The psychosis metabolic risk calculator (PsyMetRiC) for young people with psychosis: International external validation and site-specific recalibration in two independent European samples

Assessing the generalisability of the psychosis metabolic risk calculator (PsyMetRiC) for young people with first-episode psychosis with validation in a Hong Kong Chinese Han population: a 4-year follow-up study

“… 14 PsyMetRiC has recently been further validated in two independent Western European FEP samples of the same age group (Spain and Switzerland) and retained good discriminative accuracy (C-statistics ranged from 0.72 to 0.73). 15 The results suggest the generalizability of PsyMetRiC in European populations. Differences in MetS prevalence between different ethnicities and regions have been observed including the Western and Chinese population.…”

“…Baseline information included age at presentation, biological sex, waist circumference (cm), weight (kg), height (cm), body mass index (BMI), current smoking status, prescription of more metabolically-active antipsychotic medications ( Supplementary Table S2 ), triglycerides (mmol/L), high-density lipoprotein (HDL; mmol/L), systolic and diastolic blood pressure (mmHg), and fasting blood glucose (FBG; mmol/L). As per the original PsyMetRiC study, 15 we used the harmonized definition of MetS as a binary outcome 8 : ethnicity-specific waist circumference ≥90 cm in males and ≥80 cm in females for our sample, or BMI >29.9; alongside two of: triglycerides ≥1.70 mmol/L; HDL <1.03 mmol/L (males) or <1.29 mmol/L (females); systolic blood pressure >130 mmHg; FBG >5.60 mmol/L. When multiple follow-ups were available for each participant, we used the latest follow-up available between 1 and 12 years after baseline with the most available data.…”

More must be done to reduce cardiovascular risk for patients on antipsychotic medications

“…However, such existing tools are inaccurate in samples of older adults with schizophrenia (Berry et al, 2018), and young adults with or at risk of developing psychosis (Perry et al, 2020b). We are now working on the development of cardiometabolic risk prediction tools tailored for people with psychotic disorders, with validation studies conducted in the UK (Perry et al, 2021b), Spain and Switzerland (Perry et al, 2022b) so far. Such tools may in the future assist clinicians to more appropriately factor cardiometabolic risk into treatment plans, and encourage the targeting of more resource-heavy physical health investigations and treatments in a cost-effective manner.…”

“…While research conducted on samples of patients with chronic psychotic disorders may be subject to confounding by lifestyle or iatrogenic factors, there is a growing body of research suggesting that psychotic disorders may feature an inherent cardiometabolic risk. For example, disrupted glucose-insulin (Perry et al ., 2016; Pillinger et al ., 2017a) and lipid homeostasis (Pillinger et al ., 2017b) can be detected by psychosis onset in young antipsychotic naive individuals, and may even predate it (Perry et al ., 2021c). Similarly, findings from longitudinal studies suggest that higher concentrations of inflammatory markers may predate the onset of psychotic disorders (Osimo et al, 2021a), and findings from Mendelian randomisation studies implicate a potential causal role for inflammation in schizophrenia pathogenesis (Perry et al ., 2021d), and inflammation as a potential common cause for comorbid schizophrenia and insulin resistance (Perry et al ., 2021a).…”

The importance of external validation to advance precision psychiatry

“… 2 PsyMetRiC uses age, Black/African Caribbean ethnicity, Asian/Other ethnicity, sex, body mass index, current smoking status, prescription of a metabolically-active antipsychotic and high-density lipoprotein and triglyceride concentrations to predict risk of metabolic syndrome up to 6 years. Perry and colleagues’ paper 3 in this issue of Lancet Regional Health - Europe presents results from two further external validations in Spain ( n = 466) and Switzerland ( n = 558), showing that PsyMetRiC retains its predictive performance. These results suggest that PsyMetRiC is viable for implementation in clinical sites across Western Europe to improve early identification of cardiometabolic risk and inform personalised treatment decisions for young people with psychosis.…”