Barcelona snapshots

Prof. Oliver Howes

Oliver Howes psychiatrist Controversias Psiquiatry Barcelona
King's College London & Imperial College London, United Kingdom
Talk From the street to the striatum: the pathogenesis of schizophrenia and what this means for treatment response and resistance
Date Friday, April 26th, 2019
Time 9:45 to 10:30
Round Table Treatment-resistance in schizophrenia


Oliver Howes is Professor of Molecular Psychiatry at the Institute of Psychiatry, Psychology and Neuroscience, King's College, London and Programme Leader at the MRC Clinical Sciences Centre, Imperial College, London. His clinical work is as Consultant Psychiatrist at The Maudsley Hospital where he runs a service for people with psychoses.

His research interests centre on the causes and treatment of affective and psychotic disorders. His recent work has focussed on understanding the role of dopamine and neuroinflammation in the development of psychosis, the effects of antipsychotic drugs, & the causes of cognitive impairments. This work has been recognised through a number of awards including the Royal College of Psychiatrists Researcher of the Year Award (2017), Schizophrenia International Research Society Rising Star Award 2013, European Psychiatric Association Biological Psychiatry Prize (2012), the Royal Society of Medicine Psychiatry Prize (2010), and the British Association of Psychopharmacology Clinical Psychopharmacology Prize (2007). He was made an honorary associate of the European College of Neuropsychopharmacology in 2006.

Other career highlights include working as a junior potato scrubber on a farm. He spends his spare time trying to find the world's best ice-cream.


This talk will cover neurobiological mechanisms underlying symptoms in schizophrenia, how risk factors may act on brain mechanism to lead to the onset of psychosis and how this links to the mode of action of antipsychotic treatment, focusing on in vivo dopaminergic findings. Recent meta-analytic data identifying the nature and locus of the dopaminergic alterations in schizophrenia will be reviewed. These data show no major abnormality in striatal dopamine D2/3 receptors or dopamine transporter availability, although a heterogeneity meta-analysis indicates increased heterogeneity in schizophrenia. In contrast, imaging measures of striatal dopamine synthesis and release capacity show large effect size elevations, and are linked to the development of psychosis. Findings in the prodrome to psychosis will also be reviewed. Moreover, new analyses identify the dorsal rather than mesolimbic striatum as the locus of the major alterations. Cortical dopamine D2/3 receptors are not altered, but new data on cortical dopaminergic function show blunted release, with implications for understanding negative symptoms. The evidence that striatal dopamine function is linked to treatment response will also be reviewed. The implications of these neurobiological findings for current treatments, as well as developing new treatments, will also be covered. Recent data highlight that patients with antipsychotic treatment non-responsive and resistant schizophrenia show differences in dopamine and glutamate function relative to patients with antipsychotic treatment responsive schizophrenia. These data will be reviewed and the implications for treatment and controversies considered.


[PDF] Jauhar S et al (2018). Determinants of treatment response in first-episode psychosis: an 18F-DOPA PET study. Mol Psychiatry. 2018 Apr 20. doi: 10.1038/s41380-018-0042-4.

[web] McCutcheon R et al (2018). Antipsychotic plasma levels in the assessment of poor treatment response in schizophrenia. Acta Psychiatr Scand. 2018 Jan;137(1):39-46. doi: 10.1111/acps.12825. Epub 2017 Oct 26..

[PDF] Howes OD, McCutcheon R, Owen MJ, Murray RM (2017). The Role of Genes, Stress, and Dopamine in the Development of Schizophrenia. Biol Psychiatry. 2017 Jan 1;81(1):9-20. doi: 10.1016/j.biopsych.2016.07.014.

[PDF] Mouchlianitis E et al (2015). Treatment-Resistant Schizophrenia Patients Show Elevated Anterior Cingulate Cortex Glutamate Compared to Treatment-Responsive. Schizophrenia Bulletin vol. 42 no. 3 pp. 744–752, 2016.