Author Response: Clinical, Neuroimmunologic, and CSF Investigations in First Episode Psychosis

Dr. Tebartz et al. misunderstand our manuscript.1 First, since our initial description of anti-NMDAR encephalitis, we have recommended CSF studies for patients with first-episode psychosis (FEP) of unclear etiology. Second, CSF studies are rarely performed in psychiatric facilities (as reviewed in Dalmau et al.2); thus, we provided an algorithm emphasizing those cases that, even in these facilities, should have CSF studies. Third, signs, symptoms, paraclinical features, and comorbidities of autoimmune encephalitis (AE) have been repurposed as red or yellow flags of autoimmune psychosis,3 and we agree that FEP patients with any of these AE features should have CSF studies. What we do criticize is the inclusion of these flags in the criteria developed to facilitate the diagnosis of autoimmune psychosis in patients with minimal or no features of AE because, in this setting, the criteria and flags are of very limited value.1

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