Using an indirect subtraction binding technique and human postmortem tissue, several laboratories [1][2][3] reported finding increases in dopamine D 4 receptors in caudate nuclei of schizophrenic patients, although others [4][5][6] have not replicated these findings. NGD-94-1 is a selective D 4 antagonist with low affinity for the D 2 and D 3 receptors. 7,8 [ 3 H]NGD-94-1 has been used in this study to directly determine the density of D 4 receptors in normals (n = 13) and schizophrenic subjects (n = 7) off antipsychotic drugs for at least 3 months prior to death, or on antipsychotic (n = 7) drugs at the time of death. Human postmortem coronal brain sections were incubated with [ 3 H]NGD-94-1 and autoradiograms developed; and binding in pertinent regions was quantified. In normals, the highest density of [ 3 H]NGD-94-1 binding was in the hippocampus (68 fmol mg −1 , temporal (33), insular (30), and entorhinal cortices (24.9). Significant increases in [ 3 H]NGD-94-1 density in schizophrenics (n = 14) vs normals (n = 13) were observed in the entorhinal cortex (46%) at both low and high magnifications. The increases observed in the schizophrenics were found in both schizophrenics off antipsychotic drugs for at least 3 months prior to death and those on antipsychotic drugs at the time of death. Thus, the changes may be disease-related and not a consequence of pharmacological treatment. No significant differences were found between the two schizophrenic groups in any brain area studied.Antipsychotic drugs are known to be antagonists of the dopamine D 2 receptor and this is generally considered to be their mode of action. More recently the dopamine D 2 receptor has been found to consist of a family of receptors composed of the D 2 , D 3 , and D 4 receptors. 9 The D 2 receptor subtype is located in the caudate, putamen, nucleus accumbens, globus pallidus and lesser amounts in the substantia nigra, pituitary, and the limbic and neo-cortex. 10,11 The D 3 receptor subtype is highly localized to the ventral striatum and may functionally oppose D 2 subtype stimulation. 12 The D 4 receptor subtype is distinctive in its predominant distribution to cortex, particularly in the limbic regions, and may have a possible link with cognitive functioning in animals. 13 Which one of these receptors, or groups of receptors, is responsible for antipsychotic activity is still an unanswered question.Recently, using an indirect binding technique, increases in the dopamine D 4 receptor density had been reported 1-3 in schizophrenic subjects but replication of this finding was not always possible. 4 It also has low affinity at most other monoamine receptors, with its affinity for the cloned 5-HT 1A receptor being the highest. NGD94-1 also has very low affinity for the following receptors such as the muscarinic, sigma, adrenergic, histamine, NMDA, NPY, and opiate receptors. 8 In this study we have used human postmortem tissue from normal subjects and compared them to schizophrenic subjects who were either off antipsychotic drugs for at least 3...