In a sample of 130 patients who had undergone MRI (transverse T2-weighted SE sequence) patchy white matter lesions (WML) were documented according to number and spatial distribution in the brain. Ventricle-to-Brain Ratio (VBR) was determined. Configural frequency analysis led to delineation of four patient groups on the basis of WML location: 1. no WML (n = 35), 2. right frontal-temporal WML (n = 23), 3. bifrontal WML (n = 12), 4. WML in all/all but one brain region (n = 16). Psychopathological symptoms reported in the course of a maximum of 3 years were documented by chart review. In the 'pervasive WML' group psychopathological items characteristic of organic brain syndromes prevailed, mean VBR exceeded values in all other groups (ANOVA, p < 0.001). WML spatial distribution accounted for 10.2% of total psychopathological variance. Patient age, but not VBR, had a significant impact on symptom profile (MANCO-VA). When the 'pervasive WML' group was excluded, the finding of a significant effect of WML location on psychopathological symptom profiles was robust. Bifrontal WML were associated with thought incoherence, right frontal-temporal WML with affective symptoms. Findings support an impact of spatial distribution of unspecific WML on psychopathological symptoms in psychiatric patients.