Schizophrenia continues to remain one of the major unsolved conditions of our time, contributing significantly to causes of disability worldwide. Advances in neuroimaging have demonstrated that schizophrenia appears to be primarily a neurodevelopmental disorder. The dopamine theory of schizophrenia continues to hold sway but interest is growing in the role of other neurotransmitters. Genetic linkage studies continue to suggest that specific chromosomes have a role in the aetiology of the condition but the findings are, as yet, inconsistent. A new generation of drug therapies and reforms of the mental health system have meant that it is now possible to treat the majority of those with this condition in the community albeit, in some instances, against their will. The medical complications of both the disorder, the lifestyle changes resulting from the disorder and the new and older medications have come to prominence in recent years. The development of guidelines for treatment has the potential to reduce the variability in clinical practice that currently exists in the management of the condition. (Intern Med J 2005; 35: 413-418)