a clear readout of the risk of metabolic syndrome within six years and type 2 diabetes within ten years of psychosis onset.

Ensuring Fairness and Addressing Bias

Researchers took deliberate steps to ensure PsyMetRiC operates fairly across different demographic groups, particularly those historically underserved by healthcare systems. Inspired by the work of the STANDING Together collaboration at the University of Birmingham, the team recognized the potential for societal inequalities to become embedded in health datasets, potentially exacerbating existing biases in prediction tools. They carefully tested the algorithms to mitigate this risk.

Dr. Perry explains that the team prioritized outcomes that are meaningful to both clinicians and patients. The original PsyMetRiC study predicted metabolic syndrome, a term not always readily understood by either group. The updated version focuses on outcomes – like the risk of diabetes or significant weight gain – that are more easily grasped and more likely to motivate behavioral changes.

Communicating Risk Effectively

PsyMetRiC presents risk information in a variety of formats, including graphical representations, numeric scores, and an indication of the uncertainty inherent in the predictions. It also adapts the “heart age” score approach, which has proven effective in encouraging positive lifestyle changes like smoking cessation, improved diet, and increased physical activity. The goal is to foster more informed and productive conversations between clinicians and patients about preventative measures and interventions.

The PsyMetRiC web application is certified as a Class 1 Medical Device by the UK’s Medicines & Healthcare products Regulatory Agency (MHRA), signifying its suitability for clinical use. It’s among the first psychiatric prediction tools to achieve this certification.

Health professionals can sign up for a free account to access the app after agreeing to the terms of use. The tool is expected to receive ongoing updates based on new research, stakeholder feedback, and the results of future studies evaluating its health economic impact and overall effectiveness.

Expanding Reach and Future Directions

PsyMetRiC has already been tested in several countries, including Spain, Switzerland, Finland, the Netherlands, Canada, Hong Kong, and Australia. Researchers have recently secured funding to extend testing to the United States. They also plan to adapt the tool for use in settings outside the UK.

The ultimate aim of PsyMetRiC is to increase awareness of the physical health risks faced by young people with psychosis, facilitate more comprehensive conversations between doctors and patients, and ultimately reduce premature mortality through earlier intervention and preventative care.

You can find more information about the study and the PsyMetRiC tool at the University of Birmingham’s news page. Further details on the research are available in The Lancet Psychiatry. Information on the original PsyMetRiC study can be found at the National Institutes of Health’s PubMed Central.