Sandra, Thank you for your excellent review of this article and I have long been a fan of attempting to treat all mental illness symptoms with approaches that don’t involve medications if at all possible. However, I also agree with the two previous comments that the use of marijuana absolutely needs to be taken into consideration when dealing with any psychotic symptoms. We in Colorado are experiencing a significant rise in psychosis and violence with psychosis in emergency rooms and mental health programs/substance abuse treatment programs directly correlating with the increase in THC potency in the marijuana available. In the state hospital where I work a large majority of the folks I have been asked to do substance abuse assessments on were using marijuana either alone or in addition to other drugs at the time of their incident offense and they were so actively psychotic and violent they ended up on a lot of medications in order to keep them from harming themselves or others. I try to convince their medical providers to attempt to get them off meds once they are stable but this is a hard sell because they were so violent before. When we have had similar patients go through our 90 day inpatient dual diagnosis program in the same hospital, I have been successful in getting some off meds and in others significantly reducing their medications with good outcomes which to me indicates marijuana was playing a big role in their psychotic symptoms. Also we frequently discover the person doesn’t really have schizophrenia or schizoaffective disorder but more likely severe PTSD they have been attempting to “treat” with marijuana. In my experience PTSD psychosis does not respond to antipsychotic medication at all and therefore find EMDR and similar treatments most effective once the person is no longer using marijuana. I believe the study that jewelsfs was taking about is: Patel R et al. Association of cannabis use with hospital admission and antipsychotic treatment failure in first episode psychosis: an observational study. BMJ Open 2016;6:e009888. doi:10.1136/bmjopen-2015-009888 A large observational study of over 2000 participants showing that cannabis was associated with substantially worse clinical outcomes resulting in the use of multiple antipsychotics. I hope this is helpful.