Major depression accompanied by psychosis may be a separate nosological entity from nonpsychotic depression. Investigators have noted behavioral and biochemical differences in psychotic and nonpsychotic patients, as well as differences in response to treatment. A previous study using computed tomography (CT) found enlargement of the lateral cerebral ventricles in patients with manic-depressive illness with psychotic symptoms. The present study examined CT scans of patients with major affective illness that was accompanied by hallucinations, delusions, or both. The ventricles of the depressed group were significantly larger than those of a group of normal controls.