Cortical atrophy measured with computed tomography was observed in ten of 53 schizophrenic patients. Levels of homovanillic acid, dihydroxyphenyl acetic acid (DOPAC), conjugated DOPAC, and dopamine sulfate (DASO4) were measured in the cerebrospinal fluid of these patients during a drug-free evaluation. Patients with cortical atrophy had lower cerebrospinal fluid levels of homovanillic acid, DOPAC, and conjugated DOPAC but higher DASO4 levels. Combined measures of dopamine utilization were significantly lower in patients with cortical atrophy. We did not find significant clinical or demographic differences between the patients with and without cortical atrophy. Patients without brain atrophy who had dopamine utilization above the mean showed more psychotic symptoms and shorter duration of illness, while those with dopamine below the mean had more negative symptoms. We propose that both state- and trait-dependent variables affect dopamine turnover.