Healthcare (Commonwealth Union) – A new web-based risk assessment tool, PsyMetRiC, designed for use in clinical settings, is now available to estimate the likelihood that young people with psychosis will develop cardiometabolic conditions such as obesity, metabolic syndrome, and diabetes.
The algorithms powering PsyMetRiC have been specifically developed for younger individuals experiencing psychosis. They can estimate the probability of significant weight gain within one year, the onset of metabolic syndrome within six years, and the development of type 2 diabetes over a ten-year period. The tool was created and validated using anonymised routine health records from more than 25,000 young people with psychosis in the UK, tracked over a period exceeding two decades. The research behind the tool has been published in The Lancet Psychiatry.
On average, individuals living with severe mental illness have a life expectancy around 15 years shorter than that of the general population, largely due to an increased likelihood of developing preventable physical health conditions. Although general practitioners have long used prediction tools to identify patients who might benefit from preventive treatments—such as statins to reduce the risk of heart attacks or strokes—these models were not designed for younger people and tend to perform poorly in patients with psychosis.
As a result, those who stand to gain the most from early preventive care often do not receive it.
Dr Benjamin Perry, Associate Clinical Professor of Psychiatry indicated that psychotic disorders are generally diagnosed when individuals are in their late teens and early twenties, and the effect on lifestyles can be heavy. He further indicated that individuals with psychosis may be less likely to consume healthy food, or carry out exercises, and have an increased chance of smoking.
Dr Perry added that, antipsychotic medicines may have side effects that make patients feel hungrier, or feel increased sedation, playing a role in weight gain and individuals with psychosis may experience healthcare and other inequalities as well, which is an obstacle for them from getting the same standard of physical healthcare as others in the population.
“Consequently, factors that predispose people to obesity, diabetes and heart disease, are detectable from the onset of psychosis – many years earlier than would be typical for the rest of the population.”
With access to much larger UK population-level datasets, the research team was able to significantly enhance PsyMetRiC, increasing its predictive accuracy and developing an improved version known as PsyMetRiC2.
The researchers placed strong emphasis on feedback from stakeholders, including clinicians, carers, and young people who have lived experience of psychosis. The McPin Foundation, working alongside The Centre for Mental Health and Equally Well, collaborated with individuals with lived experience to ensure the application would provide outcome measures that are both meaningful in clinical settings and valued by patients.
PsyMetRiC has been designed to be straightforward and practical for use in clinical practice, requiring only basic information that is routinely recorded in medical settings to generate predictions.
As part of the validation study aimed at assessing the generalisability of the PsyMetRiC algorithms, the researchers carefully examined whether the tool would function fairly for people from diverse, particularly under-served, backgrounds.
Dr Benjamin Perry explained that the team drew inspiration from the work of the STANDING Together collaboration, led by Birmingham-based researchers including Dr Joseph Alderman and Professor Alastair Denniston. Their work highlighted a critical concern: when social inequalities are embedded in health datasets, tools developed from those datasets may also inherit those biases, potentially worsening existing disparities.
The PsyMetRiC app is intended to support, rather than replace, clinical decision-making. The outcome measures built into the tool focus on predicting results that are valued by both doctors and patients—an important factor in situations where encouraging behavioural change may be more beneficial than relying solely on medication.
