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Leading psychopharmacologist in schizophrenia
When Rob Kerwin arrived at the Maudsley to begin his psychiatric training his bosses were secretly in awe of him. For he was in the vanguard of a new breed of psychiatrists—thoroughly trained in neuroscience, experienced in research, eager to shape the field in their image. Their attitude was appropriate: within three years Rob was a full time member of the academic staff and publishing research supporting a crucial role of glutamate in schizophrenia.
Rob had comparatively humble beginnings in Salford but won a place at Trinity College, Cambridge, to study medicine. After completing preclinical studies he obtained a Medical Research Council PhD studentship in pharmacology at Bristol University, where he studied dopamine and other neurotransmitters in animal models. He also did some postdoctoral work with the late David Marsden at the Institute of Neurology. He completed his clinical training at Westminster Medical School and embarked on further clinical and research work in cardiology at the Hammersmith Hospital, but after a brief attachment in neuropsychiatry at Queen Square he realised his heart was in psychiatry and in 1986 joined the Maudsley rotation.
His rise through the ranks was rapid despite what he often derided as the prevailing “gerontocracy.” By 1995 and with head of department Robin Murray's staunch support, he was awarded a personal chair in neuropharmacology and had a large and growing team applying the range of state of the art technologies to translational schizophrenia research.
His research was broad but shared a common theme of understanding the neurochemical basis of schizophrenia, always with a view towards improving treatment. His first important work was with Ian Everall on postmortem brain tissue showing changes in morphology and receptor binding. He and Lyn Pilowsky, his then training fellow, later made use of neuroreceptor ligand studies using single photon emission computed tomography (SPECT) to image and map dopamine, γ aminobutyric acid (GABA), and serotonin receptor subtypes in the brains of healthy volunteers and patients. This work clarified the side effect profile and the unique effectiveness due to its limbic selectivity of clozapine in otherwise treatment resistant patients, and it earned him the Joel Elkes International Award for Psychopharmacology. More recent work with Maria Arranz has used allelic association pharmacogenetic techniques to predict the response to pharmacological agents. This strand has had important commercial applications and has given rise to a spin off company.
Ironically, one of Rob's most influential papers in psychosis research was published out of his PhD studies in Nature back in 1979 with Pycock and Carter. This showed that early lesions in rat brain could produce distant effects mediated by dopamine after a delay—a finding which gave crucial support for still dominant neurodevelopmental theories of schizophrenia.
Outside the world of clinical neuroscience, Rob was a keen rower and regular at Henley. He had a passion for flying light aircraft and frequently terrified and entranced friends and colleagues by taking them with him. On one occasion, taking time out from a conference, he managed to scramble a squadron of the US Air Force by inadvertently flying over their bases in the Arizona desert.
As a clinician Rob helped set up a National Psychosis Unit at the Bethlem Royal Hospital which deservedly won Hospital Doctor's psychiatry team of the year award. He struggled latterly to continue his clinical work in the face of repeated admissions to hospital for dangerous complications of sarcoidosis, adverse effects of steroid treatment, and increasing antipathy from the NHS towards specialist expertise within psychiatry.
His influence on clinical psychiatry went far beyond his direct service to patients—for example, as an adviser to the National Institute for Health and Clinical Excellence (NICE) on its technology appraisal panel, as a prolific author of papers relevant to practice, as a regular lecturer in the United Kingdom and around the world, and as an architect of a number of large pragmatic clinical trials. UK psychiatrists will be most grateful for the Maudsley prescribing guidelines, which he helped to initiate. These began life as a pamphlet intended only for local hospital staff but have now become an essential handbook for all practising psychiatrists.
Rob's intellect could be intimidating, and he sometimes retreated behind a gruff façade. He could be scathing towards the less rigorous practices of the pharmaceutical industry, yet despite, or perhaps because of his candour, he remained a valued adviser and collaborator with many companies. He was also a generous mentor, a skilled and witty debater, and loyal friend.
He leaves a wife, Fiona, a clinical oncologist, and three daughters.
Robert William Kerwin, professor of clinical neuropharmacology Institute of Psychiatry, King's College, London, and honorary consultant psychiatrist South London and Maudsley NHS Trust, 1994-2007 (b 1955; q Cambridge/Westminster Medical School, 1983; MA, PhD, DSc, FRCPsych), died from cardiac complications of sarcoidosis on 8 February 2007.