const pptxgen = require("pptxgenjs"); const { execSync } = require("child_process"); // ── Download images ────────────────────────────────────────────────────────── const imageUrls = [ "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_c15d08e0dd752872fa031aa7a5deede911b2adc14d3b85f690cede444da2d393.jpg", "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_e6dc38038b4066d8e1650ce1e862ba4e5962ed6a568bf9decd7152d735822831.jpg", ]; const imgs = JSON.parse( execSync( `node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}` ).toString() ); const dopaminePathwayImg = imgs[0].error ? null : imgs[0].base64; const brainCompareImg = imgs[1].error ? null : imgs[1].base64; // ── Color Palette ───────────────────────────────────────────────────────────── const C = { navy: "0D1B2A", // dominant dark background midnight: "1A2744", // secondary dark teal: "1DB8A4", // accent — vibrant teal tealLight: "2ED8C0", // lighter teal for highlights white: "FFFFFF", offWhite: "E8F0EE", lightGray: "B0C4C1", amber: "F0A500", // warm accent for warnings/key points red: "E05050", // danger/important slate: "4A6070", // muted body text on light bg }; const pres = new pptxgen(); pres.layout = "LAYOUT_16x9"; pres.author = "Case Presentation"; pres.title = "Schizophrenia – Case Presentation"; // ── Helpers ─────────────────────────────────────────────────────────────────── function addSlide() { return pres.addSlide(); } function sectionBg(slide) { slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy } }); } function topBar(slide, color = C.teal) { slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.07, fill: { color: color } }); } function accentLine(slide, y = 0.95, w = 1.2, color = C.teal) { slide.addShape(pres.ShapeType.rect, { x: 0.5, y, w, h: 0.04, fill: { color } }); } function slideTitle(slide, text, y = 0.18) { slide.addText(text, { x: 0.5, y, w: 9, h: 0.55, fontSize: 26, bold: true, color: C.white, fontFace: "Calibri", margin: 0 }); } function subTitle(slide, text, y = 0.78) { slide.addText(text, { x: 0.5, y, w: 9, h: 0.3, fontSize: 11, color: C.teal, fontFace: "Calibri", bold: true, charSpacing: 2, margin: 0 }); } function bodyBullets(slide, items, x, y, w, h, opts = {}) { const textArr = items.map((it, i) => { if (typeof it === "string") { return { text: it, options: { bullet: true, breakLine: i < items.length - 1, fontSize: opts.fontSize || 14, color: opts.color || C.white, fontFace: "Calibri" } }; } // { text, sub } → bold header + sub-bullets const rows = []; rows.push({ text: it.text, options: { bullet: true, breakLine: true, bold: true, fontSize: opts.fontSize || 14, color: opts.color || C.tealLight, fontFace: "Calibri" } }); (it.subs || []).forEach((s, si) => { rows.push({ text: " " + s, options: { bullet: false, breakLine: si < it.subs.length - 1 || i < items.length - 1, fontSize: (opts.fontSize || 14) - 1.5, color: opts.color || C.offWhite, fontFace: "Calibri" } }); }); return rows; }).flat(); slide.addText(textArr, { x, y, w, h }); } function card(slide, x, y, w, h, fillColor = C.midnight) { slide.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: fillColor }, line: { color: C.teal, width: 0.5 }, shadow: { type: "outer", blur: 6, offset: 3, angle: 45, color: "000000", opacity: 0.35 } }); } function labelBox(slide, text, x, y, w, h, fillColor = C.teal, textColor = C.navy) { slide.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: fillColor } }); slide.addText(text, { x, y, w, h, fontSize: 11, bold: true, color: textColor, align: "center", valign: "middle", fontFace: "Calibri", margin: 0 }); } // ───────────────────────────────────────────────────────────────────────────── // SLIDE 1 — TITLE // ───────────────────────────────────────────────────────────────────────────── { const s = addSlide(); sectionBg(s); // Decorative circles s.addShape(pres.ShapeType.ellipse, { x: 7.5, y: -0.8, w: 4.5, h: 4.5, fill: { color: C.midnight }, line: { color: C.midnight } }); s.addShape(pres.ShapeType.ellipse, { x: 8.2, y: 0.5, w: 2.8, h: 2.8, fill: { color: C.teal }, line: { color: C.teal } }); s.addShape(pres.ShapeType.rect, { x: 0, y: 5.1, w: 10, h: 0.525, fill: { color: C.midnight } }); s.addShape(pres.ShapeType.rect, { x: 0, y: 5.05, w: 10, h: 0.07, fill: { color: C.teal } }); s.addText("SCHIZOPHRENIA", { x: 0.5, y: 1.0, w: 7.5, h: 1.0, fontSize: 48, bold: true, color: C.white, fontFace: "Calibri", charSpacing: 4, margin: 0 }); s.addShape(pres.ShapeType.rect, { x: 0.5, y: 2.1, w: 3.5, h: 0.06, fill: { color: C.teal } }); s.addText("Case Presentation", { x: 0.5, y: 2.25, w: 7, h: 0.55, fontSize: 22, color: C.tealLight, fontFace: "Calibri", italic: true, margin: 0 }); s.addText("Psychiatry | DSM-5-TR Criteria | Evidence-Based Management", { x: 0.5, y: 2.95, w: 7.5, h: 0.35, fontSize: 12, color: C.lightGray, fontFace: "Calibri", charSpacing: 1, margin: 0 }); s.addText("Sources: Harrison's 22e · Goldman-Cecil Medicine · Adams & Victor · Goodman & Gilman", { x: 0.3, y: 5.12, w: 9.4, h: 0.35, fontSize: 9, color: C.lightGray, fontFace: "Calibri", align: "center", margin: 0 }); } // ───────────────────────────────────────────────────────────────────────────── // SLIDE 2 — OVERVIEW / AGENDA // ───────────────────────────────────────────────────────────────────────────── { const s = addSlide(); sectionBg(s); topBar(s); slideTitle(s, "Presentation Outline"); accentLine(s); const sections = [ ["01", "Definition & Epidemiology"], ["02", "Historical Background"], ["03", "Etiology & Pathophysiology"], ["04", "Clinical Features"], ["05", "DSM-5-TR Diagnostic Criteria"], ["06", "Differential Diagnosis"], ["07", "Investigations"], ["08", "Treatment — Pharmacological"], ["09", "Treatment — Psychosocial"], ["10", "Prognosis & Complications"], ]; sections.forEach(([num, label], i) => { const col = i < 5 ? 0 : 1; const row = i % 5; const x = 0.5 + col * 4.8; const y = 1.1 + row * 0.88; card(s, x, y, 4.5, 0.72, C.midnight); s.addShape(pres.ShapeType.rect, { x, y, w: 0.55, h: 0.72, fill: { color: C.teal } }); s.addText(num, { x, y, w: 0.55, h: 0.72, fontSize: 13, bold: true, color: C.navy, align: "center", valign: "middle", fontFace: "Calibri", margin: 0 }); s.addText(label, { x: x + 0.65, y, w: 3.8, h: 0.72, fontSize: 13, color: C.white, valign: "middle", fontFace: "Calibri", margin: 0 }); }); } // ───────────────────────────────────────────────────────────────────────────── // SLIDE 3 — DEFINITION & EPIDEMIOLOGY // ───────────────────────────────────────────────────────────────────────────── { const s = addSlide(); sectionBg(s); topBar(s); slideTitle(s, "Definition & Epidemiology"); accentLine(s); subTitle(s, "WHAT IS SCHIZOPHRENIA?", 0.95); s.addText( "A heterogeneous psychotic syndrome characterized by perturbations of language, perception, thinking, social activity, affect, and volition — with no pathognomonic features.", { x: 0.5, y: 1.32, w: 9, h: 0.65, fontSize: 13, color: C.offWhite, fontFace: "Calibri", italic: true } ); // Stats cards const stats = [ ["~1%", "Lifetime prevalence worldwide"], ["50%", "Concordance in MZ twins"], ["40%", "Risk if both parents affected"], ["~15", "New cases per 100,000/year"], ["10%", "Lifetime suicide risk"], ["½", "Of all psych hospital beds"], ]; stats.forEach(([val, label], i) => { const col = i % 3; const row = Math.floor(i / 3); const x = 0.5 + col * 3.1; const y = 2.05 + row * 1.55; card(s, x, y, 2.85, 1.35, C.midnight); s.addText(val, { x, y: y + 0.1, w: 2.85, h: 0.65, fontSize: 28, bold: true, color: C.teal, align: "center", fontFace: "Calibri", margin: 0 }); s.addText(label, { x, y: y + 0.75, w: 2.85, h: 0.5, fontSize: 11, color: C.lightGray, align: "center", fontFace: "Calibri", margin: 4 }); }); s.addText("Peak onset: late adolescence to young adulthood · Slightly more common in males · Earlier onset in males", { x: 0.5, y: 5.22, w: 9, h: 0.28, fontSize: 9.5, color: C.lightGray, fontFace: "Calibri", align: "center", italic: true, margin: 0 }); } // ───────────────────────────────────────────────────────────────────────────── // SLIDE 4 — HISTORICAL BACKGROUND // ───────────────────────────────────────────────────────────────────────────── { const s = addSlide(); sectionBg(s); topBar(s); slideTitle(s, "Historical Background"); accentLine(s); const timeline = [ { year: "1890s", person: "Emil Kraepelin", text: 'Separated "dementia praecox" from bipolar psychosis. Emphasized onset in adolescence, chronic deteriorating course.' }, { year: "1911", person: "Eugen Bleuler", text: 'Coined "Schizophrenia." Described the four A\'s: loose Associations, flat Affect, Ambivalence, Autism.' }, { year: "1952", person: "Henri Laborit", text: "Chlorpromazine discovered. Revolutionized treatment — first effective pharmacotherapy." }, { year: "1980+", person: "DSM Era", text: "Operational criteria introduced. Dopamine hypothesis formalized. Atypical antipsychotics developed (clozapine 1989)." }, ]; timeline.forEach(({ year, person, text }, i) => { const y = 1.05 + i * 1.1; s.addShape(pres.ShapeType.ellipse, { x: 0.3, y: y + 0.15, w: 0.6, h: 0.6, fill: { color: C.teal } }); s.addText(year.slice(0, 4), { x: 0.3, y: y + 0.15, w: 0.6, h: 0.6, fontSize: 9, bold: true, color: C.navy, align: "center", valign: "middle", fontFace: "Calibri", margin: 0 }); s.addShape(pres.ShapeType.rect, { x: 0.6, y: y + 0.43, w: 0.5, h: 0.03, fill: { color: C.teal } }); s.addText(person, { x: 1.2, y, w: 2.2, h: 0.38, fontSize: 12, bold: true, color: C.tealLight, fontFace: "Calibri", margin: 0 }); s.addText(text, { x: 1.2, y: y + 0.38, w: 8.3, h: 0.58, fontSize: 12, color: C.offWhite, fontFace: "Calibri", margin: 0 }); }); } // ───────────────────────────────────────────────────────────────────────────── // SLIDE 5 — ETIOLOGY // ───────────────────────────────────────────────────────────────────────────── { const s = addSlide(); sectionBg(s); topBar(s); slideTitle(s, "Etiology & Risk Factors"); accentLine(s); // Left column — Genetic card(s, 0.4, 1.05, 4.4, 4.3, C.midnight); labelBox(s, "GENETIC FACTORS", 0.4, 1.05, 4.4, 0.38); s.addText([ { text: "Genetic heritability ~50%", options: { bullet: true, breakLine: true, bold: true, color: C.tealLight, fontSize: 12.5, fontFace: "Calibri" } }, { text: "~6.6% risk in first-degree relatives", options: { bullet: true, breakLine: true, color: C.offWhite, fontSize: 12, fontFace: "Calibri" } }, { text: "40% risk if both parents affected", options: { bullet: true, breakLine: true, color: C.offWhite, fontSize: 12, fontFace: "Calibri" } }, { text: "MZ twin concordance: 50% vs DZ: 10%", options: { bullet: true, breakLine: true, color: C.offWhite, fontSize: 12, fontFace: "Calibri" } }, { text: "GWAS: hundreds of small-effect risk loci + CNVs", options: { bullet: true, breakLine: true, color: C.offWhite, fontSize: 12, fontFace: "Calibri" } }, { text: "Pathways: immunity, inflammation, cell signaling, synaptic plasticity", options: { bullet: true, breakLine: false, color: C.offWhite, fontSize: 12, fontFace: "Calibri" } }, ], { x: 0.55, y: 1.5, w: 4.1, h: 3.7 }); // Right column — Environmental card(s, 5.2, 1.05, 4.4, 4.3, C.midnight); labelBox(s, "ENVIRONMENTAL & DEVELOPMENTAL", 5.2, 1.05, 4.4, 0.38, C.amber, C.navy); s.addText([ { text: "Neurodevelopmental", options: { bullet: true, breakLine: true, bold: true, color: C.amber, fontSize: 12.5, fontFace: "Calibri" } }, { text: "Prenatal infection / maternal malnutrition", options: { bullet: true, breakLine: true, color: C.offWhite, fontSize: 12, fontFace: "Calibri" } }, { text: "Obstetric complications, winter birth", options: { bullet: true, breakLine: true, color: C.offWhite, fontSize: 12, fontFace: "Calibri" } }, { text: "Increasing paternal age", options: { bullet: true, breakLine: true, color: C.offWhite, fontSize: 12, fontFace: "Calibri" } }, { text: "Psychosocial", options: { bullet: true, breakLine: true, bold: true, color: C.amber, fontSize: 12.5, fontFace: "Calibri" } }, { text: "Urban upbringing, social isolation", options: { bullet: true, breakLine: true, color: C.offWhite, fontSize: 12, fontFace: "Calibri" } }, { text: "Substance use (especially cannabis)", options: { bullet: true, breakLine: true, color: C.offWhite, fontSize: 12, fontFace: "Calibri" } }, { text: "Psychosocial stressors precipitate relapses", options: { bullet: true, breakLine: false, color: C.offWhite, fontSize: 12, fontFace: "Calibri" } }, ], { x: 5.35, y: 1.5, w: 4.1, h: 3.7 }); } // ───────────────────────────────────────────────────────────────────────────── // SLIDE 6 — PATHOPHYSIOLOGY (with dopamine pathway image) // ───────────────────────────────────────────────────────────────────────────── { const s = addSlide(); sectionBg(s); topBar(s); slideTitle(s, "Pathophysiology"); accentLine(s); // Left: text card(s, 0.4, 1.05, 5.0, 4.35, C.midnight); s.addText([ { text: "Dopamine Hypothesis", options: { bullet: false, breakLine: true, bold: true, fontSize: 14, color: C.tealLight, fontFace: "Calibri" } }, { text: "Mesolimbic pathway HYPERACTIVITY → Positive symptoms (hallucinations, delusions)", options: { bullet: true, breakLine: true, fontSize: 12, color: C.offWhite, fontFace: "Calibri" } }, { text: "Mesocortical pathway HYPOACTIVITY → Negative & cognitive symptoms", options: { bullet: true, breakLine: true, fontSize: 12, color: C.offWhite, fontFace: "Calibri" } }, { text: "All antipsychotics act on D2 receptors in ventral striatum", options: { bullet: true, breakLine: true, fontSize: 12, color: C.offWhite, fontFace: "Calibri" } }, { text: "Glutamate Hypothesis", options: { bullet: false, breakLine: true, bold: true, fontSize: 14, color: C.amber, fontFace: "Calibri" } }, { text: "NMDA receptor hypofunction on GABAergic interneurons → cortical disinhibition", options: { bullet: true, breakLine: true, fontSize: 12, color: C.offWhite, fontFace: "Calibri" } }, { text: "Explains negative & cognitive symptoms unresponsive to typical APDs", options: { bullet: true, breakLine: true, fontSize: 12, color: C.offWhite, fontFace: "Calibri" } }, { text: "Neurodevelopmental Model", options: { bullet: false, breakLine: true, bold: true, fontSize: 14, color: C.tealLight, fontFace: "Calibri" } }, { text: "Subtle cortical cytoarchitectural disruption (non-gliotic) — lesion present at birth or acquired early in life", options: { bullet: true, breakLine: false, fontSize: 12, color: C.offWhite, fontFace: "Calibri" } }, ], { x: 0.55, y: 1.12, w: 4.65, h: 4.22 }); // Right: image if (dopaminePathwayImg) { s.addImage({ data: dopaminePathwayImg, x: 5.6, y: 1.05, w: 4.05, h: 4.35 }); s.addText("Dopaminergic pathways — mesocortical & mesolimbic", { x: 5.6, y: 5.42, w: 4.05, h: 0.2, fontSize: 8, color: C.lightGray, align: "center", fontFace: "Calibri", italic: true, margin: 0 }); } else { card(s, 5.6, 1.05, 4.05, 4.35, C.midnight); s.addText("Dopamine Pathway Diagram\n(Mesocortical / Mesolimbic)", { x: 5.6, y: 2.5, w: 4.05, h: 1.5, fontSize: 13, color: C.lightGray, align: "center", fontFace: "Calibri" }); } } // ───────────────────────────────────────────────────────────────────────────── // SLIDE 7 — CLINICAL FEATURES // ───────────────────────────────────────────────────────────────────────────── { const s = addSlide(); sectionBg(s); topBar(s); slideTitle(s, "Clinical Features"); accentLine(s); subTitle(s, "POSITIVE · NEGATIVE · DISORGANIZED · COGNITIVE", 0.95); // Positive symptoms card(s, 0.35, 1.12, 4.55, 2.15, C.midnight); labelBox(s, "POSITIVE SYMPTOMS", 0.35, 1.12, 4.55, 0.36, C.teal, C.navy); s.addText([ { text: "Hallucinations (typically auditory — voices commenting, commanding)", options: { bullet: true, breakLine: true, fontSize: 11.5, color: C.offWhite, fontFace: "Calibri" } }, { text: "Delusions (persecutory, grandiose, referential, thought insertion/withdrawal)", options: { bullet: true, breakLine: true, fontSize: 11.5, color: C.offWhite, fontFace: "Calibri" } }, { text: "Disorganized thinking / speech (loosening of associations, tangentiality, word salad)", options: { bullet: true, breakLine: false, fontSize: 11.5, color: C.offWhite, fontFace: "Calibri" } }, ], { x: 0.5, y: 1.52, w: 4.2, h: 1.65 }); // Negative symptoms card(s, 5.1, 1.12, 4.55, 2.15, C.midnight); labelBox(s, "NEGATIVE SYMPTOMS", 5.1, 1.12, 4.55, 0.36, C.amber, C.navy); s.addText([ { text: "Flat affect / blunted emotional expression", options: { bullet: true, breakLine: true, fontSize: 11.5, color: C.offWhite, fontFace: "Calibri" } }, { text: "Avolition (lack of motivation), Abulia, Anhedonia", options: { bullet: true, breakLine: true, fontSize: 11.5, color: C.offWhite, fontFace: "Calibri" } }, { text: "Alogia (poverty of speech)", options: { bullet: true, breakLine: true, fontSize: 11.5, color: C.offWhite, fontFace: "Calibri" } }, { text: "Social withdrawal, diminished social engagement", options: { bullet: true, breakLine: false, fontSize: 11.5, color: C.offWhite, fontFace: "Calibri" } }, ], { x: 5.25, y: 1.52, w: 4.2, h: 1.65 }); // Disorganized / Motor card(s, 0.35, 3.38, 4.55, 1.95, C.midnight); labelBox(s, "DISORGANIZED / MOTOR", 0.35, 3.38, 4.55, 0.36, C.tealLight, C.navy); s.addText([ { text: "Grossly disorganized behavior / catatonia", options: { bullet: true, breakLine: true, fontSize: 11.5, color: C.offWhite, fontFace: "Calibri" } }, { text: "Inappropriate affect (giggling, incongruent responses)", options: { bullet: true, breakLine: true, fontSize: 11.5, color: C.offWhite, fontFace: "Calibri" } }, { text: "Motor rigidity, tremor, dyskinesias (~25% untreated)", options: { bullet: true, breakLine: false, fontSize: 11.5, color: C.offWhite, fontFace: "Calibri" } }, ], { x: 0.5, y: 3.78, w: 4.2, h: 1.45 }); // Cognitive card(s, 5.1, 3.38, 4.55, 1.95, C.midnight); labelBox(s, "COGNITIVE SYMPTOMS", 5.1, 3.38, 4.55, 0.36, "9B59B6", C.white); s.addText([ { text: "Impaired working memory & executive function", options: { bullet: true, breakLine: true, fontSize: 11.5, color: C.offWhite, fontFace: "Calibri" } }, { text: "Inability to abstract / separate relevant from irrelevant", options: { bullet: true, breakLine: true, fontSize: 11.5, color: C.offWhite, fontFace: "Calibri" } }, { text: "Poor sustained attention and verbal fluency", options: { bullet: true, breakLine: false, fontSize: 11.5, color: C.offWhite, fontFace: "Calibri" } }, ], { x: 5.25, y: 3.78, w: 4.2, h: 1.45 }); } // ───────────────────────────────────────────────────────────────────────────── // SLIDE 8 — DSM-5-TR DIAGNOSTIC CRITERIA // ───────────────────────────────────────────────────────────────────────────── { const s = addSlide(); sectionBg(s); topBar(s); slideTitle(s, "DSM-5-TR Diagnostic Criteria"); accentLine(s); subTitle(s, "ALL CRITERIA MUST BE MET", 0.95); // Criterion A card(s, 0.4, 1.1, 5.8, 2.55, C.midnight); labelBox(s, "CRITERION A — ≥2 of the following for ≥1 month", 0.4, 1.1, 5.8, 0.38, C.teal, C.navy); const critA = [ ["1. Delusions", "(at least one of items 1–3 required)"], ["2. Hallucinations", ""], ["3. Disorganized speech", ""], ["4. Grossly disorganized or catatonic behavior", ""], ["5. Negative symptoms", "(diminished emotion, avolition)"], ]; critA.forEach(([main, note], i) => { const y = 1.54 + i * 0.42; s.addShape(pres.ShapeType.ellipse, { x: 0.5, y: y + 0.08, w: 0.22, h: 0.22, fill: { color: C.teal } }); s.addText(main, { x: 0.8, y, w: 3.6, h: 0.38, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 }); if (note) s.addText(note, { x: 4.42, y, w: 1.65, h: 0.38, fontSize: 10, color: C.lightGray, fontFace: "Calibri", italic: true, valign: "middle", margin: 0 }); }); // Criteria B/C/D/E const otherCriteria = [ ["B", "Social/Occupational Dysfunction", "Marked decline in work, interpersonal relations, or self-care since onset"], ["C", "Duration", "Continuous signs ≥6 months (including ≥1 month of Criterion A symptoms; may include prodromal/residual periods)"], ["D", "Rule out Schizoaffective / Mood disorder", "No major mood episodes concurrently, or mood episodes brief relative to active/residual phases"], ["E", "Rule out substance/medical condition", "Not attributable to physiological effects of substance or another medical condition"], ]; otherCriteria.forEach(([letter, title, desc], i) => { const y = 1.1 + i * 1.12; card(s, 6.4, y, 3.25, 1.0, C.midnight); s.addShape(pres.ShapeType.rect, { x: 6.4, y, w: 0.38, h: 1.0, fill: { color: C.amber } }); s.addText(letter, { x: 6.4, y, w: 0.38, h: 1.0, fontSize: 16, bold: true, color: C.navy, align: "center", valign: "middle", fontFace: "Calibri", margin: 0 }); s.addText(title, { x: 6.85, y: y + 0.04, w: 2.7, h: 0.36, fontSize: 11, bold: true, color: C.tealLight, fontFace: "Calibri", margin: 0 }); s.addText(desc, { x: 6.85, y: y + 0.4, w: 2.7, h: 0.55, fontSize: 10, color: C.offWhite, fontFace: "Calibri", margin: 0 }); }); s.addText("Brief Psychotic Disorder: <1 mo | Schizophreniform: 1–6 mo | Schizophrenia: >6 mo", { x: 0.4, y: 5.2, w: 9.2, h: 0.28, fontSize: 9.5, color: C.amber, align: "center", fontFace: "Calibri", bold: true, margin: 0 }); } // ───────────────────────────────────────────────────────────────────────────── // SLIDE 9 — DIFFERENTIAL DIAGNOSIS // ───────────────────────────────────────────────────────────────────────────── { const s = addSlide(); sectionBg(s); topBar(s); slideTitle(s, "Differential Diagnosis"); accentLine(s); subTitle(s, "EXCLUSION IS ESSENTIAL — DIAGNOSIS OF EXCLUSION", 0.95); const ddx = [ { cat: "Psychiatric", color: C.teal, items: ["Schizoaffective disorder (schizophrenia + independent mood episodes)", "Brief psychotic disorder (<1 month)", "Schizophreniform disorder (1–6 months)", "Bipolar disorder with psychotic features", "Major depressive disorder with psychosis", "Delusional disorder (delusions only, no other symptoms)"] }, { cat: "Medical & Neurological", color: C.amber, items: ["Autoimmune encephalitis (anti-NMDA receptor) — must rule out in first episode", "CNS tumors, epilepsy (temporal lobe)", "Delirium, dementia (Wilson's, Huntington's)", "Endocrine: thyroid, Cushing's, SLE cerebritis", "Vitamin B12 / folate deficiency"] }, { cat: "Substance-Induced", color: C.red, items: ["Stimulants (amphetamines, cocaine) — mimic positive symptoms", "Cannabis (especially high-THC) — precipitates/worsens psychosis", "Phencyclidine (PCP) — mimics both positive and negative symptoms", "Prescription drugs: dopaminergics, steroids, anticholinergics"] }, ]; ddx.forEach(({ cat, color, items }, ci) => { const x = 0.35 + ci * 3.22; card(s, x, 1.1, 3.0, 4.25, C.midnight); labelBox(s, cat.toUpperCase(), x, 1.1, 3.0, 0.36, color, ci === 0 ? C.navy : C.white); const textArr = items.map((it, ii) => ({ text: it, options: { bullet: true, breakLine: ii < items.length - 1, fontSize: 11, color: C.offWhite, fontFace: "Calibri" } })); s.addText(textArr, { x: x + 0.15, y: 1.5, w: 2.7, h: 3.75 }); }); s.addText("Key: Rule out organic / substance cause before labeling schizophrenia — especially in FIRST episode psychosis!", { x: 0.4, y: 5.27, w: 9.2, h: 0.25, fontSize: 9.5, color: C.amber, bold: true, align: "center", fontFace: "Calibri", margin: 0 }); } // ───────────────────────────────────────────────────────────────────────────── // SLIDE 10 — INVESTIGATIONS // ───────────────────────────────────────────────────────────────────────────── { const s = addSlide(); sectionBg(s); topBar(s); slideTitle(s, "Investigations"); accentLine(s); subTitle(s, "TO EXCLUDE ORGANIC CAUSES — NO DIAGNOSTIC TEST FOR SCHIZOPHRENIA", 0.95); const invx = [ { title: "Blood Tests", color: C.teal, items: ["CBC, metabolic panel (CMP)", "TFTs (thyroid function)", "B12, folate, serum copper", "Serum ceruloplasmin (Wilson's)", "HIV, VDRL/RPR (syphilis)", "ANA, anti-dsDNA (SLE)", "Drug screen (toxicology)"] }, { title: "CSF & Serology", color: C.amber, items: ["LP if encephalitis suspected", "Anti-NMDAR antibodies", "Anti-VGKC, anti-AMPA (autoimmune)", "CSF cell count, glucose, protein"] }, { title: "Neuroimaging", color: "9B59B6", items: ["MRI brain (preferred over CT)", "Rule out structural lesions, tumors", "Findings in schizophrenia:", " • Ventricular enlargement", " • Reduced cortical gray matter (esp. prefrontal)", " • No pathognomonic MRI finding"] }, { title: "EEG", color: C.tealLight, items: ["Rule out temporal lobe epilepsy", "Non-specific abnormalities in ~20% of schizophrenia patients"] }, ]; invx.forEach(({ title, color, items }, i) => { const col = i % 2; const row = Math.floor(i / 2); const x = 0.35 + col * 4.85; const y = 1.1 + row * 2.2; card(s, x, y, 4.6, 2.05, C.midnight); labelBox(s, title.toUpperCase(), x, y, 4.6, 0.34, color, i === 0 || i === 2 ? C.navy : C.white); const textArr = items.map((it, ii) => ({ text: it, options: { bullet: !it.startsWith(" "), breakLine: ii < items.length - 1, fontSize: 11.5, color: it.startsWith(" ") ? C.lightGray : C.offWhite, fontFace: "Calibri" } })); s.addText(textArr, { x: x + 0.15, y: y + 0.4, w: 4.3, h: 1.6 }); }); s.addText("Schizophrenia is a clinical diagnosis — investigations serve to EXCLUDE organic causes.", { x: 0.4, y: 5.27, w: 9.2, h: 0.25, fontSize: 9.5, color: C.amber, bold: true, align: "center", fontFace: "Calibri", margin: 0 }); } // ───────────────────────────────────────────────────────────────────────────── // SLIDE 11 — PHARMACOLOGICAL TREATMENT // ───────────────────────────────────────────────────────────────────────────── { const s = addSlide(); sectionBg(s); topBar(s); slideTitle(s, "Pharmacological Treatment"); accentLine(s); subTitle(s, "ANTIPSYCHOTICS — CORNERSTONE OF ACUTE & MAINTENANCE THERAPY", 0.95); // First-gen table card(s, 0.35, 1.08, 9.3, 1.85, C.midnight); labelBox(s, "FIRST-GENERATION (TYPICAL) ANTIPSYCHOTICS — D2 Antagonists", 0.35, 1.08, 9.3, 0.34, C.slate, C.white); const fgaHeaders = ["Drug", "Dose (mg/day)", "Potency", "Key Side Effects"]; const fgaData = [ ["Chlorpromazine", "100–1000", "Low", "Anticholinergic, sedation, orthostasis, photosensitivity"], ["Haloperidol", "1–40", "High", "High EPS, tardive dyskinesia, little sedation"], ["Trifluoperazine", "2–50", "High", "EPS common, less anticholinergic"], ["Perphenazine", "4–64", "Mid", "Less EPS than high-potency; comparable to SGAs (CATIE)"], ]; const colWidths = [1.8, 1.6, 1.2, 4.5]; fgaHeaders.forEach((h, ci) => { const x = 0.4 + colWidths.slice(0, ci).reduce((a,b) => a+b, 0); s.addText(h, { x, y: 1.44, w: colWidths[ci], h: 0.28, fontSize: 10, bold: true, color: C.teal, fontFace: "Calibri", margin: 2 }); }); fgaData.forEach((row, ri) => { const y = 1.74 + ri * 0.3; const bg = ri % 2 === 0 ? "1F2F3F" : C.midnight; s.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 9.3, h: 0.3, fill: { color: bg } }); row.forEach((cell, ci) => { const x = 0.4 + colWidths.slice(0, ci).reduce((a,b) => a+b, 0); s.addText(cell, { x, y, w: colWidths[ci], h: 0.3, fontSize: 10, color: C.offWhite, fontFace: "Calibri", valign: "middle", margin: 2 }); }); }); // Second-gen table card(s, 0.35, 3.05, 9.3, 2.35, C.midnight); labelBox(s, "SECOND-GENERATION (ATYPICAL) ANTIPSYCHOTICS — Lower EPS, Metabolic Risk", 0.35, 3.05, 9.3, 0.34, C.teal, C.navy); const sgaHeaders = ["Drug", "Dose (mg/day)", "Key Features / Side Effects"]; const sgaData = [ ["Clozapine", "150–600", "Most efficacious for treatment-resistant schizophrenia; agranulocytosis risk — mandatory WBC monitoring; weight gain"], ["Olanzapine", "10–20", "Broad efficacy (+ and − symptoms); significant weight gain, metabolic syndrome, hyperglycemia"], ["Risperidone", "4–16", "D2 + 5HT2A; dose-dependent EPS; hyperprolactinemia; LAI formulation available"], ["Quetiapine", "400–800", "Less EPS; strong antihistamine sedation; metabolic effects; used for negative/cognitive symptoms"], ["Aripiprazole", "10–30", "D2 partial agonist; weight-neutral; akathisia; adjunct for depression"], ["Cariprazine", "1.5–6", "D3/D2 partial agonist; may be superior for negative symptoms over risperidone (2026 network meta-analysis)"], ]; const sgaColWidths = [1.8, 1.6, 5.7]; sgaHeaders.forEach((h, ci) => { const x = 0.4 + sgaColWidths.slice(0, ci).reduce((a,b) => a+b, 0); s.addText(h, { x, y: 3.41, w: sgaColWidths[ci], h: 0.26, fontSize: 10, bold: true, color: C.teal, fontFace: "Calibri", margin: 2 }); }); sgaData.forEach((row, ri) => { const y = 3.69 + ri * 0.33; const bg = ri % 2 === 0 ? "1F2F3F" : C.midnight; s.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 9.3, h: 0.33, fill: { color: bg } }); row.forEach((cell, ci) => { const x = 0.4 + sgaColWidths.slice(0, ci).reduce((a,b) => a+b, 0); s.addText(cell, { x, y, w: sgaColWidths[ci], h: 0.33, fontSize: 9.5, color: C.offWhite, fontFace: "Calibri", valign: "middle", margin: 2 }); }); }); } // ───────────────────────────────────────────────────────────────────────────── // SLIDE 12 — ANTIPSYCHOTIC SIDE EFFECTS // ───────────────────────────────────────────────────────────────────────────── { const s = addSlide(); sectionBg(s); topBar(s); slideTitle(s, "Antipsychotic Side Effects"); accentLine(s); const sideEffects = [ { title: "Extrapyramidal (EPS)", color: C.red, items: ["Acute dystonia (oculogyric crisis, torticollis) — treat with anticholinergics", "Parkinsonism (bradykinesia, rigidity, tremor)", "Akathisia (motor restlessness) — most distressing to patients", "Tardive dyskinesia (TD) — late-onset, potentially irreversible choreoathetoid movements"] }, { title: "Metabolic", color: C.amber, items: ["Weight gain — especially clozapine, olanzapine", "Dyslipidemia, hyperglycemia, metabolic syndrome", "Monitor: fasting glucose, lipids, BMI regularly"] }, { title: "Hormonal / Autonomic", color: "9B59B6", items: ["Hyperprolactinemia (galactorrhea, amenorrhea) — risperidone, typicals", "Orthostatic hypotension (alpha-1 blockade)", "Anticholinergic: dry mouth, urinary retention, constipation, blurred vision"] }, { title: "Serious / Rare", color: C.tealLight, items: ["Agranulocytosis — clozapine (0.5–1.6%); CBC monitoring weekly (1st 6 mo)", "Neuroleptic Malignant Syndrome (NMS): fever, rigidity, altered consciousness, autonomic instability — medical emergency", "QTc prolongation — thioridazine (withdrawn), ziprasidone, haloperidol"] }, ]; sideEffects.forEach(({ title, color, items }, i) => { const col = i % 2; const row = Math.floor(i / 2); const x = 0.35 + col * 4.85; const y = 1.05 + row * 2.25; card(s, x, y, 4.6, 2.1, C.midnight); labelBox(s, title.toUpperCase(), x, y, 4.6, 0.33, color, i === 1 || i === 2 ? C.navy : C.white); const textArr = items.map((it, ii) => ({ text: it, options: { bullet: true, breakLine: ii < items.length - 1, fontSize: 11, color: C.offWhite, fontFace: "Calibri" } })); s.addText(textArr, { x: x + 0.15, y: y + 0.38, w: 4.3, h: 1.65 }); }); } // ───────────────────────────────────────────────────────────────────────────── // SLIDE 13 — PSYCHOSOCIAL TREATMENT // ───────────────────────────────────────────────────────────────────────────── { const s = addSlide(); sectionBg(s); topBar(s); slideTitle(s, "Psychosocial Treatment"); accentLine(s); subTitle(s, "PHARMACOTHERAPY ALONE IS INSUFFICIENT", 0.95); const interventions = [ { icon: "🧠", title: "Cognitive Behavioral Therapy (CBT)", text: "Addresses dysfunctional thoughts about delusions and hallucinations. Improves insight and coping strategies." }, { icon: "👨‍👩‍👧", title: "Family Psychoeducation", text: "Educates families on illness course, reduces expressed emotion (EE). Critical for reducing relapse rates." }, { icon: "🏥", title: "Assertive Community Treatment (ACT)", text: "Multidisciplinary case-management teams. Active outreach in the community. Reduces hospitalization." }, { icon: "🎯", title: "Social Skills Training", text: "Structured behavioral techniques to improve interpersonal competence, communication, and daily living skills." }, { icon: "💼", title: "Vocational Rehabilitation", text: "Supported employment programs. Improves occupational functioning and quality of life." }, { icon: "🌱", title: "Early Intervention Programs", text: "First-episode psychosis clinics. Early identification of at-risk individuals. May alter long-term illness trajectory." }, ]; interventions.forEach(({ icon, title, text }, i) => { const col = i % 3; const row = Math.floor(i / 3); const x = 0.35 + col * 3.2; const y = 1.08 + row * 2.2; card(s, x, y, 3.0, 2.0, C.midnight); s.addText(icon, { x, y: y + 0.15, w: 3.0, h: 0.55, fontSize: 22, align: "center", fontFace: "Segoe UI Emoji", margin: 0 }); s.addText(title, { x: x + 0.1, y: y + 0.72, w: 2.8, h: 0.42, fontSize: 11.5, bold: true, color: C.teal, align: "center", fontFace: "Calibri", margin: 0 }); s.addText(text, { x: x + 0.1, y: y + 1.14, w: 2.8, h: 0.76, fontSize: 10.5, color: C.offWhite, align: "center", fontFace: "Calibri", margin: 0 }); }); } // ───────────────────────────────────────────────────────────────────────────── // SLIDE 14 — PROGNOSIS & COMPLICATIONS (with brain comparison image) // ───────────────────────────────────────────────────────────────────────────── { const s = addSlide(); sectionBg(s); topBar(s); slideTitle(s, "Prognosis & Complications"); accentLine(s); // Left: prognosis text card(s, 0.35, 1.05, 5.1, 4.35, C.midnight); s.addText([ { text: "Course of Illness", options: { bullet: false, breakLine: true, bold: true, fontSize: 14, color: C.tealLight, fontFace: "Calibri" } }, { text: "Progressive deterioration early, then partial stabilization", options: { bullet: true, breakLine: true, fontSize: 12, color: C.offWhite, fontFace: "Calibri" } }, { text: "Negative symptoms dominate in 1/3 of patients — poor prognosis", options: { bullet: true, breakLine: true, fontSize: 12, color: C.offWhite, fontFace: "Calibri" } }, { text: "As patients age, positive symptoms tend to attenuate", options: { bullet: true, breakLine: true, fontSize: 12, color: C.offWhite, fontFace: "Calibri" } }, { text: "Permanent remission: rare but occurs", options: { bullet: true, breakLine: true, fontSize: 12, color: C.offWhite, fontFace: "Calibri" } }, { text: "Poor Prognostic Factors", options: { bullet: false, breakLine: true, bold: true, fontSize: 14, color: C.amber, fontFace: "Calibri" } }, { text: "Insidious onset, prominent negative symptoms, low premorbid function, male sex, early onset, poor treatment compliance", options: { bullet: true, breakLine: true, fontSize: 12, color: C.offWhite, fontFace: "Calibri" } }, { text: "Complications", options: { bullet: false, breakLine: true, bold: true, fontSize: 14, color: C.red, fontFace: "Calibri" } }, { text: "Suicide: ~10% lifetime risk (most common cause of premature death)", options: { bullet: true, breakLine: true, fontSize: 12, color: C.offWhite, fontFace: "Calibri" } }, { text: "Substance abuse comorbidity: ~50%", options: { bullet: true, breakLine: true, fontSize: 12, color: C.offWhite, fontFace: "Calibri" } }, { text: "Metabolic syndrome from antipsychotic treatment", options: { bullet: true, breakLine: false, fontSize: 12, color: C.offWhite, fontFace: "Calibri" } }, ], { x: 0.5, y: 1.12, w: 4.7, h: 4.22 }); // Right: brain comparison image if (brainCompareImg) { s.addImage({ data: brainCompareImg, x: 5.6, y: 1.05, w: 4.05, h: 4.35 }); s.addText("Healthy vs Schizophrenia dopaminergic pathway comparison", { x: 5.6, y: 5.42, w: 4.05, h: 0.2, fontSize: 8, color: C.lightGray, align: "center", fontFace: "Calibri", italic: true, margin: 0 }); } else { card(s, 5.6, 1.05, 4.05, 4.35, C.midnight); s.addText("Healthy vs Schizophrenia\nBrain Pathway Diagram", { x: 5.6, y: 2.5, w: 4.05, h: 1.5, fontSize: 13, color: C.lightGray, align: "center", fontFace: "Calibri" }); } } // ───────────────────────────────────────────────────────────────────────────── // SLIDE 15 — SUMMARY / KEY TAKEAWAYS // ───────────────────────────────────────────────────────────────────────────── { const s = addSlide(); sectionBg(s); topBar(s, C.amber); s.addShape(pres.ShapeType.rect, { x: 0, y: 5.1, w: 10, h: 0.525, fill: { color: C.midnight } }); s.addShape(pres.ShapeType.rect, { x: 0, y: 5.05, w: 10, h: 0.07, fill: { color: C.amber } }); slideTitle(s, "Key Takeaways", 0.2); s.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.82, w: 2.0, h: 0.04, fill: { color: C.amber } }); const takeaways = [ ["🔑", "Diagnosis", "Clinical diagnosis (DSM-5-TR) requiring ≥2 symptoms ≥1 month + 6-month total duration — always EXCLUDE organic causes first"], ["🧬", "Pathophysiology", "Dopamine imbalance: mesolimbic hyperactivity (positive symptoms) + mesocortical hypofunction (negative/cognitive symptoms)"], ["💊", "Treatment", "Atypical (SGAs) are first-line; Clozapine for treatment-resistant; Long-acting injectables reduce relapse; Psychosocial therapy is essential"], ["⚠️", "Side Effects", "EPS/TD (typicals), Metabolic syndrome (SGAs), Agranulocytosis (clozapine) — monitor proactively"], ["📈", "Prognosis", "Chronic relapsing course; ~10% suicide risk; early intervention and family involvement improve outcomes"], ["🔬", "Recent Evidence", "2026 network meta-analysis confirms SGAs + muscarinic agents; Cariprazine shows promise for negative symptoms (Lancet 2026)"], ]; takeaways.forEach(([icon, label, text], i) => { const col = i % 2; const row = Math.floor(i / 3); const x = 0.35 + col * 4.85; const y = 0.95 + row * 1.42; // slightly shift last row const adjY = i >= 4 ? y + (i - 4) * 0.0 : y; card(s, x, adjY < 5 ? adjY : adjY, 4.6, 1.28, C.midnight); s.addText(icon, { x, y: adjY + 0.12, w: 0.65, h: 1.04, fontSize: 22, align: "center", valign: "middle", fontFace: "Segoe UI Emoji", margin: 0 }); s.addText(label, { x: x + 0.7, y: adjY + 0.1, w: 3.8, h: 0.36, fontSize: 12, bold: true, color: C.amber, fontFace: "Calibri", margin: 0 }); s.addText(text, { x: x + 0.7, y: adjY + 0.46, w: 3.8, h: 0.75, fontSize: 11, color: C.offWhite, fontFace: "Calibri", margin: 0 }); }); s.addText("Harrison's Principles of Internal Medicine 22e · Goldman-Cecil Medicine · Adams & Victor's Neurology 12e · Goodman & Gilman's Pharmacology 14e", { x: 0.3, y: 5.12, w: 9.4, h: 0.35, fontSize: 8.5, color: C.lightGray, fontFace: "Calibri", align: "center", margin: 0 }); } // ───────────────────────────────────────────────────────────────────────────── // WRITE FILE // ───────────────────────────────────────────────────────────────────────────── pres.writeFile({ fileName: "/home/daytona/workspace/schizophrenia-ppt/Schizophrenia_Case_Presentation.pptx" }) .then(() => console.log("SUCCESS: File written")) .catch(err => { console.error("ERROR:", err); process.exit(1); });