Schizophrenia, a chronic and disabling mental disorder affecting about 1% of the world's population, has remained poorly understood for a century. Current treatments, particularly pharmacological ones, have not significantly improved outcomes for most patients. However, a new perspective views schizophrenia as a neurodevelopmental disorder with psychosis as a late, potentially preventable stage. This shift in understanding offers hope for prevention and cure in the next two decades. Schizophrenia is a syndrome characterized by psychosis, with symptoms such as paranoid delusions and auditory hallucinations emerging in late adolescence or early adulthood. These symptoms have remained largely unchanged over the past century. Despite advances in treatment, outcomes for patients remain poor, with less than 14% recovering within five years of a psychotic episode. Long-term outcomes are marginally better, but most people with schizophrenia are not employed, and many are homeless. The history of schizophrenia reflects changing perspectives on the disorder. Early formulations emphasized a fundamental disorder of thought and feeling, while later theories focused on brain chemistry, particularly dopamine. However, these approaches have not led to significant improvements in treatment. Recent research suggests that schizophrenia may be a neurodevelopmental disorder, with early brain development playing a critical role. Genetic studies have identified several genes associated with schizophrenia, but individual effect sizes are modest. Environmental factors, such as prenatal malnutrition, infections, and perinatal injury, have also been linked to increased risk for schizophrenia. Gene-by-environment studies may provide more robust insights, as well as epigenetic maps that reveal the 'scars' of early experiences. The neurodevelopmental model of schizophrenia suggests that psychosis emerges in late adolescence or early adulthood, following an early insult. This model implies the importance of timing and the opportunity for earlier intervention and prevention. Recent longitudinal studies have identified differences in brain development in children with schizophrenia, including excessive losses of grey matter and cortical thinning. The stages of schizophrenia include risk, prodrome, psychosis, and chronic disability. Early detection and intervention may improve outcomes, particularly for those in the prodrome stage. Cognitive deficits are a major contributor to the disability of schizophrenia, and research into cognitive remediation may lead to effective treatments. Integration of care is essential for improving outcomes, as current treatment is fragmented. Better treatments, not just better systems, will be necessary for better outcomes. Stigma associated with schizophrenia may also be reduced in the future, with a shift in terminology and a focus on personalized care. In 2030, the prognosis for schizophrenia may be significantly improved through early detection, early intervention, and a focus on cognitive deficits. The integration of genetics, experience, and development may lead to a new taxonomy of schizophrenia, identifying many disorders within the syndrome and replacing the aggregate label with more precise diagnoses based on pathophysiology. The goal will be to cure and prevent schizophrenia through personalized care and early intervention.Schizophrenia, a chronic and disabling mental disorder affecting about 1% of the world's population, has remained poorly understood for a century. Current treatments, particularly pharmacological ones, have not significantly improved outcomes for most patients. However, a new perspective views schizophrenia as a neurodevelopmental disorder with psychosis as a late, potentially preventable stage. This shift in understanding offers hope for prevention and cure in the next two decades. Schizophrenia is a syndrome characterized by psychosis, with symptoms such as paranoid delusions and auditory hallucinations emerging in late adolescence or early adulthood. These symptoms have remained largely unchanged over the past century. Despite advances in treatment, outcomes for patients remain poor, with less than 14% recovering within five years of a psychotic episode. Long-term outcomes are marginally better, but most people with schizophrenia are not employed, and many are homeless. The history of schizophrenia reflects changing perspectives on the disorder. Early formulations emphasized a fundamental disorder of thought and feeling, while later theories focused on brain chemistry, particularly dopamine. However, these approaches have not led to significant improvements in treatment. Recent research suggests that schizophrenia may be a neurodevelopmental disorder, with early brain development playing a critical role. Genetic studies have identified several genes associated with schizophrenia, but individual effect sizes are modest. Environmental factors, such as prenatal malnutrition, infections, and perinatal injury, have also been linked to increased risk for schizophrenia. Gene-by-environment studies may provide more robust insights, as well as epigenetic maps that reveal the 'scars' of early experiences. The neurodevelopmental model of schizophrenia suggests that psychosis emerges in late adolescence or early adulthood, following an early insult. This model implies the importance of timing and the opportunity for earlier intervention and prevention. Recent longitudinal studies have identified differences in brain development in children with schizophrenia, including excessive losses of grey matter and cortical thinning. The stages of schizophrenia include risk, prodrome, psychosis, and chronic disability. Early detection and intervention may improve outcomes, particularly for those in the prodrome stage. Cognitive deficits are a major contributor to the disability of schizophrenia, and research into cognitive remediation may lead to effective treatments. Integration of care is essential for improving outcomes, as current treatment is fragmented. Better treatments, not just better systems, will be necessary for better outcomes. Stigma associated with schizophrenia may also be reduced in the future, with a shift in terminology and a focus on personalized care. In 2030, the prognosis for schizophrenia may be significantly improved through early detection, early intervention, and a focus on cognitive deficits. The integration of genetics, experience, and development may lead to a new taxonomy of schizophrenia, identifying many disorders within the syndrome and replacing the aggregate label with more precise diagnoses based on pathophysiology. The goal will be to cure and prevent schizophrenia through personalized care and early intervention.