The distribution of mood-congruent and mood-incongruent symptoms in 49 first-admission DSM-III-R psychotic bipolar and 35 psychotic depressed patients is presented. Most patients had mood-incongruent symptoms (77.4%). 73% of mood-incongruent bipolars and 32% of incongruent depressives had a combination of mood-congruent and mood-incongruent symptoms. Demographic and clinical variables were unrelated to incongruence. The only 24-month clinical outcome predicted by mood incongruence was poorer GAF rating. 15 of the 16 patients whose diagnosis was changed at follow-up from affective to nonaffective psychosis had mood-incongruent features initially. The findings raise questions about the general prognostic utility of mood congruence.