Returning to routine after a psychotic episode

After a psychotic episode, there are some aspects that make returning to routine difficult:

• Much of the antipsychotic medication has side effects (slows thinking, flattens emotions, lowers libido, etc.), which also makes it difficult to return to a normal routine.
• In addition, you may feel bad about actions, words, or even thoughts developed during the outbreak that make it difficult to reconnect with the people you were close to during the crisis.
• Once a person is diagnosed, it is time to confront social stigma and work on self-stigma , that is, not to create in ourselves the stereotypes that fall on mental health (dangerousness, incompetence, inconstancy, impulsiveness, etc.) feeling shame, guilt, pitying ourselves or limiting ourselves.

It is likely that immediately after the outbreak you will not be able to directly resume everything you did before, but surely little by little you will be able to resume many of the things you did that made you feel good.

Every recovery process is different and takes time. Regarding managing expectations, we believe it's best to set easy, short-term goals to boost self-esteem and then gradually expand them in the medium and long term.

The goal is to have a life project that satisfies you and has meaning.

The first thing we need to know is that there is no legal provision that obliges you to say that you have gone through a psychotic episode.

The decision to tell or not is entirely yours.

The important thing is that when you consider whether or not to share your experience in this area, you do so taking into account the pros and cons that this openness may entail, since it is an experience that is still socially stigmatized and by sharing it we may expose ourselves to more discrimination.

Pros:

• Relating to others with honesty (not having to hide or lie).
• Discovering that, like you, there are many more people who have suffered psychological distress.
• The possibility of finding support within the group.
• Achieve reasonable adjustments in the workplace.

Cons:

• The possibility of receiving various forms of discrimination: distancing, mobbing , relegation to minor tasks, degradation or dismissal alleging reasons other than the mental health problem.

The decision to tell or not is entirely yours.

The important thing when making this decision is to consider the pros and cons that this openness may entail, since it is an experience that is still socially stigmatized and by talking about it we may expose ourselves to more discrimination.

Explaining it to colleagues can have advantages:

• Relating to others with honesty (not having to hide or lie).
• Discovering that, like you, there are many more people who have suffered psychological distress.
• The possibility of finding support within the group.

But there are also disadvantages due to the social stigma and lack of awareness that still exists.

In the case of minors, we must bear in mind that it will be the parents or legal guardians who will ultimately decide whether or not to explain it to the teachers.

What we would not recommend is the consumption of psychoactive substances; otherwise, resuming life is positive and highly advisable.

First psychotic episodes and substance abuse

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Yes, social relationships are very beneficial, both to provide support and to give a sense of belonging and rootedness (preventing isolation).

Doing physical exercise or doing some activity that you enjoy, and maintaining a regular and balanced diet are also habits that help prevent new psychotic episodes.

Allowing us some flexibility, a routine we like creates stability because it helps us organize our day.

A healthy routine should include time for work and leisure activities, with realistic goals, and good eating and sleeping habits.

It's not easy to support a loved one in times of suffering, but there are some guidelines that can help:

• Maintain close, consistent, and reciprocal emotional family relationships .
• Pay attention to criticism, overprotection, and hostility.
• Maintain a clear family organization (rules, roles).
• Having clear communication about the disorder and its management.
• Assume that recovery processes take time and are not linear .
• To transmit hope .
• Hear .
• To accompany without deciding for the other person.

During adolescence and youth, peer groups are the main references and therefore have a fundamental role; in this sense, having their support promotes good development.

Some guidelines for supporting our friends who are in recovery are:

• Maintain close, consistent, and reciprocal emotional relationships.
• Pay attention to criticism, overprotection, and hostility.
• Having clear communication about the disorder and its management with close friends.
• Assume that recovery processes take time and are not linear.
• To transmit hope.
• Hear.
• To accompany without deciding for the other person.

It depends on each specific case; some students will need it and others won't.

Some adaptation proposals that can be implemented in the educational center are:

• Having flexible hours
• Curricular (content) and/or methodological (times, types of exercises, etc.) adaptation.
• To be able to leave the class if needed

There are several warning signs that teaching teams can detect in their interactions with students or in the classroom:

• Difficulty concentrating.
• Decreased academic performance.
• Impulsiveness.
• Alterations in thought and perception.
• Confused thoughts.
• Distrust towards people in the environment.
• Sudden mood swings.
• Social isolation.
• Drowsiness in class due to sleep problems.
• Lack of personal care or hygiene.
• Unusual and excessively intense ideas.
• Strange feelings or absence of feelings.
• Problems expressing oneself verbally.
• Difficulty distinguishing reality from fantasy.
• Disorganization of behavior.
• Lack of energy, motivation, interest, etc., in an extreme and involuntary manner.

If you detect several of these signs, we recommend contacting the person's family or close circle to inform them of the situation.

If you are unable to contact the family and there are any alarming signs, call 061 or your local emergency medical services number.

Whether or not to explain that you have a psychotic disorder, and when to explain it, is a very personal decision.

Furthermore, we will have to make this decision repeatedly throughout our lives, and we don't have to limit ourselves to a single response or strategy, since each specific context involves different expectations and consequences (work, relationships, friendships, etc.), and we won't always find ourselves in the same personal situation. Between the option of not explaining and always explaining, there is a spectrum ranging from complete concealment to selective disclosure, indiscriminate disclosure, and social activism.

That said, one option is to explain it once people already know you, so that prejudices don't hinder the start of a relationship or prevent them from treating you differently (for example, with overprotectiveness, infantilization, belittling, controlling behavior, etc.). I find this option very interesting in most social situations. Another option is to explain it at the beginning of a relationship so that "natural filtering" takes place, removing from your life those people who discriminate against you for this reason.

By setting small and medium-sized goals that you can achieve, valuing the achievement of these goals, and surrounding yourself with people who value you.

Taking back control of your life project increases self-esteem and generates well-being.

It's important to feel you have trustworthy people you can lean on and talk to about your worries. Furthermore, identity is built in relation to others, so it's crucial that our close circle reflects a positive image of ourselves back to us. This can help boost self-esteem, if positive, or lower it, if negative.

Relapses depend on multiple factors; life is full of difficult or stressful moments. From our perspective, the person best prepared to avoid or minimize relapses is the one with the disorder who is aware of their situation and manages it to live with it as best as possible. Overprotection or external control does not help people with mental health problems take responsibility for their own lives.

Relapses in psychotic disorders

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Regarding how to know if a person is in crisis, there are several warning signs:

• Difficulty concentrating.
• Decreased academic performance.
• Impulsiveness.
• Alterations in thought and perception.
• Confused thoughts.
• Distrust towards people in the environment.
• Sudden mood swings.
• Social isolation.
• Drowsiness in class due to sleep problems.
• Lack of personal care or hygiene.
• Unusual and excessively intense ideas.
• Strange feelings or absence of feelings.
• Problems expressing oneself verbally.
• Difficulty distinguishing reality from fantasy.
• Disorganization of behavior.
• Lack of energy, motivation, interest, etc., in an extreme and involuntary manner.

Most people with psychotic disorders are stable for most of their lifespan, meaning that their personal and work performance does not necessarily have to be affected in any way.

Just like any other employee returning from sick leave, people with a psychosis diagnosis can perform their job like anyone else.

There are different options that can help you gradually get back into your routines:

• Contact mental health support groups, also known as first-person mental health organizations . These organizations, which you can join, offer leisure, cultural, and awareness-raising activities, Mutual Support Groups (MSGs), advocacy for the rights of this community, and more. It's a space where you can regain your daily routine without feeling judged.
• Contact or join a Social Club . You can apply directly or ask your designated professional to submit an application to the social club.

Both associations and social clubs can offer you support to carry out activities of interest to you and gradually recover your previous activity.

The important thing is to identify which activities motivate you most. There are many options, for example:

• Nurture social relationships by meeting up with friends or family.
• Practice hobbies
• Engage in physical activity or sports
• Volunteering
• Take courses