Brain imaging has revealed alterations in dopamine uptake, release and receptor levels in patients with schizophrenia that have been resolved at the scale of striatal subregions. However, the underlying synaptic mechanisms are at a finer scale. Dopamine neuron synaptic actions vary across the striatum, involving not only variations in dopamine release, but also in dopamine neuron connectivity, cotransmission, modulation and activity. Optogenetic studies have revealed that dopamine neurons release dopamine in a synaptic signal mode, and that the neurons also release glutamate and GABA as cotransmitters, with striking regional variation. Fast glutamate and GABA cotransmission convey discrete patterns of dopamine neuron activity to striatal neurons. Glutamate may function not only in a signaling role at a subset of dopamine neuron synapses, but also in mediating vesicular synergy, contributing to regional differences in loading of dopamine into synaptic vesicles. Regional differences in dopamine neuron signaling are likely to be differentially involved in the schizophrenia disease process, and likely determine the subregional specificity of the action of psychostimulants that exacerbate the disorder, and antipsychotics that ameliorate the disorder. Elucidating dopamine neuron synaptic signaling offers the potential for achieving greater pharmacological specificity through intersectional pharmacological actions targeting subsets of dopamine neuron synapses.