Psychosis Screening
  • Home
  • Overview
  • Know the Signs
    • Signs of Psychosis
    • About Psychosis & Risk
    • Family History & Other Risk Factors
  • Find the Words
    • Asking about Psychosis
    • Follow-Up Questions
    • Mental Health Differentials
  • Make the Connection
    • Choosing a Path >
      • Path 1: Reassure & Redirect
      • Path 2: Educate & Monitor
      • Path 3: Specialized Assessment & Treatment
      • Path 4: Same-Day Assessment
    • Medical Workup Considerations
  • Resources
    • For Providers
    • For Patients & Families
    • Mental Health Referral Resources

Choosing a Path

PATH 1: reassure & redirect
IF
The ​EXPERIENCE is not psychotic-like/is better explained by:
  • Cultural/familial norms
  • Developmental stage
  • Other mental/medical health diagnoses (see Medical Workup Considerations)
THEN
  • Reassure the patient; help them put their experience in context and know they are not alone
  • Connect them to relevant educational resources and/or redirect them to appropriate mental health treatment​
SEE MORE
PATH 2: EDUCATE & MONITOR
IF
  • Mild or vague psychotic-like content that is not IMPACTING, RECURRING, or PROGRESSING
  • Family history of psychosis
THEN
  • Educate the patient and family on general mental health resources and direct them to call if symptoms increase in intensity, frequency, or impact
  • Monitor the patient’s symptoms and screen regularly for additional psychotic-like experiences
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PATH 3: specialized ASSESSMENT & TREATMENT
IF
  • Psychotic-like content that is IMPACTING, RECURRING, or PROGRESSING
  • Suspicion/concern psychosis may be emerging even without relevant self-disclosure
THEN
  • Refer the patient to specialized assessment of psychosis and/or psychosis risk
  • Seek consultation/specialized treatment options
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PATH 4: SAME-DAY ASSESSMENt
IF
  • Suicidal/violent thoughts or impulses
  • Significantly out of touch with reality
  • Behavior that is severely disorganized or dangerous
  • Questionable ability to manage command hallucinations to hurt themselves or someone else 
THEN
If these are not sufficiently managed by existing
treatment:
  • Seek consultation from MCPAP or mental health professional trained to address this level of need
  • Respond to risk of harm using established protocols
  • Consider calling a mobile crisis team or recommending that the family bring the child to a Psychiatric Emergency Room
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​To choose the appropriate path, consider:

1. CONSULTING WITH AN EXPERIENCED MENTAL HEALTH CLINICIAN:
  • With knowledge of the age group and any other relevant features (cultural, special populations, such as developmentally-disordered adolescents)
  • With knowledge and experience with psychosis, particularly the early signs
  • With good skills in differential diagnosis 

2. ​CONSULTING NNCPAP (A NATIONAL PSYCHIATRY RESOURCE FOR PCPs) OR ONE OF THE FOLLOWING PSYCHOSIS-SPECIFIC RESOURCES:
  • Massachusetts:
    • Massachusetts Psychosis Network for Early Treatment (MAPNET): Website
    • Center for Early Detection, Assessment, and Response to Risk (CEDAR): Website
  • Maine: ​The PIER Program: Website

​3. REFERRING THE PATIENT FOR A COMPREHENSIVE PSYCHOLOGICAL, MEDICAL, NEUROLOGICAL, AND/OR NEUROPSYCHOLOGICAL EVALUATION as indicated by complexity, timing, family history, or symptom combination, details, or atypicality. 
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Informational tool produced by the Center for Early Detection, Assessment, and Response to Risk (CEDAR) in conjunction with Boston Children’s Hospital (BCH) Psychiatry & Adolescent Medicine, the Massachusetts Child Psychiatry Access Project (MCPAP) and the Prevention Collaborative. ​This work was funded by the Sidney R. Baer, Jr. Foundation, the Massachusetts Department of Mental Health, and the Beth Israel Deaconess Medical Center and Harvard Medical School Departments of Psychiatry.

​​Copyright © 2019 PsychosisScreening.org. PsychosisScreening.org consents to the copying, republishing, redistributing, or otherwise reproducing of this work so long as the resultant work carries with it express attribution of authorship to the contributors listed here.
  • Home
  • Overview
  • Know the Signs
    • Signs of Psychosis
    • About Psychosis & Risk
    • Family History & Other Risk Factors
  • Find the Words
    • Asking about Psychosis
    • Follow-Up Questions
    • Mental Health Differentials
  • Make the Connection
    • Choosing a Path >
      • Path 1: Reassure & Redirect
      • Path 2: Educate & Monitor
      • Path 3: Specialized Assessment & Treatment
      • Path 4: Same-Day Assessment
    • Medical Workup Considerations
  • Resources
    • For Providers
    • For Patients & Families
    • Mental Health Referral Resources