In "Clinical, Neuroimmunologic, and CSF Investigations in First Episode Psychosis," Guasp et al. and the Barcelona group reported that 21 of 105 patients with first-episode psychosis (FEP) met the criteria by Pollak et al. for possible or probable autoimmune psychosis (AP), none of whom had autoimmune antibodies or developed NMDAR encephalitis. In a separate cohort, 2 of 3 patients referred for a second opinion with FEP who had NMDA receptor antibodies did not meet the criteria by Pollak et al. for possible AP. They concluded that the criteria by Pollak et al. are overly dependent on neurologic features and propose their own algorithmic approach to screen for AP, which includes the performance of MRI, EEG, and testing for serum neuronal antibodies for all patients with FEP even in the absence of neurologic warning symptoms. Pollak et al. commented that all 3 patients in the one FEP cohort with autoimmune antibodies, in fact, met the criteria for possible AP because of the presence of a movement disorder and/or cognitive dysfunction. Furthermore, they questioned the recommendation by Guasp et al. to perform an extensive workup in the setting of FEP without neurologic symptoms because of concern that this is not only a poor use of resources but it is also not feasible in most psychiatric settings. Dalmau et al. and the Barcelona group respond that (1) although echolalia is one of the 12 features of catatonia, it can be present independently and (2) because there is a broad differential diagnosis for FEP, which includes systemic, neurologic, and psychiatric disorders, facilities that care for patients with FEP must be able to perform a thorough diagnostic evaluation themselves or transfer patients elsewhere.

在“首发精神病的临床、神经免疫学和脑脊液调查”中，Guasp 等人。巴塞罗那小组报告说，105 名首发精神病 (FEP) 患者中有 21 名符合 Pollak 等人的标准。对于可能的或可能的自身免疫性精神病 (AP)，没有人有自身免疫性抗体或发展为 NMDAR 脑炎。在一个单独的队列中，3 名具有 NMDA 受体抗体的 FEP 患者中有 2 名不符合 Pollak 等人的标准。对于可能的 AP。他们得出的结论是 Pollak 等人的标准。过度依赖神经系统特征并提出了他们自己的算法方法来筛查 AP，其中包括对所有 FEP 患者进行 MRI、EEG 和血清神经元抗体检测，即使在没有神经系统警告症状的情况下。波拉克等人。评论说，由于存在运动障碍和/或认知功能障碍，一个 FEP 队列中具有自身免疫抗体的所有 3 名患者实际上都符合可能的 AP 标准。此外，他们质疑 Guasp 等人的建议。在没有神经系统症状的 FEP 的情况下进行广泛的检查，因为担心这不仅资源使用不当，而且在大多数精神病学环境中也不可行。达尔毛等人。巴塞罗那小组回应说：（1）虽然回声是紧张症的 12 个特征之一，但它可以独立存在（2）因为 FEP 有广泛的鉴别诊断，包括全身、神经和精神疾病，