Outcome has been a key concern in schizophrenia since Kraepelin first identified the disorder. The outcomes that researchers and clinicians use and value in their work with it have changed to reflect evolving theories about it and the available interventions. This supplement tracks those changes and examines the merits and use of structured approaches to understand this most complex disorder

Treating psychotic disorders in their earliest stages has become a key focusfor research and clinical care. This paper reviews evidence of the capacityto identify those at increased risk for psychotic disorder and to intervenein the identified, high-risk individuals to ameliorate the course ofdisorder. Issues involved in preventive oriented clinical care areaddressed, such as risk/benefit considerations, ethical and safety issuesand the value of stage-specific interventions. Clinical predictorsidentified in recent research, promising intervention trials and proposedclinical practice guidelines are described. An approach based on activeengagement, support and monitoring, yet with a conservative approach tomedication use is advocated at present. Potential neurobiological processeshave been studied and reinforce the sense that this is a critical phase foractive treatment, and may prove helpful in understanding the process oftransition across stages of illness. More research is required inprediction, neurobiology and treatment

The increased schizophrenia risks for residents of cities with high levelsof competition and for members of disadvantaged groups (for example migrantsfrom low- and middle-income countries, people with low IQ, hearingimpairments or a history of abuse) suggest that social factors are importantfor aetiology. Dopaminergic dysfunctioning is a key mechanism inpathogenesis. This editorial is a selective literature review to delineate amechanism whereby social factors can disturb dopamine function in the brain.Experiments with rodents have shown that social defeat leads to dopaminergichyperactivity and to behavioural sensitisation, whereby the animal displaysan enhanced behavioural and dopamine response to dopamine agonists.Neuroreceptor imaging studies have demonstrated the same phenomena inpatients with schizophrenia who had never received antipsychotics. Inhumans, the chronic experience of social defeat may lead to sensitisation(and/or increased baseline activity) of the mesolimbic dopamine system andthereby increase the risk for schizophrenia

Supervised community treatment to address ‘revolving door’ care is part of the new Mental Health Act in England and Wales. Two recent epidemiological studies in Australia (n > 118 000), as well as a systematic review of all previous literature using appropriately matched or randomised controls (n = 1108), suggest that it is unlikely to help.

Clergy continue to have a central role in many communities and the utility of their involvement in the care of people with mental health problems is increasingly argued. However, there has been a failure to examine the form and parameters of partnerships between faith-based organisations and psychiatry.

Amphetamine-type stimulants are the second most widely used drugs in the world. Over prescription results in diversion for recreational use and the development of dependence. The internet plays a significant role in global misuse of amphetamine-type stimulants, permitting uncontrolled dispensing by online pharmacies and providing information on techniques for illicit manufacture.