Early Psychosis Symptoms Noted by Family Physicians in Electronic Medical Records During Help-Seeking Visits in Primary Care: Symptômes précoces de psychose relevés par les médecins généralistes dans les dossiers médicaux électroniques lors de consultations en soins primaires pour demande d'aide.

Abstract

BackgroundThe objectives of this study were (1) to describe the symptoms noted by family physicians during help-seeking visits for early psychosis, relative to a validated screening tool for early psychosis in primary care, and (2) to examine the referral disposition of patients meeting the screening tool cut-off.MethodsWe constructed a retrospective cohort of Ontario residents aged 14-35 years with an incident diagnosis of non-affective psychotic disorder between 2005-2015 in health administrative data, and at least one visit in the Electronic Medical Record Primary Care database during the 6 months prior to the date of psychotic disorder diagnosis (n = 572). We abstracted symptoms of psychosis noted by the family physician in the electronic medical records and compared these to the Primary Care Checklist (PCCL) for early psychosis.ResultsThe most frequent PCCL items noted were "tension or nervousness" (13.3%), "depressive mood" (12.5%), "increased stress or deterioration in functioning" (7.5%), and "sleep difficulties" (6.6%). The PCCL cut-off was met by 187 patients (33%) across 327 visits (8%). A greater proportion of visits meeting the PCCL cut-off had psychosis noted as the main presenting issue (55.4% vs. 6.8%) and resulted in referral to mental health services (33.3% vs. 6.0%) than those not meeting the cut-off. However, two in three visits where the screening cut-off for early psychosis was met did not result in a referral to mental health services.DiscussionThe findings of this study suggest that family physicians may benefit from a screening tool when early psychosis is suspected to improve identification and guide referral practices.