Changes in symptoms along the course of episodic and recurrent psychosis have yet to be fully elucidated. We investigated the long-term course, at least 5 years, of 40 patients suffering from episodic and recurrent psychosis. A total of 324 episodes observed in these patients were categorized, on the basis of their principal symptom, into three types; episodes of confusion, episodes with hallucinations and delusions, and those with affective symptoms. We divided the 40 patients into the favorable outcome group and the poor outcome group and compared the characteristics of the two groups. In the favorable outcome group, affective episodes were found to be more frequent in later episodes whereas in the poor outcome group, confusion episodes continued to be the most frequent throughout the course. We discuss diagnostic issues concerning episodic-recurrent psychosis and try to locate it within the domain of schizophrenia.