This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
In “Clinical, Neuroimmunologic, and CSF Investigations in First Episode Psychosis,” Guasp et al. created an algorithm for the workup of first-episode psychosis to identify autoimmune encephalitis that includes CSF testing for (1) all patients with concomitant new-onset neurologic symptoms or (2) patients without neurologic symptoms who have abnormal serum neuronal antibodies, EEG, or brain MRI. Tebartz van Elst et al. note concerns with this algorithm because it can be challenging to determine whether cognitive deficits are neurologic or psychiatric, and it does not account for comorbidities that are associated with autoimmune encephalitis. They suggest that all patients with first-episode psychosis should have a lumbar puncture. Guasp et al. reinforce that CSF testing should be performed for all patients with first-episode psychosis of unclear etiology but emphasize that this algorithm is beneficial because it provides guidance for psychiatric facilities, where CSF testing is rarely performed. They further respond that neurologic and psychiatric cognitive deficits can be distinguished through the neurologic examination and that inclusion of comorbidities in the algorithm would be of limited value. Last, they note that the literature does not demonstrate a benefit to indiscriminate CSF testing in all patients with schizophreniform and affective disorders.
In “Clinical, Neuroimmunologic, and CSF Investigations in First Episode Psychosis,” Guasp et al. created an algorithm for the workup of first-episode psychosis to identify autoimmune encephalitis that includes CSF testing for (1) all patients with concomitant new-onset neurologic symptoms or (2) patients without neurologic symptoms who have abnormal serum neuronal antibodies, EEG, or brain MRI. Tebartz van Elst et al. note concerns with this algorithm because it can be challenging to determine whether cognitive deficits are neurologic or psychiatric, and it does not account for comorbidities that are associated with autoimmune encephalitis. They suggest that all patients with first-episode psychosis should have a lumbar puncture. Guasp et al. reinforce that CSF testing should be performed for all patients with first-episode psychosis of unclear etiology but emphasize that this algorithm is beneficial because it provides guidance for psychiatric facilities, where CSF testing is rarely performed. They further respond that neurologic and psychiatric cognitive deficits can be distinguished through the neurologic examination and that inclusion of comorbidities in the algorithm would be of limited value. Last, they note that the literature does not demonstrate a benefit to indiscriminate CSF testing in all patients with schizophreniform and affective disorders.
Footnotes
Author disclosures are available upon request (journal{at}neurology.org).
- Received March 28, 2022.
- Accepted in final form March 28, 2022.
- © 2022 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
