Hi ysraal,   I'm not sure what exactly you mean; however, I will answer based on what I think you're saying and then please feel free to clarify.   A psychotic episode, breakdown or other manifestation of SZ can be triggered by stress or the environment or abuse, in someone with a genetic tendency toward SZ.  The underlying cause could be unique to each person based on what's going on in his or her life at the time he or she gets sick.  This doesn't mean the person doesn't have SZ, it just means the cause is different from one person to another.   You use the term "defer a psychosis rule-out." What do you mean by rule-out? To defer making a diagnosis of SZ if the underlying cause, is what caused the psychosis?  Forgive me if I sound dense or am oversimplifying.  I will tell you my own story:  I believe the stress of visiting my beloved Grandpa in the hospital, where he was in a coma hooked up to a respirator in the intensive care unit, drove me over the edge and I had a breakdown.  Does that mean I don't have SZ?  No, I trust the diagnosis was accurate.   Do write back if you feel I'm off track.   Regards, Christina