Psychiatrist Questions

Schizophrenia and OCD

What are the strongest possible meds combo for schizophrenia (with predominant negative symptoms but also delusions/paranoia/thought disorganization) and very severe OCD? I currently take 600 mg Quetiapine, 60 mg Prozac and 15 mg Abilify.

Male | 31 years old
Medications: quetiapine, fluoxetine, aripiprazole
Conditions: schizophrenia, OCD

3 Answers

The highest dose of Quetiapine studied is 800mg for schizophrenia, and in terms of OCD, 80mg is the highest dose of Prozac that has been studied to be effective. Aripiprazole could theoretically be increased too, with a highest dose of 25-30mg. I do not believe there is a specific combination of medications that works well for everyone across the board, it’s about finding the combination that works the best for your specific symptoms.
Extremely important question as well as a difficult question. It is always best to customize Medication’s to a specific individual including drug interaction, medical issues, potential side effect tolerability. Many people believe that Clozapine is the strongest medicine for schizophrenia but it comes with significant number of side effects. OCD is classically helped by SSRIs including Prozac, Zoloft, and Luvox. The negative symptoms in schizophrenia have a wide range of treatments that go in and out of vogue.
The most important thing is to work closely with your psychopharmacologist and be very honest with your prioritization of symptoms you desire to reduce.

Lance Steinberg MD, Inc.
Assistant Clinical Professor
UCLA (Geffen) NPI
That is a difficult question because there are so many other factors besides medications that have to line up as well to help with your illness. Ideally, one antipsychotic should address your symptoms of schizophrenia, optimizing the dosage to measure effectiveness. Second generation antipsychotic medications have been shown to target the negative symptoms better than first generation. Two antipsychotic medications in the same class has not been shown to be more effective than one medication (despite the belief of many psychiatrists). OCD is an anxiety disorder that often presents similar to psychosis in terms of the perseverating and obsessive thoughts. SSRI medications are first line treatment for OCD and you'll have extra coverage for your obsessive thoughts with the antipsychotic medication. It's a matter of finding the right combo that fits with your genetic makeup and optimizing the medications. That along with therapeutic interventions to help with the psychological components will give you a better chance to decrease your symptoms. Good luck.