Schizophrenia is still one of the most mysterious and costliest
mental disorders in terms of human suffering and societal expenditure. Here, we focus on the key developments in biology, epidemiology, and pharmacology of
schizophrenia and provide a syndromal framework in which these aspects can be understood together. Symptoms typically emerge in adolescence and early adulthood. The incidence of the disorder varies greatly across places and migrant groups, as do symptoms, course, and treatment response across individuals. Genetic vulnerability is shared in part with
bipolar disorder and recent molecular genetic findings also indicate an overlap with developmental disorders such as
autism. The diagnosis of
schizophrenia is associated with demonstrable alterations in brain structure and changes in
dopamine neurotransmission, the latter being directly related to
hallucinations and delusions. Pharmacological treatments, which block the
dopamine system, are effective for delusions and
hallucinations but less so for disabling cognitive and motivational impairments. Specific vocational and psychological interventions, in combination with
antipsychotic medication in a context of community-case management, can improve functional outcome but are not widely available. 100 years after being so named, research is beginning to understand the
biological mechanisms underlying the symptoms of
schizophrenia and the psychosocial factors that moderate their expression. Although current treatments provide control rather than cure, long-term hospitalisation is not required and prognosis is better than traditionally assumed.