SUMMARY Earlier cross-sectional studies have suggested that CT findings of ventricular enlargement and increased cortical markings in schizophrenic patients are not progressive, but individual patients have rarely been followed prospectively. Fifteen patients with chronic schizophrenia were rescanned on the same model machine after 7 to 9 years of continuous illness and, in seven cases, of continuous hospitalisation. It was not possible to demonstrate significant changes in either ventricular-brain ratio or frontal atrophy scores. These results suggest that the pathologic process responsible for CT changes in schizophrenia is static and is not affected by 8 years of neuroleptic medication and institutionalisation.The presence of ventricular enlargement in some schizophrenic patients has led to speculation about the importance of structural brain pathology in the pathogenesis of the illness.' 2 This non-specific finding could arise from focal pathology of periventricular structures or could be part of a more generalised process as seen in a variety of neurological diseases. The time course of ventricular enlargement may provide insight into the nature of the underlying neuropathological process. Stable ventricular size would be expected with a static lesion, while progressive enlargement would suggest ongoing degeneration of cerebral structures and might implicate psychiatric treatment such as medication or institutionalisation as playing a causative role.3Earlier studies have provided both indirect and direct evidence that lateral ventricular enlargement is not progressive. Repeated pneumoencephalographic studies failed to reveal an increase in lateral ventricular size in most schizophrenic patients 2 months to 8 years after the initial studies despite clinical deterioration in many.4 The majority of computed tomography (CT) studies of ventricular size have failed to

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