Based on a number needed to assess (NNA) of 18 for clinically relevant abnormalities, Blackman et al. (2023) conclude that their findings “support the use of MRI as part of the initial clinical assessment of all patients with FEP.” However, due to the authors’ liberal definition of clinical relevance together with the exclusion of patients with a suspected non-psychiatric cause of psychosis in most of the included studies, it remains debatable whether routine screening is warranted for all patients with FEP. Given recent evidence about the prevalence of autoimmune encephalitis as a potential cause of FEP (Scott et al., 2018), there may be other diagnostic procedures that are better warranted than routine neuroimaging in FEP depending on clinical presentation.