In The Netherlands, approximately 1 in 8 citizens (2.2 million) have an IQ between 70 and 85. Together the combination of a low IQ (< 70) and low adaptive functioning is referred to as mild intellectual disability (ID). People with ID are vulnerable to stress and psychological problems. The diagnosis and treatment of psychotic symptoms in patients with mild ID can prove to be a challenge. In this clinical lesson we present two different cases. We encourage physicians to adhere to a holistic approach. Furthermore the AAIDD model may guide structuring the analysis of psychotic symptoms. This enables finding the right treatment which may include medical treatment or emphasis on context improvement or a combination of both. Upon treatment initiation with antipsychotics, it's important to start low and go slow regarding the dosage. And if the context is the main problem, it is important to taper off the use of antipsychotics.