const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Nursing Education";
pres.title = "Schizophrenia: Comprehensive Nursing Guide";

// ─── COLOR PALETTE ───────────────────────────────────────────────────────────
const C = {
  darkBg:    "1A1A2E",   // deep navy – title / section dividers
  midBg:     "16213E",   // darker navy
  accent1:   "0F3460",   // strong blue
  accent2:   "E94560",   // vivid rose – highlights / key terms
  teal:      "0A9396",   // teal – positive symptoms
  amber:     "E9C46A",   // amber – warnings / side effects
  green:     "2A9D8F",   // green – positive actions
  white:     "FFFFFF",
  offWhite:  "E8E8F0",
  lightGray: "B0B8CC",
  darkText:  "1A1A2E",
  cardBg:    "22274A",
};

// ─── HELPER FUNCTIONS ─────────────────────────────────────────────────────────

function titleSlide(pres) {
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function contentSlide(pres, title, bullets, opts = {}) {
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function tableSlide(pres, title, headers, rows, opts = {}) {
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// ═══════════════════════════════════════════════════════════════════
// BUILD ALL SLIDES
// ═══════════════════════════════════════════════════════════════════

// SLIDE 1 – Title
titleSlide(pres);

// SLIDE 2 – Agenda / Overview
{
  const s = pres.addSlide();
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    { num: "01", title: "What is Schizophrenia?",         color: C.teal },
    { num: "02", title: "Epidemiology & Risk Factors",    color: C.accent2 },
    { num: "03", title: "Pathophysiology",                color: C.green },
    { num: "04", title: "DSM-5 Diagnosis & Criteria",     color: C.amber },
    { num: "05", title: "Symptoms: Positive & Negative",  color: C.teal },
    { num: "06", title: "Nursing Assessment",             color: C.accent2 },
    { num: "07", title: "Pharmacological Treatment",      color: C.green },
    { num: "08", title: "Side Effects & Monitoring",      color: C.amber },
    { num: "09", title: "Nursing Interventions & Care",   color: C.teal },
    { num: "10", title: "Psychosocial Rehabilitation",    color: C.accent2 },
    { num: "11", title: "Crisis Management & Safety",     color: C.green },
    { num: "12", title: "Family & Discharge Education",   color: C.amber },
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}

// ──────────────────────────────────────────────────────────────────────────────
// SECTION 1 – DEFINITION
// ──────────────────────────────────────────────────────────────────────────────
sectionSlide(pres, "01", "What is Schizophrenia?", "Understanding the disorder fundamentals");

contentSlide(pres, "Definition of Schizophrenia", [
  { text: "Schizophrenia is a severe, chronic mental disorder characterised by disruptions in thinking, perception, emotions, language, sense of self, and behaviour", bold: true },
  "It is a heterogeneous syndrome – no single feature is pathognomonic (diagnostic by itself)",
  "Onset typically in late adolescence to early adulthood (peak age 20–35 years)",
  "Males tend to present 3–5 years earlier than females",
  "Course is often chronic with episodic exacerbations and remissions",
  "About 10% of patients with schizophrenia die by suicide",
  "Source: Harrison's Principles of Internal Medicine, 22nd Edition (2025)",
], { accentColor: C.teal });

contentSlide(pres, "Historical Background", [
  "Emil Kraepelin (1896): First clearly separated schizophrenia from bipolar psychosis; called it 'dementia praecox' (early deterioration)",
  "Eugen Bleuler (1911): Renamed 'schizophrenia' (split mind); described the 4 As – Affect, Autism, Ambivalence, Associations",
  { text: "DSM-5 (2013) and ICD-11 (2019): Current diagnostic standards used globally", bold: true },
  "Schizophrenia is NOT split personality (that is dissociative identity disorder)",
  "The diagnosis applies when symptoms persist for ≥ 6 months with at least 1 month of active psychosis",
  "Spectrum includes: Brief Psychotic Disorder, Schizophreniform Disorder, Schizophrenia, Schizoaffective Disorder",
], { accentColor: C.teal });

// ──────────────────────────────────────────────────────────────────────────────
// SECTION 2 – EPIDEMIOLOGY
// ──────────────────────────────────────────────────────────────────────────────
sectionSlide(pres, "02", "Epidemiology & Risk Factors", "Who is affected and why?");

{
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    fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0,
  });
  const stats = [
    { label: "Lifetime Prevalence", value: "~1%", sub: "Worldwide", color: C.teal },
    { label: "Annual Incidence", value: "15/100,000", sub: "New cases per year", color: C.accent2 },
    { label: "US Episodes/yr", value: "~300,000", sub: "Acute episodes", color: C.green },
    { label: "Suicide Risk", value: "~10%", sub: "Lifetime risk", color: C.amber },
  ];
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  // additional bullets
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    { text: "Equal sex incidence, but males present ~3–5 years earlier", options: { bullet: true, color: C.offWhite, fontSize: 14, breakLine: true } },
    { text: "~$155.7 billion in direct + indirect costs annually in the USA (Harrison's 2025)", options: { bullet: true, color: C.offWhite, fontSize: 14, breakLine: true } },
    { text: "Higher rates in urban areas, lower socioeconomic groups (downward drift)", options: { bullet: true, color: C.offWhite, fontSize: 14, breakLine: false } },
  ];
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contentSlide(pres, "Risk Factors for Schizophrenia", [
  { text: "GENETIC FACTORS", bold: true, highlight: true },
  "General population risk: ~1% | First-degree relatives: ~6.6% | Both parents affected: 40%",
  "Monozygotic twin concordance: 50% | Dizygotic twin concordance: 10%",
  "Multiple gene loci involved; CNV (copy number variants) at 22q11, 15q13.3, 1q21",
  { text: "ENVIRONMENTAL & NEURODEVELOPMENTAL FACTORS", bold: true, highlight: true },
  "Prenatal complications, viral infections during pregnancy (influenza), malnutrition",
  "Winter/spring birth; maternal stress; urban upbringing; advanced paternal age",
  { text: "SUBSTANCE USE (2023–2025 Updates)", bold: true, highlight: true },
  "Cannabis use in adolescence strongly linked to earlier onset and worse outcomes",
  "Cannabis, amphetamines, and stimulants can precipitate or worsen psychosis",
], { accentColor: C.accent2 });

// ──────────────────────────────────────────────────────────────────────────────
// SECTION 3 – PATHOPHYSIOLOGY
// ──────────────────────────────────────────────────────────────────────────────
sectionSlide(pres, "03", "Pathophysiology", "Brain mechanisms nurses need to understand");

contentSlide(pres, "Neurobiological Basis of Schizophrenia", [
  { text: "DOPAMINE HYPOTHESIS", bold: true, highlight: true },
  "All effective antipsychotics block dopamine D2 receptors – strongest evidence for dopamine's role",
  "Subcortical DA HYPERFUNCTION (striatum): drives positive symptoms (hallucinations, delusions)",
  "Prefrontal cortex DA HYPOFUNCTION: drives negative symptoms and cognitive deficits (more treatment-refractory)",
  "Psychostimulants increasing DA can induce or worsen psychosis",
  { text: "GLUTAMATE HYPOTHESIS", bold: true, highlight: true },
  "NMDA receptor hypofunction in glutamatergic neurons explains some negative + cognitive symptoms",
  "PCP (phencyclidine) and ketamine block NMDA receptors and mimic schizophrenia symptoms",
  { text: "STRUCTURAL BRAIN CHANGES", bold: true, highlight: true },
  "Reduced grey matter; enlarged lateral ventricles; subtle cortical cytoarchitectural disruptions",
  "Non-gliotic neuropathology – damage is neurodevelopmental, not degenerative",
], { accentColor: C.green });

// ──────────────────────────────────────────────────────────────────────────────
// SECTION 4 – DIAGNOSIS
// ──────────────────────────────────────────────────────────────────────────────
sectionSlide(pres, "04", "DSM-5 Diagnostic Criteria", "Clinical standards for diagnosis");

contentSlide(pres, "DSM-5 Criteria for Schizophrenia (2013)", [
  { text: "CRITERION A – At least 2 of the following (≥1 must be from first 3):", bold: true, highlight: true },
  "1. Delusions",
  "2. Hallucinations",
  "3. Disorganised speech",
  "4. Grossly disorganised or catatonic behaviour",
  "5. Negative symptoms (diminished expression, avolition)",
  { text: "CRITERION B – Significant decline in functioning (work, relationships, self-care)", bold: true, highlight: true },
  { text: "CRITERION C – Continuous signs for ≥ 6 months (including ≥1 month active phase)", bold: true, highlight: true },
  { text: "CRITERIA D, E, F – Rule out schizoaffective, mood disorders, substances, medical conditions", bold: true, highlight: true },
], { accentColor: C.amber });

twoColSlide(pres,
  "Differential Diagnosis – What to Rule Out",
  "Primary Psychiatric", [
    "Schizoaffective disorder – mood episodes + psychosis",
    "Bipolar disorder with psychotic features",
    "Major depression with psychosis",
    "Delusional disorder (no disorganisation)",
    "Brief psychotic disorder (< 1 month)",
    "Schizophreniform disorder (1–6 months)",
    "Personality disorders (schizotypal, schizoid)",
  ],
  "Medical & Substance Causes", [
    "Drug-induced psychosis (cannabis, amphetamines, PCP, cocaine)",
    "Alcohol withdrawal",
    "Autoimmune encephalitis (Anti-NMDA receptor)",
    "CNS infections (HSV encephalitis, neurosyphilis)",
    "Epilepsy – temporal lobe seizures",
    "Thyroid disorders, Wilson's disease",
    "Parkinson's disease medications",
  ],
  { leftColor: C.teal, rightColor: C.accent2 }
);

// ──────────────────────────────────────────────────────────────────────────────
// SECTION 5 – SYMPTOMS
// ──────────────────────────────────────────────────────────────────────────────
sectionSlide(pres, "05", "Symptom Profile", "Positive, Negative & Cognitive dimensions");

twoColSlide(pres,
  "Positive vs Negative Symptoms",
  "POSITIVE Symptoms (Added experiences)", [
    "Delusions – fixed false beliefs (persecutory, grandiose, referential)",
    "Hallucinations – auditory most common (command hallucinations are high-risk)",
    "Disorganised thinking / speech (loosening of associations, word salad, neologisms)",
    "Grossly disorganised behaviour (bizarre actions, poor self-care)",
    "Catatonia – stupor, waxy flexibility, posturing, mutism",
    "Agitation and aggression during acute episodes",
  ],
  "NEGATIVE Symptoms (Absence of normal function)", [
    "Affective flattening – reduced emotional expression",
    "Alogia – poverty of speech",
    "Avolition – lack of motivation and goal-directed activity",
    "Anhedonia – inability to feel pleasure",
    "Asociality – social withdrawal, diminished interpersonal interaction",
    "Attention and working memory deficits",
    "Negative symptoms: poor long-term prognosis; respond poorly to medication",
  ],
  { leftColor: C.accent2, rightColor: C.teal }
);

contentSlide(pres, "Cognitive Symptoms & Course of Illness", [
  { text: "COGNITIVE SYMPTOMS (affect ~80% of patients):", bold: true, highlight: true },
  "Deficits in working memory, attention, processing speed, executive function",
  "Present before psychosis onset; related to functional disability",
  "Often more disabling for daily life than positive symptoms",
  { text: "COURSE OF ILLNESS:", bold: true, highlight: true },
  "Prodromal phase: social withdrawal, odd beliefs, decreased function (months–years before diagnosis)",
  "Acute phase: florid positive symptoms requiring treatment",
  "Residual phase: negative symptoms dominate; some functional recovery possible",
  "As patients age, positive symptoms often attenuate",
  "~10% achieve full recovery; chronic course is typical for the majority",
  "Schizoaffective disorder: schizophrenia symptoms + independent mood episodes",
], { accentColor: C.green });

// ──────────────────────────────────────────────────────────────────────────────
// SECTION 6 – NURSING ASSESSMENT
// ──────────────────────────────────────────────────────────────────────────────
sectionSlide(pres, "06", "Nursing Assessment", "Systematic evaluation for nursing staff");

contentSlide(pres, "Initial Nursing Assessment", [
  { text: "MENTAL STATUS EXAMINATION (MSE):", bold: true, highlight: true },
  "Appearance, behaviour, speech, mood, affect, thought process, thought content, perception, cognition, insight & judgement",
  { text: "SCREENING TOOLS (mandatory since 2024 guidelines):", bold: true, highlight: true },
  "PANSS (Positive and Negative Syndrome Scale) – standard symptom severity measure",
  "BPRS (Brief Psychiatric Rating Scale) – quick severity screen",
  "Columbia Suicide Severity Rating Scale (C-SSRS) – suicide risk (mandatory)",
  "AUDIT / DAST-10 – substance use screening (cannabis and stimulants especially)",
  { text: "PHYSICAL HEALTH ASSESSMENT:", bold: true, highlight: true },
  "Vital signs, weight, BMI, waist circumference (baseline for metabolic monitoring)",
  "ECG (QTc interval – baseline before antipsychotics)",
  "Labs: FBC, metabolic panel, fasting glucose, HbA1c, lipid profile, LFTs, TFTs, prolactin",
], { accentColor: C.accent2 });

contentSlide(pres, "Nursing Diagnosis (NANDA-Based)", [
  { text: "Priority Nursing Diagnoses:", bold: true, highlight: true },
  "1. Disturbed sensory perception related to hallucinations/delusions",
  "2. Disturbed thought processes related to psychosis",
  "3. Social isolation related to negative symptoms and stigma",
  "4. Risk for self-directed/other-directed violence related to psychosis",
  "5. Impaired self-care deficit related to avolition and cognitive impairment",
  "6. Non-compliance with medication regimen related to lack of insight",
  "7. Disturbed sleep pattern related to psychotic symptoms",
  "8. Risk for metabolic syndrome related to antipsychotic medications",
  "9. Caregiver role strain related to caring for person with chronic mental illness",
  "10. Ineffective coping related to chronic mental illness",
], { accentColor: C.accent2 });

// ──────────────────────────────────────────────────────────────────────────────
// SECTION 7 – PHARMACOLOGICAL TREATMENT
// ──────────────────────────────────────────────────────────────────────────────
sectionSlide(pres, "07", "Pharmacological Treatment", "Antipsychotics: evidence-based prescribing");

contentSlide(pres, "Antipsychotic Medications: Overview", [
  { text: "MECHANISM OF ACTION:", bold: true, highlight: true },
  "All antipsychotics primarily block dopamine D2 receptors in subcortical pathways",
  "Atypical agents also block serotonin (5-HT2A) receptors – reduces EPS and may improve negative symptoms",
  { text: "CLASSIFICATION:", bold: true, highlight: true },
  "First-Generation (FGA / Typical): e.g. haloperidol, chlorpromazine, fluphenazine",
  "Second-Generation (SGA / Atypical): e.g. clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, paliperidone",
  "Third-Generation: Aripiprazole, cariprazine (partial D2 agonists) – better for negative symptoms",
  { text: "KEY 2024 EVIDENCE (Lancet Psychiatry, Efthimiou et al. 2024):", bold: true, highlight: true },
  "Clozapine and long-acting injectable (LAI) antipsychotics show greatest reduction in relapse rates",
  "Cariprazine may be superior to risperidone specifically for predominantly negative symptom patients",
  "No clear efficacy difference among most SGAs for overall symptom control",
], { accentColor: C.green });

tableSlide(pres,
  "Common Antipsychotics: Nursing Reference",
  ["Drug", "Class", "Route", "Key Feature", "Main Concern"],
  [
    ["Haloperidol", "FGA", "PO/IM/IV", "Acute agitation", "High EPS risk"],
    ["Chlorpromazine", "FGA", "PO/IM", "Sedating", "Orthostatic hypotension"],
    ["Clozapine", "SGA", "PO only", "Treatment-resistant; best for suicide", "Agranulocytosis – mandatory weekly/bi-weekly WBC"],
    ["Olanzapine", "SGA", "PO/IM", "Effective, sedating", "Weight gain, metabolic syndrome"],
    ["Risperidone", "SGA", "PO/LAI", "Widely used", "EPS at higher doses, hyperprolactinaemia"],
    ["Quetiapine", "SGA", "PO", "Low EPS, sedating", "Metabolic effects"],
    ["Aripiprazole", "3rd Gen", "PO/IM/LAI", "Weight neutral, partial D2 agonist", "Akathisia"],
    ["Cariprazine", "3rd Gen", "PO", "Better for negative symptoms", "Akathisia"],
    ["Paliperidone", "SGA", "PO/LAI monthly", "LAI available", "Hyperprolactinaemia"],
  ],
  { accentColor: C.green }
);

contentSlide(pres, "Treatment-Resistant Schizophrenia (TRS)", [
  { text: "DEFINITION:", bold: true, highlight: true },
  "Failure to respond to ≥ 2 adequate trials of different antipsychotics (adequate = therapeutic dose for ≥ 6 weeks)",
  "Affects ~30% of patients with schizophrenia",
  { text: "CLOZAPINE – First-line for TRS (Practice Guideline, Correll et al. CNS Drugs 2022):", bold: true, highlight: true },
  "Superior efficacy over all other antipsychotics for TRS",
  "Reduces suicidality significantly (FDA-approved for suicidal schizophrenia)",
  "NURSING ROLE: Mandatory WBC monitoring before initiation and ongoing (weekly x 6 months, then bi-weekly)",
  "Monitor for early signs: fever, sore throat – report immediately",
  { text: "CLOZAPINE NURSING MONITORING CHECKLIST:", bold: true, highlight: true },
  "WBC > 3500/mm³ and ANC > 2000/mm³ required before each dispensing",
  "Enrol patient in REMS (Risk Evaluation and Mitigation Strategy) programme",
], { accentColor: C.green });

contentSlide(pres, "Long-Acting Injectable (LAI) Antipsychotics", [
  { text: "WHY LAI? (Key for Nursing Practice):", bold: true, highlight: true },
  "Removes daily adherence burden – given every 2 weeks to 3 months depending on drug",
  "Evidence: LAIs associated with lowest relapse rates (Goldman-Cecil, 2025)",
  "Allows nurses to verify administration; detects non-adherence early",
  { text: "AVAILABLE LAIs:", bold: true, highlight: true },
  "Haloperidol decanoate – IM every 4 weeks",
  "Fluphenazine decanoate – IM every 2–3 weeks",
  "Risperidone LAI (Risperdal Consta) – IM every 2 weeks",
  "Paliperidone palmitate (Invega Sustenna) – IM monthly; Invega Trinza – IM every 3 months",
  "Aripiprazole monohydrate (Abilify Maintena) – IM monthly",
  { text: "NURSING RESPONSIBILITY:", bold: true, highlight: true },
  "Rotate injection sites; document site and lot number; observe 30 minutes post-injection",
], { accentColor: C.green });

// ──────────────────────────────────────────────────────────────────────────────
// SECTION 8 – SIDE EFFECTS
// ──────────────────────────────────────────────────────────────────────────────
sectionSlide(pres, "08", "Side Effects & Monitoring", "What nurses must watch for");

cardRowSlide(pres, "Extrapyramidal Side Effects (EPS)", [
  {
    label: "Acute Dystonia",
    color: C.accent2,
    items: ["Sudden painful muscle spasm", "Neck, jaw, tongue", "Onset: hours–days", "Treat: IM benztropine or diphenhydramine", "More common with FGAs"],
  },
  {
    label: "Akathisia",
    color: C.amber,
    items: ["Motor restlessness", "Unable to sit still", "Can increase suicide risk", "Treat: propranolol or benzodiazepine", "Common with aripiprazole"],
  },
  {
    label: "Parkinsonism",
    color: C.teal,
    items: ["Tremor, rigidity, bradykinesia", "Shuffling gait, mask facies", "Treat: reduce dose or add anticholinergic", "Less common with SGAs"],
  },
  {
    label: "Tardive Dyskinesia",
    color: C.green,
    items: ["Involuntary repetitive movements", "Face, tongue, limbs", "Chronic; may be irreversible", "Risk reduced with SGAs", "Treat: valbenazine, deutetrabenazine"],
  },
], { accentColor: C.accent2 });

contentSlide(pres, "Metabolic Side Effects & Monitoring", [
  { text: "METABOLIC SYNDROME (major concern with SGAs, especially olanzapine, clozapine, quetiapine):", bold: true, highlight: true },
  "Weight gain, hyperglycaemia, dyslipidaemia, hypertension",
  "Increased risk of type 2 diabetes and cardiovascular disease",
  { text: "NURSING MONITORING SCHEDULE (2024 Guidelines):", bold: true, highlight: true },
  "Baseline: weight, BMI, fasting glucose, fasting lipids, blood pressure, waist circumference",
  "4 weeks: weight",
  "8 weeks: weight",
  "12 weeks: weight, fasting glucose, fasting lipids, blood pressure",
  "Then every 3 months: weight | Annually: full metabolic panel",
  { text: "OTHER IMPORTANT SIDE EFFECTS:", bold: true, highlight: true },
  "Hyperprolactinaemia (risperidone) – galactorrhoea, menstrual irregularity, sexual dysfunction, osteoporosis",
  "QTc prolongation – baseline ECG required; avoid if QTc > 500ms",
  "Sedation – fall risk; patient education on driving and machinery",
], { accentColor: C.amber });

contentSlide(pres, "Neuroleptic Malignant Syndrome (NMS) – EMERGENCY", [
  { text: "⚠ LIFE-THREATENING EMERGENCY – Nurses must recognise immediately!", bold: true, highlight: true },
  { text: "CLASSIC TETRAD:", bold: true },
  "1. Hyperthermia (fever > 38°C, may exceed 41°C)",
  "2. Severe muscle rigidity ('lead-pipe' rigidity)",
  "3. Autonomic instability (BP fluctuations, tachycardia, diaphoresis, incontinence)",
  "4. Altered consciousness (confusion, stupor, coma)",
  { text: "INCIDENCE: 0.01–0.02% of antipsychotic-exposed patients; mortality if untreated: 10–20%", bold: true },
  { text: "NURSING ACTIONS:", bold: true, highlight: true },
  "STOP antipsychotic IMMEDIATELY – call medical team urgently",
  "Supportive care: cool the patient, IV fluids, monitor vitals",
  "Medical treatment: dantrolene, bromocriptine; ICU admission",
  "Document time of onset, all medications, vital sign trend",
], { accentColor: C.accent2 });

// ──────────────────────────────────────────────────────────────────────────────
// SECTION 9 – NURSING INTERVENTIONS
// ──────────────────────────────────────────────────────────────────────────────
sectionSlide(pres, "09", "Nursing Interventions & Care", "Evidence-based nursing practice");

contentSlide(pres, "Nursing Interventions: Psychosis Management", [
  { text: "COMMUNICATION STRATEGIES:", bold: true, highlight: true },
  "Use calm, clear, simple language; avoid arguing with delusions",
  "Do NOT reinforce hallucinations (do not agree they are real) but acknowledge patient's distress",
  "Maintain therapeutic nurse-patient relationship – trust is foundational",
  "Use open-ended questions; avoid overloading with information",
  { text: "SAFETY MEASURES:", bold: true, highlight: true },
  "Maintain safe environment: remove potential weapons, ensure line of sight",
  "De-escalation techniques: space, tone, non-threatening posture, minimal stimulation",
  "Document any threats or command hallucinations in detail",
  { text: "PROMOTING ORIENTATION:", bold: true, highlight: true },
  "Consistent daily routines reduce anxiety and confusion",
  "Reality orientation activities; structured activities and occupational therapy",
], { accentColor: C.teal });

contentSlide(pres, "Medication Adherence Nursing Strategies", [
  { text: "WHY ADHERENCE IS A CRITICAL NURSING PRIORITY:", bold: true, highlight: true },
  "Non-adherence is the most common cause of relapse; 50–75% of patients stop medication within a year",
  "Lack of insight (anosognosia) is the primary barrier – patients may not believe they are unwell",
  { text: "EVIDENCE-BASED NURSING STRATEGIES:", bold: true, highlight: true },
  "Motivational interviewing – non-confrontational exploration of ambivalence",
  "Psychoeducation about medication benefits and side effect management",
  "Simplify regimen: once-daily dosing; consider LAI for chronic non-adherers",
  "Involve family/carers in medication support and monitoring",
  "THERAPEUTIC DRUG MONITORING – check blood levels where available (clozapine, haloperidol)",
  { text: "2025 UPDATE – Peer-support specialists:", bold: true, highlight: true },
  "Integrate peer-support specialists into nursing workflows (2025 guidelines)",
  "Culturally sensitive care to reduce health disparities in marginalised communities",
], { accentColor: C.teal });

contentSlide(pres, "Physical Health Nursing Care", [
  { text: "Patients with schizophrenia die 15–20 years earlier than general population (largely preventable causes):", bold: true, highlight: true },
  "Cardiovascular disease, respiratory disease, diabetes, obesity",
  { text: "NURSING RESPONSIBILITIES:", bold: true, highlight: true },
  "Annual physical health review including metabolic monitoring",
  "Smoking cessation support (70% of patients with schizophrenia smoke)",
  "Promote physical activity – structured exercise programmes",
  "Nutritional assessment and dietary counselling; weight management",
  "Sexual health and reproductive health considerations",
  "Dental care – poor oral hygiene common due to anticholinergic effects",
  "Screen for hypertension, diabetes, dyslipidaemia annually",
  { text: "SLEEP HYGIENE:", bold: true, highlight: true },
  "Sleep disturbance is near-universal; assess and address sleep quality",
  "Educate on sleep hygiene; avoid screen time, stimulants before bed",
], { accentColor: C.teal });

// ──────────────────────────────────────────────────────────────────────────────
// SECTION 10 – PSYCHOSOCIAL
// ──────────────────────────────────────────────────────────────────────────────
sectionSlide(pres, "10", "Psychosocial Rehabilitation", "Beyond medication – holistic recovery");

contentSlide(pres, "Psychosocial Interventions", [
  { text: "COMPREHENSIVE PSYCHOSOCIAL REHABILITATION – KEY COMPONENTS:", bold: true, highlight: true },
  { text: "1. Cognitive Behavioural Therapy for Psychosis (CBTp):", bold: true },
  "Helps patients challenge distressing beliefs; manage symptoms; reduce relapse",
  { text: "2. Social Skills Training:", bold: true },
  "Structured practice of communication, self-care, community living skills",
  { text: "3. Family Therapy / Psychoeducation:", bold: true },
  "High expressed emotion (EE) in family is linked to relapse – reduce EE through education",
  { text: "4. Assertive Community Treatment (ACT):", bold: true },
  "Multi-disciplinary team delivers care in community; reduces hospitalisation",
  { text: "5. Supported Employment (Individual Placement & Support – IPS):", bold: true },
  "Evidence-based approach – helps patients gain and maintain competitive employment",
  { text: "6. Early Intervention Programmes:", bold: true },
  "At first-episode psychosis (FEP) – early intensive treatment improves long-term outcomes",
], { accentColor: C.accent2 });

contentSlide(pres, "Stigma, Culture & Person-Centred Care", [
  { text: "STIGMA IS A MAJOR BARRIER TO CARE:", bold: true, highlight: true },
  "Self-stigma leads to reduced help-seeking, medication avoidance, social isolation",
  "Nurses should use person-first language: 'person with schizophrenia', not 'schizophrenic'",
  "Challenge stigmatising language and attitudes in clinical settings",
  { text: "CULTURALLY SENSITIVE CARE (2025 Guidelines Emphasis):", bold: true, highlight: true },
  "Assess cultural background – beliefs about mental illness differ across cultures",
  "Use trained interpreters (not family members) for assessment",
  "Be aware of cultural expressions of distress (idioms of distress)",
  "Address structural barriers: poverty, housing instability, discrimination",
  { text: "RECOVERY-ORIENTED PRACTICE:", bold: true, highlight: true },
  "Support patients' personal goals and values, not just symptom reduction",
  "Peer support workers (lived experience) integrated into care teams",
  "Emphasise meaningful activity, relationships, community participation",
], { accentColor: C.accent2 });

// ──────────────────────────────────────────────────────────────────────────────
// SECTION 11 – CRISIS & SAFETY
// ──────────────────────────────────────────────────────────────────────────────
sectionSlide(pres, "11", "Crisis Management & Safety", "Risk assessment and de-escalation");

contentSlide(pres, "Suicide Risk Assessment in Schizophrenia", [
  { text: "⚠ ~10% of patients with schizophrenia die by suicide – nurses must assess regularly", bold: true, highlight: true },
  { text: "HIGH-RISK FEATURES:", bold: true },
  "Command hallucinations instructing self-harm",
  "Insight into illness (awareness of functional decline)",
  "Recent discharge from hospital; first 2 weeks post-discharge = highest risk period",
  "Depressive symptoms and hopelessness",
  "Previous suicide attempts (strongest predictor)",
  "Young males with chronic illness and multiple relapses",
  { text: "PROTECTIVE FACTORS:", bold: true },
  "Therapeutic alliance; family support; religious beliefs; reasons for living",
  "Access to mental health services; medication adherence; social support",
  { text: "NURSING ACTION:", bold: true, highlight: true },
  "Use Columbia Suicide Severity Rating Scale (C-SSRS) at every assessment",
  "Safety planning: agree 'safe coping' steps and emergency contacts with patient",
  "Clozapine is the ONLY antipsychotic with FDA approval for reducing suicidality",
], { accentColor: C.accent2 });

contentSlide(pres, "De-escalation & Acute Aggression Management", [
  { text: "PREVENTION IS THE PRIORITY:", bold: true, highlight: true },
  "Identify early warning signs: increased pacing, loud voice, clenched fists, threatening statements",
  "Document and communicate risk to all team members; update care plan",
  { text: "DE-ESCALATION TECHNIQUES (NICE-aligned, 2024):", bold: true, highlight: true },
  "Ensure personal safety: stand at angle, near exit, never block patient",
  "Maintain calm, non-threatening posture and tone of voice",
  "Offer personal space; reduce environmental stimuli",
  "Use simple, clear language; validate emotions without validating threats",
  "Offer choices to restore sense of control",
  { text: "RAPID TRANQUILISATION (if de-escalation fails):", bold: true, highlight: true },
  "Lorazepam IM or oral preferred where possible",
  "Haloperidol IM for acute psychotic agitation",
  "Monitor: respiratory rate, consciousness, BP for 1 hour post-injection",
  { text: "POST-INCIDENT REVIEW:", bold: true, highlight: true },
  "Review incident with team; complete documentation; offer patient debrief",
], { accentColor: C.accent2 });

// ──────────────────────────────────────────────────────────────────────────────
// SECTION 12 – FAMILY & DISCHARGE
// ──────────────────────────────────────────────────────────────────────────────
sectionSlide(pres, "12", "Family Education & Discharge Planning", "Preparing for community living");

contentSlide(pres, "Family & Caregiver Education", [
  { text: "PSYCHOEDUCATION FOR FAMILIES:", bold: true, highlight: true },
  "Explain the illness as a brain disorder – reduce blame and guilt",
  "Teach warning signs of relapse: sleep disturbance, social withdrawal, increased suspiciousness, neglect of self-care",
  "Educate about medications: purpose, timing, side effects, importance of adherence",
  { text: "EXPRESSED EMOTION (EE) REDUCTION:", bold: true, highlight: true },
  "High EE (hostility, criticism, over-involvement) doubles relapse risk",
  "Teach: calm communication, realistic expectations, personal space",
  "Family therapy to reduce criticism and hostility",
  { text: "PRACTICAL SUPPORT:", bold: true, highlight: true },
  "Carer support groups (e.g. NAMI, SANE, Rethink Mental Illness)",
  "Respite care services; financial/legal support information",
  "Encourage carers to take care of their own mental health",
  "Share emergency contact numbers and what to do in crisis",
], { accentColor: C.amber });

contentSlide(pres, "Discharge Planning Checklist", [
  { text: "BEFORE DISCHARGE – Nursing Responsibilities:", bold: true, highlight: true },
  "✔ Medication: ensure adequate supply; educate on dose, timing, side effects",
  "✔ Outpatient follow-up: appointment confirmed within 1–2 weeks of discharge",
  "✔ Community mental health team (CMHT) referral and care coordinator identified",
  "✔ Crisis plan: documented and shared with patient, family, GP",
  "✔ Relapse signature: patient identifies personal early warning signs",
  "✔ Safety planning: remove access to means; emergency contacts agreed",
  "✔ Substance use: referral to dual diagnosis services if needed",
  { text: "POST-DISCHARGE HIGH-RISK PERIOD:", bold: true, highlight: true },
  "First 2 weeks after discharge = highest risk for suicide and readmission",
  "Schedule early telephone follow-up call within 48–72 hours",
  "Assertive outreach if patient fails to attend follow-up",
], { accentColor: C.amber });

// ──────────────────────────────────────────────────────────────────────────────
// SUMMARY SLIDE
// ──────────────────────────────────────────────────────────────────────────────
contentSlide(pres, "Key Nursing Takeaways", [
  { text: "1. ASSESS THOROUGHLY:", bold: true, highlight: true },
  "Suicide risk (C-SSRS), substance use, physical health and metabolic parameters at every encounter",
  { text: "2. MONITOR MEDICATIONS:", bold: true, highlight: true },
  "Know EPS, NMS, metabolic and prolactin-related side effects; act promptly",
  { text: "3. SUPPORT ADHERENCE:", bold: true, highlight: true },
  "Use motivational interviewing; consider LAI; involve family; psychoeducate",
  { text: "4. DE-ESCALATE SAFELY:", bold: true, highlight: true },
  "Use structured de-escalation; document; post-incident review",
  { text: "5. HOLISTIC RECOVERY:", bold: true, highlight: true },
  "Physical health, psychosocial rehabilitation, employment, housing and social inclusion",
  { text: "6. FAMILY PARTNERSHIP:", bold: true, highlight: true },
  "Reduce expressed emotion; educate on warning signs; involve in discharge planning",
  { text: "7. DISCHARGE SAFETY:", bold: true, highlight: true },
  "Follow-up within 1–2 weeks; 48-hr call; crisis plan; remove access to means",
], { accentColor: C.teal });

// REFERENCES
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    { text: "1. Harrison's Principles of Internal Medicine, 22nd Edition (2025). McGraw-Hill. Chapter: Psychiatric Disorders.", options: { bullet: true, color: C.offWhite, fontSize: 12, breakLine: true } },
    { text: "2. Goldman-Cecil Medicine International Edition (2025). Elsevier. Chapter 362: Schizophrenia.", options: { bullet: true, color: C.offWhite, fontSize: 12, breakLine: true } },
    { text: "3. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th Ed. Chapter: Antipsychotics.", options: { bullet: true, color: C.offWhite, fontSize: 12, breakLine: true } },
    { text: "4. Adams and Victor's Principles of Neurology, 12th Edition. Chapter: Schizophrenia.", options: { bullet: true, color: C.offWhite, fontSize: 12, breakLine: true } },
    { text: "5. Efthimiou O et al. Efficacy and effectiveness of antipsychotics in schizophrenia: network meta-analyses combining RCT and real-world data. Lancet Psychiatry 2024. PMID: 38215784", options: { bullet: true, color: C.amber, fontSize: 12, breakLine: true } },
    { text: "6. Correll CU et al. Guideline for initiating and managing clozapine in treatment-resistant schizophrenia. CNS Drugs 2022. PMID: 35759211", options: { bullet: true, color: C.amber, fontSize: 12, breakLine: true } },
    { text: "7. Pillinger T, Howes OD, Correll CU. Antipsychotic side-effects and personalised prescribing. Lancet Psychiatry 2023. PMID: 37774723", options: { bullet: true, color: C.amber, fontSize: 12, breakLine: true } },
    { text: "8. Wen J et al. Effectiveness of evidence-based nursing interventions in schizophrenia. Front Psychiatry 2025. PMID: 40821022", options: { bullet: true, color: C.amber, fontSize: 12, breakLine: true } },
    { text: "9. Molstrom IM et al. Prognosis of schizophrenia: systematic review and meta-analysis. Schizophr Res 2022. PMID: 36417817", options: { bullet: true, color: C.amber, fontSize: 12, breakLine: false } },
  ];
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// END SLIDE
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  s.addText("Thank You", {
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  s.addText("Questions & Discussion", {
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  s.addText("Schizophrenia: Evidence-Based Nursing Practice  |  2025", {
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  s.addText("Content based on Harrison's 22E (2025), Goldman-Cecil Medicine (2025),\nGoodman & Gilman's Pharmacology, and PubMed peer-reviewed literature 2022–2025", {
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