The purpose of the study was to examine the 4-year course and outcome in first-admitted patients with delusional psychoses, and to compare the findings with those of a 2-year follow-up. The index population comprised 88 patients. At follow-up one-fifth of the patients revealed positive psychotic symptoms, half of the patients had experienced psychotic relapse, and one-fourth had remitted fully. Compared with the findings 2 years before, some statistically significant changes were disclosed: the number of patients with positive psychotic symptoms had decreased, more patients had frequent social contacts, and more patients had good outcome according to the Strauss-Carpenter outcome scale. The findings suggest that some patients need a couple of years to improve from the clinical and social aftermaths. However, in most aspects, the findings of the 2-year and the 4-year follow-ups are comparable and predict poor course and outcome for the majority, while only a minority of the patients manage fairly well.