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External validation and recalibration of the psychosis metabolic risk calculator (PsyMetRiC) in young adults with chronic psychotic disorders in the Netherlands
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DOI：10.1192/j.eurpsy.2026.10179.png)
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Abstract
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BackgroundPeople with psychotic disorders have high cardiometabolic risk; yet prediction tools are rarely validated outside early-intervention settings. We externally validated and recalibrated the UK Psychosis Metabolic Risk Calculator (PsyMetRiC) in a Dutch cohort of young adults with psychotic disorders in long-term care.MethodsWe used data from the PHAMOUS registry. Individuals aged 16–35 years; without metabolic syndrome (MetS) at baseline (prevalence 21.2%); were included. MetS incidence over approximately 6 years (last assessment 1–6 years; cumulative incidence 29.1%) was defined using international criteria. Full (biochemical + clinical) and partial (clinical only) PsyMetRiC models were applied to 10 multiply imputed datasets. Discrimination; calibration; and decision-curve analysis (DCA) were assessed before and after logistic recalibration of intercept and slope.ResultsIn external validation; C-statistics were about 0.69 for the full and 0.67 for the partial model. Both systematically underpredicted MetS risk; recalibration yielded calibration intercepts near 0 and slopes near 1; while discrimination was unchanged. DCA suggested that; across risk thresholds of 0.10–0.35; using recalibrated PsyMetRiC could provide higher net benefit than “treat all” or “treat none.”ConclusionsIn this chronic-care cohort; PsyMetRiC showed moderate discrimination and improved calibration after logistic recalibration. The recalibrated models may support more targeted metabolic monitoring and prevention; but interpretation is limited by registry design; variable follow-up times; reliance on multiple imputation; and modest power for subgroup analyses.
Keywords:
cardiometabolic
risk-prediction
chronic
psychosis
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