Is change over time in psychotic symptoms related to social functioning?

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In psychosis, treatment often focuses on symptom reduction whereas social functioning is also essential. In
this study, we investigate positive psychotic symptoms and medication use in relation to social functioning over a 3-year
time-period in 531 patients diagnosed with psychosis. Furthermore, relations of positive symptoms with needs for care
and quality of life were also investigated.
Method: Using repeated measures analysis, changes were measured over time. Hereafter, mixed model analyses were
performed to determine the associations of social functioning, needs for care, and quality of life with psychotic symptoms
and patient characteristics. Finally, we assessed differences in symptoms and medication dose between those with an
increase and those with a decrease in social functioning.
Results: Patients significantly improved in social functioning, while psychotic symptoms increased. Improvement in
social functioning was associated with younger age, higher IQ, and lower social functioning at T1, but not with positive
symptoms. Also, improvement in social functioning was found to be related to a decrease in the dose of clozapine.
Improvement in social functioning occurs despite worsening of positive symptoms.
Conclusions: The findings suggest the need to further explore the relation between symptomatology, social functioning,
and medication use. In the treatment of psychotic disorders, one should reconsider the strong focus on reducing
psychotic symptoms. The current focus needs to shift much more toward improving functional outcome, especially
when the patient expresses a desire for change in this respect.
Non-affective psychosis, positive psychotic symptoms, social functioning, needs for care, quality of life
Original languageEnglish
JournalInternational Journal of Social Psychiatry
Publication statusPublished - 13 Aug 2021


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