A prevention for schizophrenia is still a holy grail and whether it exists at all is the $64 000 question. This grail is no closer and answers to the big question are no clearer after reading this multi-author collection of essays.

Prevention is classically divided into primary, secondary and tertiary, although the second and third are concerned with treatment and management in the health service. Primary prevention of new cases of disorder is quite different and often relies on population-based methods and changes in policy. Thus, primary prevention of cardiovascular disease includes limiting tobacco advertising and improving food labelling. Primary prevention of sudden infant death syndrome has involved public education programmes to encourage parents to lie their babies on their backs.

What are the likely public health interventions that might reduce the incidence of schizophrenia? First we must ask what causes schizophrenia. A number of chapters in this book give excellent reviews of the literature considering this question, although many are tailored to this book only by the insertion of a beginning and ending paragraph on prevention. Some of the risk factors, such as being brought up in an urban environment, seem to give little hope for prevention unless cities are done away with. Genetic risk factors can, at present, be used only to counsel those with affected relatives. Obstetric difficulties may be a causal factor, but services are in any case trying to reduce these and there would seem to be little scope for further action.

So what is the conclusion about the prevention of schizophrenia? Many limits and not many opportunities: further research is needed.