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Objective: 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.

In this paper we analyze the bureaucratic negotiation process that is implied by the budgeting system applied in Dutch hospital care. This system is based on centralized price setting while simultaneously allowing for decentralized negotiations on volumes. We apply a variant of the bureaucracy theory, according to which the bureaucratic agency (in our case the joint hospitals) are not allowed to price discriminate, but will receive a flat price per unit of output. We find that central price setting, where the insurer cannot exploit its information on hospital costs, leads to a suboptimal supply of hospital care. 4 Figures, 9 References. Adapted from the source document.