Assistance for everyday life
Plan and structure your day
"As compared with the capability of organising the work of a single day meaningfully, all else can be considered as mere child's play" ("Gegenüber der Fähigkeit, die Arbeit eines einzigen Tages sinnvoll zu ordnen, ist alles andere ein Kinderspiel” - Goethe)
Many persons with a psychosis or bipolar disorder have problems in structuring their daily life. They only get up at noon, spend a lot of time in front of the television or on the computer, and meet friends or family members less frequently than in the past. In this manner, one easily allows the entire day to pass by without accomplishing or achieving anything. For some who are affected, this leads them long-term to hardly leaving the house at all, and to having fewer and fewer social relationships.
Such conduct can have a number of causes:
- In the course of a psychosis, persons who are affected can suffer from different symptoms. One knows this symptom complex under the term negative symptoms. Symptoms included here include affective flattening (depression of emotional life), alogia (inability to speak), apathy/aboulia (inability to make decisions), anhedonia (loss in feelings of pleasure), attention disorders or asociality (indifference to social interaction). These symptoms can distinctively vary between different individuals who are affected and generally appear during the long-term course of the illness. Indeed, there are also individuals who are affected and who, in the course of their psychosis, only suffer from such symptoms and only rarely or not at all demonstrate typical symptoms of a psychosis (=positive symptoms), like hallucinations or delusion.
- For persons with psychoses and bipolar disorders, depressive phases with hopelessness, sadness, lack of drive and social regression can occur during the course of the illness. While depression is a part of the illness associated with bipolar disorders, it is less well known for psychoses that many persons affected suffer repeatedly from depressions during the course of the psychotic illness.
- A further cause can be that the persons affected suffer from active psychotic symptoms, i.e. that every contact to the outside world is associated with an increase in stress and consequently progresses to a deterioration or a confrontation with the psychosis.
- Also drugs or alcohol can play a role. Especially young persons afflicted with psychoses or bipolar disorders may have an additional dependence on cannabis which, even without a psychosis, may lead to a so-called amotivational syndrome, whereby those who are affected tend to withdraw, to lose their motivation and their incentive to undertake activities.
- In a positive sense, however, such behaviour can also represent self-protection, the need to rest and to regenerate. Here, the temporal duration is an essential point.
What can one do in such a situation? The kind of intervention and/or treatment depends on the cause. The cause can be discovered best through a conversation; consequently, the first step is to arrange to have such a conversation with a doctor or therapist.
- If the condition involves negative symptoms, a so-called atypical antipsychotic drug should be prescribed, to be attempted, if necessary, together with an antidepressant. Additionally, and especially if the behaviour is already quite extensive, it is recommended that a stationary therapy be carried out, followed by treatment in a day-care clinic in order to once again obtain a structured daily life.
- If a current depression is the cause, an antidepressant should be employed. Additionally, it must be clarified whether or not the antipsychotic therapy has brought about this condition, e.g. as a part of the so-called EPS. If the depression is seen to occur in persons who are affected with a bipolar disorder, the condition of the person affected must be regulated using a so-called phase-prophylactic before beginning the antidepressant therapy. Psychotherapeutically, in both cases, a behavioural therapy ought to be taken into consideration.
- If active psychotic symptoms are the cause, the antipsychotic treatment must first be improved. If these symptoms have already existed for a longer period of time and do not disappear once again without any problem, a special psychotherapy can also be employed in order to attain a better relationship with the delusions and hallucinations.
- If drugs or alcohol are the cause, the person affected should be motivated to undergo an appropriate drug therapy. If the addiction is very extensive, one can first of all undergo a stationary withdrawal therapy and, as a part of this, begin with a so-called motivational enhancement therapy.
- If the behaviour involves a healthy retreat and self-protection in order to reduce stress, the person affected should be supported and continue to receive further therapies routinely.
Generally, it can be very helpful to plan and structure every day. Hereby, the following should be taken into consideration:
- As soon as you are feeling better once again and you continue to improve further, you will want to continue with your previous lifestyle again as quickly as possible. That is understandable! However, you must realise that recovery takes a longer time and that it happens in small steps and not in giant leaps. You will have to learn to accept this. Therefore, be sure to see to it that all steps occur at your speed and that you do not overstrain yourself.
- If possible, plan your day in writing - write the "script" for the following day!
- Be sure to see that you do not plan to undertake too much - plan your day realistically!
- you must decide on which tasks are primary and which are secondary – set yourself clear priorities!
- Confront yourself already today with the tasks of the following day - prepare yourself mentally for the coming day!
- Do not only fill your day with duties, but also plan some free time and some time for pleasure - give your day a peak! (either privately or professionally)!
- People are "creatures of habit" – try to begin your day, as much as possible, at the same point in time!
- Do not forget to include your medications and psychosocial treatments firmly in the plan of the day - the therapy plan is a part of the daily plan!
- Be happy about the day that is to begin - begin your day in a good mood!
- Use the following plan, to plan all of your important deadlines and to thereby structure your day and your week.
My weekly plan
Please note in the plan, which, when and where you are to take part in the ambulatory therapies! You can also print out more copies of the weekly plan and update it again and again.