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​

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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.