Patients may present with symptoms that, while initially appearing to indicate concern for psychosis risk, are ultimately determined to not be psychotic-like or to be better explained by something else. Such cases may include:

1. A patient whose EXPERIENCE is consistent with cultural/familial norms
2. A patient whose EXPERIENCE is consistent with their developmental stage (e.g., daydreaming, imaginative play/friends)
3. A patient whose EXPERIENCE is consistent with other mental/medical health diagnoses (e.g., social anxiety, obsessive compulsive disorder, acute stress, substance use, brain injury; consult guidelines on medical and mental health differentials)

​When any of the above are true, consider the following steps:

REASSURE THE PATIENT, AS APPROPRIATE. Help them put their experience in context, and let them know that they are not alone. Provide education to the patient and family about relevant mental health concerns contributing to their experience; instruct them to reach back out if the experience becomes distressing or affects their behavior (IMPACTING), happens repeatedly (RECURRING), or seems to be getting worse in any other way (PROGRESSING).

REDIRECT THE PATIENT TO RELEVANT EDUCATIONAL OR MENTAL HEALTH RESOURCES appropriate to any clinically meaningful symptoms and experiences. These may include specialized care (e.g., an anxiety specialist, trauma informed care, neurology). See Resources for a list of specialized mental health services available in Massachusetts.

​During her annual physical, Marie tells you she sometimes speaks to people who are not physically there. When you ask her more about this, Marie shares that her church teaches that the spirits of deceased relatives provide protection and guidance to those still living. Marie’s mother confirms that this belief is shared by the rest of the family.

You might respond to Marie: “I’m glad that you can get comfort from your relatives. Are things feeling overwhelming right now?” If yes, or there is reason for concern that she may not be coping well, “Would it help to maybe talk with a counselor who is trained to teach people skills to get through tough times?” Consider culturally acceptable and sensitive options for additional education, support, or therapy.