Early Psychosis Symptoms Noted by Family Physicians in Electronic Medical Records During Help-Seeking Visits in Primary Care

Sep 29, 2026

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Study objectives were to characterize symptoms recorded by family physicians during help-seeking visits for early psychosis, relative to a validated primary care screening tool, and to evaluate referral outcomes for patients meeting the tool’s cut-off. A retrospective Ontario cohort (14–35 years) with incident nonaffective psychotic disorder (2005–2015) used electronic medical record visits within the prior 6 months (n=572). Frequent checklist items included tension/nervousness and depressive mood. While cut-off–meeting visits more often involved psychosis as the main presenting issue and led to mental health referrals, two of three such visits did not result in referral.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Background

Methods

Study design and data sources

Screening comparison

Results

Most frequent checklist items

Cut-off performance and referral patterns

Discussion

Author information and affiliations

Original Research 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 médecinsgénéralistes dans les dossiers médicaux électroniques lors de consultations en soins primaires pour demande d’aide The Canadian Journal of Psychiatry / La Revue Canadienne de Psychiatrie 1‐10 © The Author(s) 2025 Article reuse guidelines: [sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/07067437251355637](DOI: 10.1177/07067437251355637)[ ](DOI: 10.1177/07067437251355637)[TheCJP.ca | LaRCP.ca](TheCJP.ca | LaRCP.ca) Joshua C. Wiener, BHSc 1 , Rebecca Rodrigues, MSc 1, Jennifer N.S. Reid, MSc2,3, Suzanne Archie, MD4 , Saadia Hameed Jan, MBBS, MClSc5, Arlene G. MacDougall, MD, MSc 1,6, Lena Palaniyappan, MBBS, PhD6,7, Liisa Jaakkimainen, MD, MSc2,8, Branson Chen, MSc2, Neo Sawh, MBBS2, Kelly K. Anderson, PhD 1,2,6 and on behalf of the project co-investigators Abstract Background: The 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. Methods: We constructed a retrospective cohort of Ontario residents aged 14–35 years with an incident diagnosis of nonaffective 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. Results: The 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. Discussion: The 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. 1 Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada 2 ICES, Toronto, Ontario, Canada 3 ICES Western, London Health Sciences Centre Research Institute, London, Ontario, Canada 4 Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada 5 Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada 6 Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada 7 Douglas Mental Health University Institute, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada 8 Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Corresponding author: Joshua C. Wiener, Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. Email: [jwiener2@uwo.ca](jwiener2@uwo.ca) Abrégé Contexte: Les objectifs de cette étude étaient (1) de décrire les symptômes observés par les médecins de fami

FAQs

What were the study’s main objectives?

The study aimed to describe symptoms family physicians recorded during help-seeking visits for early psychosis using a validated primary-care screening tool, and to assess referral disposition for patients meeting the screening cut-off.

How was the study conducted and what data were used?

Researchers built a retrospective Ontario cohort of residents aged 14–35 with incident nonaffective psychotic disorder between 2005–2015, using health administrative data and electronic medical record primary care visits in the preceding 6 months (n=572).

Which symptoms on the primary care checklist were most frequently noted?

The most frequent checklist items were “tension or nervousness” (13.3%), “depressive mood” (12.5%), “increased stress or deterioration in functioning” (7.5%), and “sleep difficulties” (6.6%).

Did meeting the screening cut-off lead to mental health referrals?

Visits meeting the cut-off more often had psychosis as the main presenting issue and resulted in referral to mental health services (33.3% vs. 6.0%). However, two in three cut-off–meeting visits did not result in referral.

Sep 29, 2026

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