Question: Are there differences in the brain morphology between affective and schizoaffective disorders and are they related to the different outcome especially of patients with mixed episodes? Do patients develop atypical brain asymmetries and are there other causes eg. alcohol, number of episodes etc., which influence the outcome of the disease and brain atrophy? Methods: cCT-scans of 82 patients were retrospectively analysed using a visual instrument (CTRSS). Patients were diagnosed with ICD-10 criteria. There was no group difference for age and sex. Other relevant data was collected from the patient records. Results: In global tests there was no significant difference between the subgroups, although patients with mixed schizoaffective disorders showed greater brain atrophy than patients with nonmixed episodes. All patients had a significant larger left Sylvian Fissure. Patients with a positive family history of affective disorders are at the onset of illness significantly younger. Conclusion: There is no relation between outcome of illness and brain atrophy which is visible on a routine CT-scan. Subtle changes can be probably found by using more sensitive methods.