A 68-year-old woman is referred to the PMHNP 4 months after her husband died. The referral was made by the woman's primary care physician. She reported to the physician that she can hear her deceased husband's voice calling out to her as she is falling asleep. This usually happens after she has been talking about him with friends or looking through old photo albums. The PCP is worried the patient is having a psychotic episode and would like her to have a psychiatric evaluation. Which of the following statements explains why her symptoms are not considered to be psychotic?

Choice A reason: The content of the voice (calling her name) does not determine whether the experience is psychotic. Psychotic hallucinations are typically persistent, intrusive, and occur during full wakefulness. Calling her name alone does not rule in or out psychosis. Choice B reason: Hearing the voice of a close family member can occur in both psychotic and non-psychotic contexts. Bereavement-related hallucinations often involve familiar voices and are considered normal if they are transient and occur in specific emotional contexts. Choice C reason: The absence of command hallucinations reduces the risk of harm but does not alone determine whether the experience is psychotic. Non-command hallucinations can still be part of psychosis if they are persistent and occur outside sleep transitions. Choice D reason: Hypnagogic hallucinations—those occurring as one is falling asleep—are considered normal phenomena and not indicative of psychosis. In the context of recent bereavement and emotional triggers, this experience is consistent with a non-pathological grief response.