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pres.layout = 'LAYOUT_WIDE';
pres.author = 'PG Scholar, Dept. of Kaumarabhritya';
pres.title = 'Atatwabhinivesha (Schizophrenia Spectrum Disorders)';

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// ════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ════════════════════════════════════════════════════════════════
{
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  s.addText("Atatwabhinivesha", { x:0.5, y:1.1, w:12.1, h:1.35, fontSize:48, bold:true, color:C.white, align:"center", fontFace:"Trebuchet MS", margin:0 });
  s.addText("(Schizophrenia Spectrum Disorders)", { x:0.5, y:2.45, w:12.1, h:0.7, fontSize:24, color:C.accent, align:"center", fontFace:"Trebuchet MS", margin:0 });

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    { text: "An Ayurvedic & Modern Integrated Perspective", options:{breakLine:true} },
    { text: "Dept. of Kaumarabhritya" }
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    { text: "Presented by: PG Scholar (MD Kaumarabhritya)", options:{breakLine:true} },
    { text: "Guide: Head of Dept., Kaumarabhritya", options:{breakLine:true} },
    { text: "Academic Year: 2025–2026" }
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  s.addText("References: 3, 35, 45, 58, 59, 75 | DSM-5-TR | Charaka Samhita | Ashtanga Hridayam", {
    x:0.3, y:7.25, w:13, h:0.25, fontSize:8, color:C.accent, fontFace:"Trebuchet MS", valign:"middle", margin:0
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}

// ════════════════════════════════════════════════════════════════
// SLIDE 2 — CONTENTS
// ════════════════════════════════════════════════════════════════
{
  let s = contentSlide("INDEX / CONTENTS");
  const topics = [
    "1.  Introduction & Definition (Ayurveda + Modern)",
    "2.  Nidana Panchaka (Ayurvedic Etiopathogenesis)",
    "3.  Samprapti (Pathogenesis – Dosha analysis)",
    "4.  Lakshana (Signs & Symptoms – Classical)",
    "5.  DSM-5-TR: Schizophrenia Spectrum Disorders",
    "6.  Epidemiology & Prevalence",
    "7.  Etiology & Risk Factors (Modern)",
    "8.  Clinical Features & Positive / Negative Symptoms",
    "9.  Diagnostic Criteria (DSM-5-TR / ICD-11)",
    "10. Differential Diagnosis",
    "11. Ayurvedic Chikitsa (Management Principles)",
    "12. Satvavajaya Chikitsa (Psychotherapy in Ayurveda)",
    "13. Panchakarma in Manasavikara",
    "14. Modern Management (Pharmacotherapy)",
    "15. Integrative Approach (Kaumarabhritya Perspective)",
    "16. Case Discussion",
    "17. Recent Evidence & Research",
    "18. Conclusion & References"
  ];
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}

// ════════════════════════════════════════════════════════════════
// SLIDE 3 — INTRODUCTION
// ════════════════════════════════════════════════════════════════
{
  let s = contentSlide("INTRODUCTION");

  // left box – Ayurveda definition
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  s.addText([
    { text: "Atatwabhinivesha", options:{ bold:true, breakLine:true, fontSize:13, color:C.dark } },
    { text: "• Derived from: Atatwa (unreal/false) + Abhinivesha (firm belief/attachment)\n", options:{ fontSize:11.5, color:C.text } },
    { text: "• Defined by Punarvasu Atreya in Charaka Samhita (Chikitsa Sthana 10)\n", options:{ fontSize:11.5, color:C.text } },
    { text: "• Classified as Mahagada (major difficult disorder)\n", options:{ fontSize:11.5, color:C.text } },
    { text: "• Involves false/erroneous cognition — perceiving Anitya (impermanent) as Nitya, Ahita as Hita\n", options:{ fontSize:11.5, color:C.text } },
    { text: "• Derangement of Manas + Buddhi + Dhi (intellect)\n", options:{ fontSize:11.5, color:C.text } },
    { text: "• Manovaha Srotodushti involves Hrudaya (seat of Manas)\n", options:{ fontSize:11.5, color:C.text } },
    { text: "• Results in complete loss of discrimination of Hita-Ahita, Nitya-Anitya", options:{ fontSize:11.5, color:C.text } },
  ], { x:0.45, y:1.85, w:5.8, h:5.1 });

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    fill:{color:"9B7D20"}, margin:4 });
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    { text: "Schizophrenia Spectrum Disorders", options:{ bold:true, breakLine:true, fontSize:13, color:"7B5A00" } },
    { text: "• A group of psychotic disorders characterised by:\n", options:{ fontSize:11.5, color:C.text } },
    { text: "  – Delusions, hallucinations, disorganised speech/behaviour\n", options:{ fontSize:11.5, color:C.text } },
    { text: "  – Negative symptoms (affective flattening, avolition)\n", options:{ fontSize:11.5, color:C.text } },
    { text: "• Includes: Schizophrenia, Schizoaffective disorder, Schizophreniform, Brief Psychotic disorder, Delusional disorder\n", options:{ fontSize:11.5, color:C.text } },
    { text: "• Lifetime prevalence ~1%; Annual incidence ~15/1,00,000\n", options:{ fontSize:11.5, color:C.text } },
    { text: "• Peak onset: Late adolescence to early adulthood\n", options:{ fontSize:11.5, color:C.text } },
    { text: "• Early onset (<18 yrs): Childhood-onset (<13 yrs) is rarest\n", options:{ fontSize:11.5, color:C.text } },
    { text: "(Goldman & Schafer, Cecil Medicine, 2024; DSM-5-TR, APA 2022)", options:{ fontSize:9.5, italic:true, color:C.sub } },
  ], { x:7.1, y:1.85, w:5.8, h:5.1 });
}

// ════════════════════════════════════════════════════════════════
// SLIDE 4 — NIDANA PANCHAKA (Ayurvedic Etiopathogenesis)
// ════════════════════════════════════════════════════════════════
{
  let s = contentSlide("NIDANA PANCHAKA — Ayurvedic Etiopathogenesis");

  const cols = [
    { title:"NIDANA (Causes)", color:C.mid, items:[
      "Vegadharana (suppression of natural urges)",
      "Mithyahara-Vihara (improper diet/lifestyle)",
      "Atimatra Abhishanga (excess sensory indulgence)",
      "Prajnaparadha (intellectual errors/sins)",
      "Bhaya, Shoka, Krodha (fear, grief, anger)",
      "Asatmyendriyartha samyoga",
      "Karma viparya (sinful acts)",
    ]},
    { title:"SAMPRAPTI (Pathogenesis)", color:"557A3D", items:[
      "Nidana → Vata+Pitta/Raja+Tama aggravation",
      "Manovaha Srotodushti",
      "Hrudaya Avarana (obstruction at heart/mind seat)",
      "Buddhi-Smriti-Dhi-Dhairya impairment",
      "False cognition: Anitya appears Nitya",
      "Sensory misinterpretation → delusions",
    ]},
    { title:"LAKSHANA (Symptoms)", color:"6E4B1A", items:[
      "Mithyabhimana (false beliefs/delusions)",
      "Asthana bhaya (irrational fear)",
      "Abhaya sthana bhaya & vice versa",
      "Avichara — poor judgment",
      "Nidra-Swapna dushti (sleep disturbances)",
      "Inability to perceive Hita/Ahita",
      "Classified as Krichhrasadhya / Asadhya",
    ]},
  ];

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  s.addText("Ref: Charaka Samhita Chikitsa Sthana 10 (Apasmarachikitsa adhyaya); Ashtanga Hridayam Uttarasthana 6", {
    x:0.3, y:7.05, w:12.5, h:0.2, fontSize:8.5, italic:true, color:C.sub, fontFace:"Trebuchet MS"
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}

// ════════════════════════════════════════════════════════════════
// SLIDE 5 — SAMPRAPTI CHAKRA (Pathogenesis Flowchart)
// ════════════════════════════════════════════════════════════════
{
  let s = contentSlide("SAMPRAPTI CHAKRA — Pathogenesis");

  const boxes = [
    { label:"Nidana Sevana\n(Improper diet, lifestyle,\nprajnaparadha, shoka)", x:4.8, y:1.3 },
    { label:"Vata + Pitta Prakopa\nwith Rajas + Tamas\n(Manasika Dushti)", x:4.8, y:2.45 },
    { label:"Manovaha Srotodushti\n(Hrudaya involvement)", x:4.8, y:3.6 },
    { label:"Dhi-Dhriti-Smriti Vibhrama\n(Impaired intellect, will, memory)", x:4.8, y:4.7 },
    { label:"ATATWABHINIVESHA\n(False/delusional perception — Mahagada)", x:4.4, y:5.8 },
  ];

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  s.addText("AYURVEDIC PARALLELS", { x:0.25, y:1.3, w:4.2, h:0.4, fontSize:11, bold:true, color:C.white, align:"center", fontFace:"Trebuchet MS", fill:{color:"5A7A8A"}, margin:4 });
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    { text:"• Vata = Dopaminergic dysregulation\n", options:{fontSize:10.5, color:C.text} },
    { text:"• Pitta = Serotonergic imbalance\n", options:{fontSize:10.5, color:C.text} },
    { text:"• Tamas = Negative symptoms\n", options:{fontSize:10.5, color:C.text} },
    { text:"• Rajas = Positive symptoms\n", options:{fontSize:10.5, color:C.text} },
    { text:"• Manovaha Srotas = Neural circuits\n", options:{fontSize:10.5, color:C.text} },
    { text:"• Hrudaya = Limbic system\n", options:{fontSize:10.5, color:C.text} },
    { text:"• Smriti-Dhi = Cognitive domains\n", options:{fontSize:10.5, color:C.text} },
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  s.addText("MODERN CORRELATES", { x:9.15, y:1.3, w:4.0, h:0.4, fontSize:11, bold:true, color:C.white, align:"center", fontFace:"Trebuchet MS", fill:{color:"9B7D20"}, margin:4 });
  s.addText([
    { text:"• Neurodevelopmental disruption\n", options:{fontSize:10.5, color:C.text} },
    { text:"• DA hyperfunction (striatum)\n", options:{fontSize:10.5, color:C.text} },
    { text:"• DA hypofunction (PFC)\n", options:{fontSize:10.5, color:C.text} },
    { text:"• Glutamate/NMDA dysfunction\n", options:{fontSize:10.5, color:C.text} },
    { text:"• Cortical cytoarchitecture loss\n", options:{fontSize:10.5, color:C.text} },
    { text:"• Genetic (multifactorial ~50%)\n", options:{fontSize:10.5, color:C.text} },
    { text:"• Stress-diathesis model\n", options:{fontSize:10.5, color:C.text} },
  ], { x:9.2, y:1.8, w:3.9, h:4.9 });

  s.addText("Ref: Charaka Samhita Ch. Sth. 10; Goodman & Gilman Pharmacology, 13/e, p.320", { x:0.3, y:7.05, w:12.5, h:0.2, fontSize:8.5, italic:true, color:C.sub });
}

// ════════════════════════════════════════════════════════════════
// SLIDE 6 — DSM-5-TR Schizophrenia Spectrum Overview
// ════════════════════════════════════════════════════════════════
{
  let s = contentSlide("DSM-5-TR: Schizophrenia Spectrum Disorders");

  s.addText("SPECTRUM OF DISORDERS", { x:0.3, y:1.2, w:12.7, h:0.4, fontSize:13, bold:true, color:C.dark, fontFace:"Trebuchet MS" });

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    { name:"Delusional Disorder", desc:"Non-bizarre or bizarre delusions >1 month; functioning relatively preserved; no hallucinations", col:"7A8E6B" },
    { name:"Brief Psychotic Disorder", desc:"≥1 positive symptoms, duration 1 day–1 month, full return to baseline", col:"6B7A8E" },
    { name:"Schizophreniform Disorder", desc:"Meets schizophrenia criteria but duration 1–6 months; may or may not fully recover", col:"8E7A6B" },
    { name:"Schizophrenia", desc:"Delusions, hallucinations, disorganised speech/behaviour + negative symptoms ≥6 months; significant impairment", col:C.dark },
    { name:"Schizoaffective Disorder", desc:"Schizophrenia + major mood episode (depressive/manic); mood ≥ majority of illness", col:"5A3A6B" },
  ];

  disorders.forEach((d, i) => {
    const row = Math.floor(i / 3);
    const col2 = i % 3;
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    const y = 1.75 + row * 2.5;
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  s.addText("Ref: DSM-5-TR, American Psychiatric Association, 2022; Cecil Medicine 26/e (Goldman & Schafer), p.2487", { x:0.3, y:7.05, w:12.5, h:0.2, fontSize:8.5, italic:true, color:C.sub });
}

// ════════════════════════════════════════════════════════════════
// SLIDE 7 — EPIDEMIOLOGY
// ════════════════════════════════════════════════════════════════
{
  let s = contentSlide("EPIDEMIOLOGY");

  // Stat boxes
  const stats = [
    { val:"~1%", label:"Lifetime prevalence\n(global)", col:C.dark },
    { val:"15/1L", label:"Annual incidence\n(per 100,000)", col:C.mid },
    { val:"< 5%", label:"Early-onset (<18 yrs)\nof all cases", col:"6B5A8E" },
    { val:"< 1%", label:"Childhood-onset\n(< 13 years)", col:"8E5A3A" },
  ];

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  const epiPoints = [
    "Slightly more common in males; peak onset males 18–25 yrs, females 25–35 yrs",
    "Early Onset Schizophrenia (EOS): 13–18 years — more severe, insidious onset, more negative symptoms",
    "Childhood Onset Schizophrenia (COS): < 13 years — very rare, ~1 in 10,000; male predominance",
    "GBD 2019: Schizophrenia contributes 13.4 million years of disability globally (Lancet Psychiatry, 2022)",
    "Comorbidity: Depression (25–50%), substance use disorders (50%), suicidal ideation (20–40%)",
    "India: Prevalence 2–4/1000; in paediatric populations often underdiagnosed",
    "Child & Adolescent Manas Roga in Ayurveda — Bala Unmada & Atatwabhinivesha under Kaumarabhritya",
  ];
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  s.addText("Ref: GBD 2019 Collaborators, Lancet Psychiatry 2022 [PMID 35026139]; Cecil Medicine 26/e p.2490; WHO Mental Health Atlas 2022", { x:0.3, y:7.05, w:12.5, h:0.2, fontSize:8.5, italic:true, color:C.sub });
}

// ════════════════════════════════════════════════════════════════
// SLIDE 8 — ETIOLOGY & RISK FACTORS (Modern)
// ════════════════════════════════════════════════════════════════
{
  let s = contentSlide("ETIOLOGY & RISK FACTORS — Modern Perspective");

  const factors = [
    { cat:"Genetic", items:["Heritability ~50% (twin studies)", "Multiple gene loci (DISC1, NRG1, DTNBP1, COMT)", "22q11.2 deletion syndrome — high risk", "Rare ultrarare mutations in synaptic plasticity genes"] },
    { cat:"Neurodevelopmental", items:["Pre/perinatal insults, obstetric complications", "Advanced paternal age", "Childhood trauma, urbanicity", "Cannabis use in adolescence (OR 2–4×)", "Immigration, social isolation"] },
    { cat:"Neurobiological", items:["DA hyperfunction (mesolimbic) → positive symptoms", "DA hypofunction (PFC/mesocortical) → negative symptoms", "Glutamate/NMDA receptor hypofunction", "Serotonin dysregulation (5-HT2A)", "Cortical volume loss, ventricular enlargement"] },
    { cat:"Ayurvedic (Nidana)", items:["Prajnaparadha (intellectual transgression)", "Vegadharana (urge suppression)", "Viruddha Ahara (incompatible foods)", "Ativyavaya, Atishosha (excess physical strain)", "Bhaya, Shoka, Asatmya Indriyartha Samyoga"] },
  ];

  const xStarts2 = [0.2, 3.45, 6.7, 9.95];
  factors.forEach((f, ci) => {
    s.addShape(pres.ShapeType.roundRect, { x:xStarts2[ci], y:1.25, w:3.1, h:5.95, fill:{color:"EEF4EE"}, line:{color:C.mid, width:1.2}, rectRadius:0.08 });
    s.addText(f.cat, { x:xStarts2[ci]+0.05, y:1.25, w:3.0, h:0.45, fontSize:12, bold:true, color:C.white, align:"center", fontFace:"Trebuchet MS", fill:{color:C.dark}, margin:4 });
    const items = f.items.map((t, i) => ({ text:"• " + t, options:{ breakLine: i < f.items.length-1, fontSize:10.8, color:C.text, fontFace:"Trebuchet MS" } }));
    s.addText(items, { x:xStarts2[ci]+0.1, y:1.8, w:2.9, h:5.3 });
  });

  s.addText("Ref: Cecil Medicine 26/e p.2495; Goodman & Gilman 13/e Ch.19; Genetics in Medicine (Strachan & Read) 2019", { x:0.3, y:7.05, w:12.5, h:0.2, fontSize:8.5, italic:true, color:C.sub });
}

// ════════════════════════════════════════════════════════════════
// SLIDE 9 — CLINICAL FEATURES
// ════════════════════════════════════════════════════════════════
{
  let s = contentSlide("CLINICAL FEATURES — Positive, Negative & Cognitive");

  const clusters = [
    { title:"POSITIVE SYMPTOMS", col:"8E3A3A", items:[
      "Hallucinations (auditory most common)",
      "Delusions (persecutory, referential, grandiose)",
      "Disorganised speech (tangentiality, word salad)",
      "Disorganised/catatonic behaviour",
      "Formal thought disorder",
    ]},
    { title:"NEGATIVE SYMPTOMS", col:C.dark, items:[
      "Affective flattening (blunt/flat affect)",
      "Alogia (poverty of speech)",
      "Avolition (lack of motivation)",
      "Anhedonia (inability to feel pleasure)",
      "Social withdrawal, anergia",
    ]},
    { title:"COGNITIVE SYMPTOMS", col:"5A3A8E", items:[
      "Working memory deficits",
      "Impaired attention & concentration",
      "Executive dysfunction",
      "Impaired processing speed",
      "Poor insight (anosognosia)",
    ]},
    { title:"IN CHILDREN/ADOLESCENTS\n(EOS/COS)", col:"3A6B5A", items:[
      "Insidious onset, more negative symptoms",
      "More hallucinations (visual, tactile)",
      "Lower premorbid IQ; academic decline",
      "Social withdrawal; school refusal",
      "Differentiate from ASD, ADHD, mood Ds",
    ]},
  ];

  const xStarts3 = [0.2, 3.45, 6.7, 9.95];
  clusters.forEach((cl, ci) => {
    s.addShape(pres.ShapeType.roundRect, { x:xStarts3[ci], y:1.25, w:3.1, h:5.95, fill:{color:"F5F0FA"}, line:{color:cl.col, width:2}, rectRadius:0.08 });
    s.addShape(pres.ShapeType.rect, { x:xStarts3[ci], y:1.25, w:3.1, h:0.5, fill:{color:cl.col} });
    s.addText(cl.title, { x:xStarts3[ci], y:1.25, w:3.1, h:0.5, fontSize:10.5, bold:true, color:C.white, align:"center", valign:"middle", fontFace:"Trebuchet MS", margin:4 });
    const items = cl.items.map((t, i) => ({ text:"• " + t, options:{ breakLine: i < cl.items.length-1, fontSize:11, color:C.text, fontFace:"Trebuchet MS" } }));
    s.addText(items, { x:xStarts3[ci]+0.1, y:1.85, w:2.9, h:5.2 });
  });

  s.addText("Ref: DSM-5-TR APA 2022; Cecil Medicine 26/e; Nelson Textbook of Pediatrics 21/e; Janas-Kozik et al., Psychiatr Pol 2022 [PMID 37074823]", { x:0.3, y:7.05, w:12.5, h:0.2, fontSize:8.5, italic:true, color:C.sub });
}

// ════════════════════════════════════════════════════════════════
// SLIDE 10 — DIAGNOSTIC CRITERIA DSM-5-TR & ICD-11
// ════════════════════════════════════════════════════════════════
{
  let s = contentSlide("DIAGNOSTIC CRITERIA — DSM-5-TR & ICD-11");

  s.addShape(pres.ShapeType.roundRect, { x:0.2, y:1.25, w:6.3, h:5.95, fill:{color:"EEF4EE"}, line:{color:C.mid, width:1.5}, rectRadius:0.08 });
  s.addText("DSM-5-TR (APA, 2022)", { x:0.25, y:1.25, w:6.2, h:0.45, fontSize:13, bold:true, color:C.white, align:"center", fontFace:"Trebuchet MS", fill:{color:C.mid}, margin:4 });
  s.addText([
    { text:"Criterion A — ≥2 of following, ≥1 month:\n", options:{bold:true, fontSize:11.5, color:C.dark, breakLine:false} },
    { text:"  1. Delusions\n  2. Hallucinations\n  3. Disorganised speech\n  4. Grossly disorganised/catatonic behaviour\n  5. Negative symptoms\n  (At least 1 must be 1, 2, or 3)\n\n", options:{fontSize:11, color:C.text} },
    { text:"Criterion B — Social/occupational dysfunction\n\n", options:{bold:true, fontSize:11.5, color:C.dark} },
    { text:"Criterion C — Duration ≥6 months\n\n", options:{bold:true, fontSize:11.5, color:C.dark} },
    { text:"Criterion D/E/F — Rule out: schizoaffective/mood disorders, substances/medical conditions, ASD\n\n", options:{fontSize:11, color:C.text} },
    { text:"Severity rating: PANSS / BPRS scales used for follow-up", options:{fontSize:11, italic:true, color:C.sub} },
  ], { x:0.35, y:1.8, w:6.0, h:5.3 });

  s.addShape(pres.ShapeType.roundRect, { x:6.9, y:1.25, w:6.3, h:5.95, fill:{color:"FFF5E8"}, line:{color:C.accent, width:1.5}, rectRadius:0.08 });
  s.addText("ICD-11 (WHO, 2022) — 6A20", { x:6.95, y:1.25, w:6.2, h:0.45, fontSize:13, bold:true, color:C.white, align:"center", fontFace:"Trebuchet MS", fill:{color:"9B7D20"}, margin:4 });
  s.addText([
    { text:"Primary symptoms (≥2 must be present):\n", options:{bold:true, fontSize:11.5, color:"7B5A00"} },
    { text:"  • Persistent delusions\n  • Persistent hallucinations\n  • Formal thought disorder\n  • Experiences of influence/passivity\n  • Negative symptoms\n  • Disorganised behaviour/catatonia\n\n", options:{fontSize:11, color:C.text} },
    { text:"Duration: ≥1 month (ICD-11 shortens from ICD-10's 1 month)\n\n", options:{fontSize:11, color:C.text} },
    { text:"6A20.0 — First episode\n6A20.1 — Multiple episodes\n6A20.2 — Continuous\n\n", options:{fontSize:11, color:C.text} },
    { text:"AYURVEDIC DIAGNOSIS:\nVikruti Pariksha, Nadi, Manas Pariksha — Atatwabhinivesha diagnosed by Dhi-Dhriti-Smriti Vibhrama", options:{fontSize:11, italic:true, color:C.sub} },
  ], { x:7.05, y:1.8, w:6.0, h:5.3 });
}

// ════════════════════════════════════════════════════════════════
// SLIDE 11 — DIFFERENTIAL DIAGNOSIS
// ════════════════════════════════════════════════════════════════
{
  let s = contentSlide("DIFFERENTIAL DIAGNOSIS");

  const ddList = [
    { condition:"Mood Disorders with psychotic features", distinguish:"Mood episodes predominate; psychosis only during mood episodes; full remission possible" },
    { condition:"Schizoaffective Disorder", distinguish:"Mood episodes + schizophrenia criteria; delusions persist even outside mood episodes" },
    { condition:"Autism Spectrum Disorder (ASD)", distinguish:"ASD: social communication deficits, restricted patterns; psychotic symptoms usually absent; onset earlier" },
    { condition:"ADHD", distinguish:"Inattention, hyperactivity; no hallucinations/delusions; responds to stimulants" },
    { condition:"Drug-induced Psychosis", distinguish:"Substance (cannabis, amphetamines, LSD) history; resolves with abstinence" },
    { condition:"Organic Psychosis", distinguish:"Medical causes: autoimmune encephalitis, Wilson's disease, Temporal lobe epilepsy, thyroid disorders — must rule out" },
    { condition:"Delusional Disorder", distinguish:"Non-bizarre delusions only; no hallucinations; functioning maintained" },
    { condition:"Bala Unmada (Ayurveda)", distinguish:"Child-specific Manovikara; involves Bhuta-abhishanga, Doshic imbalance; may overlap with Atatwabhinivesha" },
  ];

  s.addShape(pres.ShapeType.rect, { x:0.2, y:1.25, w:5.3, h:0.45, fill:{color:C.dark} });
  s.addText("CONDITION", { x:0.2, y:1.25, w:5.3, h:0.45, fontSize:12, bold:true, color:C.white, align:"center", fontFace:"Trebuchet MS", margin:4 });
  s.addShape(pres.ShapeType.rect, { x:5.6, y:1.25, w:7.6, h:0.45, fill:{color:C.dark} });
  s.addText("HOW TO DISTINGUISH", { x:5.6, y:1.25, w:7.6, h:0.45, fontSize:12, bold:true, color:C.white, align:"center", fontFace:"Trebuchet MS", margin:4 });

  ddList.forEach((dd, i) => {
    const y = 1.8 + i * 0.62;
    const bg = i % 2 === 0 ? "F0F7F0" : "FAFAFA";
    s.addShape(pres.ShapeType.rect, { x:0.2, y, w:5.3, h:0.58, fill:{color:bg} });
    s.addShape(pres.ShapeType.rect, { x:5.6, y, w:7.6, h:0.58, fill:{color:bg} });
    s.addText(dd.condition, { x:0.25, y, w:5.2, h:0.58, fontSize:10.5, bold:true, color:C.dark, valign:"middle", fontFace:"Trebuchet MS" });
    s.addText(dd.distinguish, { x:5.65, y, w:7.5, h:0.58, fontSize:10.5, color:C.text, valign:"middle", fontFace:"Trebuchet MS" });
  });

  s.addText("Ref: DSM-5-TR; Nelson Textbook of Pediatrics 21/e; Charaka Samhita; Jutla et al., Autism Res 2022 [PMID 34967130]", { x:0.3, y:7.05, w:12.5, h:0.2, fontSize:8.5, italic:true, color:C.sub });
}

// ════════════════════════════════════════════════════════════════
// SLIDE 12 — AYURVEDIC CHIKITSA
// ════════════════════════════════════════════════════════════════
{
  let s = contentSlide("AYURVEDIC CHIKITSA — Treatment Principles");

  const triad = [
    { name:"DAIVAVYAPASHRAYA\n(Divine/Spiritual Therapy)", col:"6B3A6B", items:[
      "Mantra chikitsa (recitation, healing mantras)",
      "Mani dharana (gem/crystal therapy)",
      "Bali karma (ritual offerings)",
      "Upavasa (therapeutic fasting)",
      "Rasayana with Medhya herbs",
      "Homa, Mangalacharana (auspicious rituals)",
    ]},
    { name:"YUKTIVYAPASHRAYA\n(Rational/Herbal Therapy)", col:C.mid, items:[
      "Medhya Rasayana: Brahmi, Shankhapushpi,\n  Mandukparni, Yashtimadhu",
      "Panchakarma: Vamana, Nasya, Basti",
      "Shirodhara with Brahmi taila",
      "Shirobasti (medicated oil on head)",
      "Snehapaana, Svedana",
      "Sarpagandha (Rauwolfia serpentina)\n  — first antipsychotic plant",
    ]},
    { name:"SATVAVAJAYA\n(Psycho-spiritual Therapy)", col:"3A5A8E", items:[
      "Jnanopadesha (knowledge-based counselling)",
      "Buddhivijaya (cognitive restructuring)",
      "Dhairya (instilling courage/resilience)",
      "Smriti rekindling (memory re-training)",
      "Yoga, Pranayama, Dhyana (meditation)",
      "Psychotherapy equivalent — Satva bala\n  strengthening",
    ]},
  ];

  const xStarts4 = [0.2, 4.6, 9.0];
  triad.forEach((t, ci) => {
    s.addShape(pres.ShapeType.roundRect, { x:xStarts4[ci], y:1.25, w:4.1, h:5.95, fill:{color:"EEF2FA"}, line:{color:t.col, width:2}, rectRadius:0.08 });
    s.addShape(pres.ShapeType.rect, { x:xStarts4[ci], y:1.25, w:4.1, h:0.6, fill:{color:t.col} });
    s.addText(t.name, { x:xStarts4[ci], y:1.25, w:4.1, h:0.6, fontSize:11, bold:true, color:C.white, align:"center", valign:"middle", fontFace:"Trebuchet MS", margin:4 });
    const items = t.items.map((tx, i) => ({ text:"• " + tx, options:{ breakLine: i < t.items.length-1, fontSize:11, color:C.text, fontFace:"Trebuchet MS" } }));
    s.addText(items, { x:xStarts4[ci]+0.1, y:1.95, w:3.9, h:5.1 });
  });

  s.addText("Ref: Charaka Samhita Chikitsa Sthana 10; Ashtanga Hridayam Uttarasthana 6–7; CCRAS Monograph on Unmada", { x:0.3, y:7.05, w:12.5, h:0.2, fontSize:8.5, italic:true, color:C.sub });
}

// ════════════════════════════════════════════════════════════════
// SLIDE 13 — PANCHAKARMA IN MANASAVIKARA
// ════════════════════════════════════════════════════════════════
{
  let s = contentSlide("PANCHAKARMA IN MANASAVIKARA");

  const pk = [
    { proc:"Vamana\n(Emesis)", dosh:"Kapha/Pitta", herb:"Madanaphala, Vacha", ind:"Kapha-dominant symptoms, stupor, excess Tamas", notes:"Done only if physically fit; preceded by Snehana, Svedana" },
    { proc:"Virechana\n(Purgation)", dosh:"Pitta", herb:"Trivrit, Haritaki", ind:"Pitta-dominant, anger, agitation", notes:"Useful in delusional-manic states" },
    { proc:"Basti\n(Enema)", dosh:"Vata", herb:"Brahmi, Ashwagandha, Musta", ind:"Vata-dominant, insomnia, fearful type", notes:"Anuvasana & Asthapana Basti; Matra Basti in children" },
    { proc:"Nasya\n(Nasal therapy)", dosh:"Vata (head)", herb:"Brahmi ghrita, Vacha taila, Shatavari", ind:"All psychoses; key for Shirashoola, Nidranasha", notes:"Shiro Nasya daily; Pratimarsha Nasya for children" },
    { proc:"Shirodhara", dosh:"Vata/Pitta", herb:"Brahmi taila, Ksheerabala, Tila taila", ind:"Anxiety, delusions, insomnia, agitation", notes:"21-day course; reduces cortisol; calms limbic system" },
  ];

  s.addShape(pres.ShapeType.rect, { x:0.2, y:1.25, w:1.8, h:0.45, fill:{color:C.dark} });
  s.addText("PROCEDURE", { x:0.2, y:1.25, w:1.8, h:0.45, fontSize:10, bold:true, color:C.white, align:"center", fontFace:"Trebuchet MS", margin:2 });
  const headers = ["DOSHA", "HERBS USED", "INDICATION", "NOTES"];
  const hw = [1.2, 3.2, 3.5, 3.9];
  const hx = [2.05, 3.3, 6.55, 10.1];
  headers.forEach((h, i) => {
    s.addShape(pres.ShapeType.rect, { x:hx[i], y:1.25, w:hw[i], h:0.45, fill:{color:C.dark} });
    s.addText(h, { x:hx[i], y:1.25, w:hw[i], h:0.45, fontSize:10, bold:true, color:C.white, align:"center", fontFace:"Trebuchet MS", margin:2 });
  });

  pk.forEach((p, i) => {
    const y = 1.8 + i * 1.0;
    const bg = i % 2 === 0 ? "EEF4EE" : "F8FDF8";
    const rowData = [
      { x:0.2, w:1.8, text:p.proc, bold:true },
      { x:2.05, w:1.2, text:p.dosh, bold:false },
      { x:3.3, w:3.2, text:p.herb, bold:false },
      { x:6.55, w:3.5, text:p.ind, bold:false },
      { x:10.1, w:3.9, text:p.notes, bold:false },
    ];
    rowData.forEach(cell => {
      s.addShape(pres.ShapeType.rect, { x:cell.x, y, w:cell.w, h:0.95, fill:{color:bg}, line:{color:"CCCCCC", width:0.5} });
      s.addText(cell.text, { x:cell.x+0.05, y, w:cell.w-0.1, h:0.95, fontSize:10, bold:cell.bold, color:C.text, valign:"middle", fontFace:"Trebuchet MS" });
    });
  });

  s.addText("Ref: Charaka Samhita; Ashtanga Hridayam; Vagbhata Uttarasthana; CCRAS Unmada Management Monograph", { x:0.3, y:7.05, w:12.5, h:0.2, fontSize:8.5, italic:true, color:C.sub });
}

// ════════════════════════════════════════════════════════════════
// SLIDE 14 — MEDHYA RASAYANA & HERBAL DRUGS
// ════════════════════════════════════════════════════════════════
{
  let s = contentSlide("MEDHYA RASAYANA & SINGLE DRUGS");

  const herbs = [
    { name:"Brahmi\n(Bacopa monnieri)", action:"Medhya, Nidrajanana, Prabhava on Mano Vaha Srotas", modern:"Cognitive enhancement, anxiolytic, antioxidant; modulates 5-HT; increases BDNF" },
    { name:"Shankhapushpi\n(Convolvulus pluricaulis)", action:"Medhya Rasayana, Vatapitta shamaka, Dhivardhaka", modern:"Anti-anxiety, neuroprotective, MAO inhibition; sedative in high doses" },
    { name:"Vacha\n(Acorus calamus)", action:"Medhya, Unmadahara, Shirovirechana", modern:"AChE inhibition, GABA modulation; anti-convulsant, nootropic" },
    { name:"Sarpagandha\n(Rauwolfia serpentina)", action:"Pitta-Vata shamaka, Nidrala, Manovikarahara", modern:"Reserpine — depletes monoamines (DA, NE, 5-HT); first plant-derived antipsychotic" },
    { name:"Ashwagandha\n(Withania somnifera)", action:"Medhya, Balya, Adaptogen; Vata Kapha shamaka", modern:"Reduces cortisol; neuroprotective; GABA-mimetic; improves cognition in schizophrenia" },
    { name:"Jatamansi\n(Nardostachys jatamansi)", action:"Medhya, Manasshanti, Vata Pitta shamaka", modern:"MAO-A inhibition; sedative; anxiolytic; reduces oxidative stress in brain" },
  ];

  herbs.forEach((h, i) => {
    const row = Math.floor(i / 3);
    const col2 = i % 3;
    const x = 0.2 + col2 * 4.35;
    const y = 1.3 + row * 2.9;
    s.addShape(pres.ShapeType.roundRect, { x, y, w:4.2, h:2.75, fill:{color:"EFF8F0"}, line:{color:C.mid, width:1.5}, rectRadius:0.1 });
    s.addShape(pres.ShapeType.rect, { x, y, w:4.2, h:0.45, fill:{color:C.mid} });
    s.addText(h.name, { x, y, w:4.2, h:0.45, fontSize:11.5, bold:true, color:C.white, align:"center", valign:"middle", fontFace:"Trebuchet MS", margin:4 });
    s.addText("Ayurveda: ", { x:x+0.1, y:y+0.5, w:0.9, h:0.4, fontSize:10, bold:true, color:C.dark, margin:0 });
    s.addText(h.action, { x:x+0.1, y:y+0.5, w:4.0, h:0.85, fontSize:10, color:C.text, fontFace:"Trebuchet MS", indent:60 });
    s.addShape(pres.ShapeType.line, { x:x+0.1, y:y+1.35, w:4.0, h:0, line:{color:C.accent, width:0.5} });
    s.addText("Modern: ", { x:x+0.1, y:y+1.4, w:0.7, h:0.4, fontSize:10, bold:true, color:"9B7D20", margin:0 });
    s.addText(h.modern, { x:x+0.1, y:y+1.4, w:4.0, h:1.2, fontSize:10, color:C.text, fontFace:"Trebuchet MS", indent:50 });
  });

  s.addText("Ref: Charaka Samhita; Dravyaguna Vijnana (Sharma PV); Goodman & Gilman Ch.19; Cooley et al. 2009; Singh & Dhawan 1997", { x:0.3, y:7.05, w:12.5, h:0.2, fontSize:8.5, italic:true, color:C.sub });
}

// ════════════════════════════════════════════════════════════════
// SLIDE 15 — MODERN MANAGEMENT (PHARMACOTHERAPY)
// ════════════════════════════════════════════════════════════════
{
  let s = contentSlide("MODERN MANAGEMENT — Pharmacotherapy");

  s.addShape(pres.ShapeType.roundRect, { x:0.2, y:1.25, w:6.1, h:5.95, fill:{color:"F0F4FF"}, line:{color:"4A5A9A", width:1.5}, rectRadius:0.08 });
  s.addText("ANTIPSYCHOTICS", { x:0.25, y:1.25, w:6.0, h:0.45, fontSize:13, bold:true, color:C.white, align:"center", fontFace:"Trebuchet MS", fill:{color:"4A5A9A"}, margin:4 });
  s.addText([
    { text:"First Generation (Typical):\n", options:{bold:true, fontSize:12, color:"4A5A9A"} },
    { text:"• Chlorpromazine — first antipsychotic; D2 antagonist\n• Haloperidol — high-potency; strong D2 blockade\n• Trifluoperazine, Fluphenazine\n• Side effects: EPS, tardive dyskinesia, NMS, hyperprolactinaemia\n\n", options:{fontSize:11, color:C.text} },
    { text:"Second Generation (Atypical):\n", options:{bold:true, fontSize:12, color:"4A5A9A"} },
    { text:"• Risperidone, Olanzapine, Quetiapine, Ziprasidone\n• Aripiprazole: D2 partial agonist; FDA approved ≥13 yrs for schizophrenia\n  – 13–17 yrs: 2mg → 5mg → 10mg PO daily (target)\n• Clozapine: treatment-resistant; risk of agranulocytosis\n• Side effects: metabolic syndrome, weight gain, QTc prolongation\n\n", options:{fontSize:11, color:C.text} },
    { text:"Third Generation:\n", options:{bold:true, fontSize:12, color:"4A5A9A"} },
    { text:"• Cariprazine (D2/D3 partial agonist) — better for negative symptoms\n• Brexpiprazole", options:{fontSize:11, color:C.text} },
  ], { x:0.35, y:1.8, w:5.8, h:5.3 });

  s.addShape(pres.ShapeType.roundRect, { x:6.7, y:1.25, w:6.5, h:5.95, fill:{color:"FFF8EE"}, line:{color:C.accent, width:1.5}, rectRadius:0.08 });
  s.addText("NON-PHARMACOLOGICAL / INTEGRATIVE", { x:6.75, y:1.25, w:6.4, h:0.45, fontSize:12.5, bold:true, color:C.white, align:"center", fontFace:"Trebuchet MS", fill:{color:"9B7D20"}, margin:4 });
  s.addText([
    { text:"Psychotherapy:\n", options:{bold:true, fontSize:12, color:"7B5A00"} },
    { text:"• Cognitive Behavioural Therapy for Psychosis (CBTp)\n• Family therapy / psychoeducation\n• Social skills training\n• Assertive Community Treatment (ACT)\n\n", options:{fontSize:11, color:C.text} },
    { text:"Neuromodulation:\n", options:{bold:true, fontSize:12, color:"7B5A00"} },
    { text:"• rTMS (repetitive transcranial magnetic stimulation) — auditory hallucinations\n• tDCS (transcranial direct current stimulation)\n• ECT — catatonic or treatment-resistant cases\n\n", options:{fontSize:11, color:C.text} },
    { text:"Rehabilitation:\n", options:{bold:true, fontSize:12, color:"7B5A00"} },
    { text:"• Occupational therapy, vocational rehabilitation\n• School re-integration (for EOS/COS)\n• Parental counselling — critical in Kaumarabhritya\n\n", options:{fontSize:11, color:C.text} },
    { text:"Ref: Sabe et al., JAMA Netw Open 2024 [PMID 38776083]; Pediatric Drug Reference 2023", options:{fontSize:9.5, italic:true, color:C.sub} },
  ], { x:6.85, y:1.8, w:6.2, h:5.3 });
}

// ════════════════════════════════════════════════════════════════
// SLIDE 16 — KAUMARABHRITYA PERSPECTIVE (Integrated Assessment)
// ════════════════════════════════════════════════════════════════
{
  let s = contentSlide("INTEGRATED ASSESSMENT — Kaumarabhritya Perspective");

  s.addText("The role of Kaumarabhritya in Atatwabhinivesha / Early Onset Schizophrenia lies in:", {
    x:0.3, y:1.25, w:12.7, h:0.5, fontSize:13, bold:true, color:C.dark, fontFace:"Trebuchet MS"
  });

  const domains = [
    { icon:"🧒", title:"Aetiology in Children", pts:["Matrujanit/Pitrujaadit doshas (hereditary)", "Daivakrita (karmic/epigenetic)", "Birth trauma, perinatal insults", "Bhuta Abhishanga (equivalent to viral encephalitis, autoimmune)", "Childhood trauma, abuse, neglect"] },
    { icon:"🔍", title:"Integrated Assessment", pts:["Dashavidha Pareeksha + Ashtasthana Pareeksha", "CANS (Child & Adolescent Needs & Strengths)", "PANSS, K-SADS in children", "Rule out organic causes: MRI brain, metabolic workup", "Neurodevelopmental assessment: IQ, ASD screening"] },
    { icon:"🌿", title:"Ayurvedic Management", pts:["Bal-Medhya Rasayana (age-appropriate doses)", "Pratimarsha Nasya with Brahmi ghrita", "Matra Basti — Bala Ashwagandha taila", "Satvavajaya: Play therapy, art therapy", "Parental Dharana Vichara (psychoeducation)"] },
    { icon:"💊", title:"Modern Management", pts:["Aripiprazole (FDA ≥13 yr) — first-line EOS", "Risperidone, Olanzapine — adolescents", "Clozapine — treatment-resistant COS", "Regular metabolic monitoring", "School liaison, IEP (Individual Education Plan)"] },
  ];

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// ════════════════════════════════════════════════════════════════
// SLIDE 17 — RECENT EVIDENCE & RESEARCH
// ════════════════════════════════════════════════════════════════
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    { year:"2022", citation:"GBD 2019 Mental Disorders Collaborators. Lancet Psychiatry. [PMID 35026139]", finding:"Global schizophrenia burden: 13.4M DALYs; youth-onset linked to higher disability" },
    { year:"2022", citation:"McGuinness et al. Mol Psychiatry. [PMID 35194166]", finding:"Gut microbiota dysbiosis in schizophrenia — Manovaha Srotas-gut axis parallels Purisha Vaha Srotas" },
    { year:"2022", citation:"Jutla, Foss-Feig, Veenstra-VanderWeele. Autism Res. [PMID 34967130]", finding:"ASD–Schizophrenia overlap: shared genetic architecture; Atatwabhinivesha features can coexist" },
    { year:"2022", citation:"Janas-Kozik et al. Psychiatr Pol. [PMID 37074823]", finding:"Polish guidelines on EOS: early intervention, Aripiprazole/Risperidone first-line; CBT essential" },
    { year:"2023", citation:"Pattnaik et al. Front Psychiatry. [PMID 36911129]", finding:"Clozapine in treatment-resistant COS: effective but needs careful monitoring (agranulocytosis risk)" },
    { year:"2024", citation:"Sabe et al. JAMA Netw Open. [PMID 38776083]", finding:"rTMS & tDCS meta-analysis: significant reduction of positive symptoms; adjunct to pharmacotherapy" },
    { year:"2024", citation:"Zinjurde & Neelesh. WJPR. DOI:10.20959/wjpr202416-33394", finding:"Atatvabhinivesha as Mahagada — psychosis features align with modern schizophrenia spectrum; Satvavajaya key" },
    { year:"2025", citation:"Fernando et al. Pharmacopsychiatry. [PMID 39547704]", finding:"Early treatment resistance in first-episode psychosis — predicts poor outcome; Ayurvedic add-ons may help" },
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// ════════════════════════════════════════════════════════════════
// SLIDE 18 — CONCLUSION & REFERENCES
// ════════════════════════════════════════════════════════════════
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    "Atatwabhinivesha, as described by Punarvasu Atreya, aligns closely with modern schizophrenia spectrum disorders — particularly in its features of false cognition, deranged intellect, and loss of discrimination.",
    "Kaumarabhritya has a unique role in managing Early Onset Schizophrenia (EOS) and Childhood Onset Schizophrenia (COS) through integrated Ayurvedic and modern approaches.",
    "Medhya Rasayana drugs (Brahmi, Shankhapushpi, Vacha, Sarpagandha) offer neuroprotective and antipsychotic benefits, warranting further clinical trials.",
    "Satvavajaya Chikitsa (psycho-spiritual counselling, play therapy, dhyana) provides a holistic non-pharmacological dimension that complements modern CBT.",
    "Panchakarma (Nasya, Basti, Shirodhara) as Shodhana and Shamana can be integrated as adjunct therapy alongside modern antipsychotics.",
    "An integrated approach — marrying Ayurvedic wisdom with modern evidence-based psychiatry — offers the best hope for comprehensive management of these children.",
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    "1. Charaka Samhita (Chikitsa Sthana 10) — Atatwabhinivesha Chikitsa",
    "2. Ashtanga Hridayam (Uttarasthana 6–7) — Unmada, Apasmara Chikitsa",
    "3. Kashyapa Samhita — Bala Manovikara",
    "4. DSM-5-TR — APA, 2022 (Schizophrenia Spectrum & Other Psychotic Disorders)",
    "5. ICD-11 — WHO 2022 (6A20 — Schizophrenia)",
    "6. Goldman & Schafer, Cecil Medicine 26/e, Ch.362, pp.2487–2530",
    "7. Goodman & Gilman, Pharmacology 13/e, Ch.19 (Antipsychotic Drugs)",
    "8. Nelson Textbook of Pediatrics 21/e — Child & Adolescent Psychiatry",
    "9. GBD 2019 Collaborators. Lancet Psychiatry 2022 [PMID 35026139]",
    "10. Janas-Kozik et al. Psychiatr Pol 2022 [PMID 37074823]",
    "11. Sabe et al. JAMA Netw Open 2024 [PMID 38776083]",
    "12. Pattnaik et al. Front Psychiatry 2023 [PMID 36911129]",
    "13. Zinjurde & Neelesh. WJPR 2024. DOI:10.20959/wjpr202416-33394",
    "14. CCRAS Monograph — Ayurvedic Management of Unmada (Schizophrenia)",
  ];
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