Create PPT on schizophrenia in detail for nursing students using recen

Create PPT on schizophrenia in detail for nursing students using recent guidelines, detailed diagram and mechanics

Reading File

Finding Sources

Searching PubMed

"schizophrenia"[MeSH Terms] AND "treatment guidelines"

Searching the Web

schizophrenia nursing guidelines 2024 2025 pathophysiology dopamine treatment

Reading File

Running Command

mkdir -p /home/daytona/workspace/schizophrenia-ppt && ls /home/daytona/workspace/

Writing File

~/schizophrenia-ppt/schizophrenia.js

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = 'LAYOUT_16x9';
pres.author = 'Orris Medical Education';
pres.title = 'Schizophrenia - A Comprehensive Guide for Nursing Students';

// ─── COLOUR PALETTE ──────────────────────────────────────────────────────────
const C = {
  dark:     '0A1628',   // deep navy (background)
  navy:     '0D2137',   // slide bg
  midBlue:  '1A4A7A',   // section panels
  accent:   '2196F3',   // electric blue accent
  gold:     'F5A623',   // highlight / callout
  teal:     '00BCD4',   // secondary accent
  green:    '4CAF50',   // positive/ok
  red:      'E53935',   // warning/danger
  orange:   'FF7043',   // side effects
  purple:   '7E57C2',   // mechanism
  white:    'FFFFFF',
  lightGray:'E8EFF8',
  textGray: 'B0C4DE',
};

// ─── HELPER FUNCTIONS ────────────────────────────────────────────────────────
function addSlide(bg) {
  const s = pres.addSlide();
  s.background = { color: bg || C.navy };
  return s;
}

function addSectionHeader(s, line1, line2, accentColor) {
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}

function boxedBullets(s, x, y, w, h, heading, items, headBg, bulletColor) {
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  s.addText(heading, { x: x + 0.12, y: y + 0.08, w: w - 0.24, h: 0.38, fontSize: 13, bold: true, color: bulletColor || C.gold, fontFace: 'Calibri', margin: 0 });
  // divider
  s.addShape(pres.ShapeType.line, { x: x + 0.12, y: y + 0.47, w: w - 0.24, h: 0, line: { color: bulletColor || C.accent, width: 0.8 } });
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    text: t,
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}

// ─── SLIDE 1 — TITLE ─────────────────────────────────────────────────────────
{
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  // diagonal gradient strip
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  s.addShape(pres.ShapeType.rect, { x: 6.5, y: 0, w: 3.5, h: 5.625, fill: { color: C.midBlue, transparency: 30 } });
  // accent bar
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.555, w: 10, h: 0.07, fill: { color: C.gold } });
  // brain icon placeholder (circle)
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  s.addText('🧠', { x: 7.0, y: 0.9, w: 2.4, h: 2.4, fontSize: 52, align: 'center', valign: 'middle' });

  s.addText('SCHIZOPHRENIA', { x: 0.5, y: 0.9, w: 6.2, h: 1.0, fontSize: 46, bold: true, color: C.white, fontFace: 'Calibri', charSpacing: 4 });
  s.addText('A Comprehensive Guide for Nursing Students', { x: 0.5, y: 1.95, w: 6.2, h: 0.5, fontSize: 18, color: C.accent, fontFace: 'Calibri', italic: true });
  // divider line
  s.addShape(pres.ShapeType.line, { x: 0.5, y: 2.55, w: 5.5, h: 0, line: { color: C.gold, width: 1.5 } });
  s.addText([
    { text: 'Based on: ', options: { bold: false, color: C.textGray } },
    { text: "Harrison's Principles 22E • Goodman & Gilman's • Adams & Victor's Neurology", options: { bold: false, color: C.white } }
  ], { x: 0.5, y: 2.75, w: 6.2, h: 0.4, fontSize: 11, fontFace: 'Calibri' });
  s.addText([
    { text: 'Guidelines: ', options: { bold: true, color: C.gold } },
    { text: 'INTEGRATE 2025 • VA/DoD CPG 2025 • DSM-5-TR', options: { color: C.white } }
  ], { x: 0.5, y: 3.2, w: 6.2, h: 0.4, fontSize: 11, fontFace: 'Calibri' });
  s.addText('June 2026', { x: 0.5, y: 4.8, w: 3, h: 0.3, fontSize: 10, color: C.textGray, fontFace: 'Calibri' });
}

// ─── SLIDE 2 — AGENDA ────────────────────────────────────────────────────────
{
  const s = addSlide();
  s.addText('Contents', { x: 0.4, y: 0.2, w: 9.2, h: 0.5, fontSize: 28, bold: true, color: C.white, fontFace: 'Calibri' });
  s.addShape(pres.ShapeType.line, { x: 0.4, y: 0.75, w: 9.2, h: 0, line: { color: C.accent, width: 1.5 } });

  const topics = [
    ['01', 'Definition & Overview', C.accent],
    ['02', 'Epidemiology & Risk Factors', C.teal],
    ['03', 'Pathophysiology & Mechanisms', C.purple],
    ['04', 'Clinical Features & Symptoms', C.gold],
    ['05', 'DSM-5-TR Diagnostic Criteria', C.green],
    ['06', 'Differential Diagnosis', C.orange],
    ['07', 'Pharmacological Treatment', C.red],
    ['08', 'Nursing Assessment & Care Plan', C.teal],
    ['09', 'Non-Pharmacological Interventions', C.accent],
    ['10', 'Complications & Prognosis', C.orange],
  ];

  topics.forEach(([num, title, col], i) => {
    const col2 = i >= 5;
    const x = col2 ? 5.2 : 0.4;
    const y = 0.95 + (i % 5) * 0.88;
    const w = 4.6;
    s.addShape(pres.ShapeType.roundRect, { x, y, w, h: 0.72, fill: { color: C.midBlue }, line: { color: col, width: 1 }, rectRadius: 0.08 });
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    s.addText(title, { x: x + 0.63, y: y + 0.12, w: w - 0.73, h: 0.48, fontSize: 13, color: C.white, fontFace: 'Calibri', valign: 'middle' });
  });
}

// ─── SLIDE 3 — DEFINITION ────────────────────────────────────────────────────
{
  const s = addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.accent } });
  s.addText('DEFINITION & OVERVIEW', { x: 0.3, y: 0.08, w: 9.4, h: 0.38, fontSize: 18, bold: true, color: C.white, fontFace: 'Calibri', margin: 0 });

  // large definition box
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 0.7, w: 9.4, h: 1.7, fill: { color: C.midBlue }, line: { color: C.accent, width: 2 }, rectRadius: 0.1 });
  s.addText([
    { text: '"', options: { fontSize: 48, bold: true, color: C.gold } },
    { text: 'Schizophrenia is a heterogeneous syndrome characterized by perturbations of language, perception, thinking, social activity, affect, and volition. It commonly begins in late adolescence with an insidious onset, often progressing from social withdrawal and perceptual distortions to recurrent delusions and hallucinations.', options: { fontSize: 13, color: C.white, italic: true } }
  ], { x: 0.5, y: 0.75, w: 9.1, h: 1.6, fontFace: 'Calibri', valign: 'middle' });
  s.addText("— Harrison's Principles of Internal Medicine 22E", { x: 0.5, y: 2.3, w: 9, h: 0.3, fontSize: 10, color: C.textGray, fontFace: 'Calibri', italic: true, align: 'right' });

  // key facts row
  const facts = [
    ['🌍', 'Prevalence', '~0.85–1.5%\nWorldwide'],
    ['📅', 'Onset', 'Late teens –\nearly 30s'],
    ['⚡', 'Acute Cases', '300,000/yr\n(USA)'],
    ['💰', 'Economic Burden', '$155.7B\n(USA, direct+indirect)'],
  ];
  facts.forEach(([icon, label, val], i) => {
    const x = 0.3 + i * 2.38;
    s.addShape(pres.ShapeType.roundRect, { x, y: 2.65, w: 2.2, h: 2.7, fill: { color: C.dark }, line: { color: C.teal, width: 1 }, rectRadius: 0.1 });
    s.addText(icon, { x, y: 2.75, w: 2.2, h: 0.55, fontSize: 26, align: 'center', valign: 'middle' });
    s.addText(label, { x, y: 3.3, w: 2.2, h: 0.35, fontSize: 11, bold: true, color: C.teal, fontFace: 'Calibri', align: 'center' });
    s.addText(val, { x, y: 3.65, w: 2.2, h: 1.5, fontSize: 14, bold: true, color: C.white, fontFace: 'Calibri', align: 'center', valign: 'top' });
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}

// ─── SLIDE 4 — EPIDEMIOLOGY ──────────────────────────────────────────────────
{
  const s = addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.teal } });
  s.addText('EPIDEMIOLOGY & RISK FACTORS', { x: 0.3, y: 0.08, w: 9.4, h: 0.38, fontSize: 18, bold: true, color: C.dark, fontFace: 'Calibri', margin: 0 });

  // Genetic risk pyramid
  const genData = [
    { label: 'General Population', risk: '1%', w: 5.5, col: C.midBlue },
    { label: '1st Degree Relative Affected', risk: '6.6%', w: 4.8, col: C.accent },
    { label: 'One Parent Affected', risk: '12%', w: 4.1, col: C.purple },
    { label: 'Both Parents Affected', risk: '40%', w: 3.4, col: C.orange },
    { label: 'Dizygotic Twin', risk: '10%', w: 2.7, col: C.gold },
    { label: 'Monozygotic Twin', risk: '50%', w: 2.0, col: C.red },
  ];

  s.addText('GENETIC RISK LADDER', { x: 0.3, y: 0.65, w: 5.5, h: 0.35, fontSize: 12, bold: true, color: C.teal, fontFace: 'Calibri' });
  genData.forEach(({ label, risk, w, col }, i) => {
    const y = 1.05 + i * 0.65;
    s.addShape(pres.ShapeType.roundRect, { x: 0.3, y, w, h: 0.52, fill: { color: col, transparency: 15 }, line: { color: col, width: 1 }, rectRadius: 0.06 });
    s.addText(`${label}  →  ${risk}`, { x: 0.45, y: y + 0.05, w: w - 0.2, h: 0.42, fontSize: 11, color: C.white, fontFace: 'Calibri', valign: 'middle', bold: i >= 4 });
  });

  // Risk factors column
  boxedBullets(s, 5.9, 0.65, 3.9, 4.8, 'RISK FACTORS', [
    'Genetic susceptibility (heritability ~80%)',
    'Winter/spring birth (viral exposure)',
    'Advanced paternal age',
    'Urban upbringing',
    'Cannabis use in adolescence',
    'Obstetric complications',
    'Immigration & social adversity',
    'Childhood trauma',
    'Prenatal malnutrition (famines)',
    'CNS infections in utero',
  ], C.midBlue, C.teal);
}

// ─── SLIDE 5 — PATHOPHYSIOLOGY OVERVIEW ─────────────────────────────────────
{
  const s = addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.purple } });
  s.addText('PATHOPHYSIOLOGY — NEUROTRANSMITTER SYSTEMS', { x: 0.3, y: 0.08, w: 9.4, h: 0.38, fontSize: 17, bold: true, color: C.white, fontFace: 'Calibri', margin: 0 });

  // Three columns: Dopamine, Glutamate, Serotonin/GABA
  const systems = [
    {
      name: 'DOPAMINE', icon: '⚡', col: C.accent,
      items: [
        'MESOLIMBIC ↑ (VTA → Limbic)',
        '→ Positive symptoms',
        '→ Hallucinations, delusions',
        '',
        'MESOCORTICAL ↓ (VTA → PFC)',
        '→ Negative symptoms',
        '→ Cognitive deficits',
        '',
        'NIGROSTRIATAL ↓',
        '→ EPS (parkinsonian SEs)',
        '',
        'TUBEROINFUNDIBULAR ↓',
        '→ ↑ Prolactin (antipsychotics)',
      ]
    },
    {
      name: 'GLUTAMATE / NMDA', icon: '🔬', col: C.purple,
      items: [
        'NMDA receptor hypofunction',
        '→ Cognitive symptoms',
        '→ Working memory deficits',
        '',
        'PCP/Ketamine mimics',
        'full schizophrenia picture',
        '',
        'Disrupts GABAergic',
        'interneurons (PV cells)',
        '→ Dis-inhibits pyramidal',
        'neurons → excess glutamate',
        '',
        'New target: muscarinic',
        'agonists (Xanomeline)',
      ]
    },
    {
      name: 'SEROTONIN / GABA', icon: '🧬', col: C.teal,
      items: [
        '5-HT2A overactivity',
        '→ Perceptual distortions',
        '→ Hallucinations (visual)',
        '',
        '5-HT2A blockade by',
        'atypical antipsychotics',
        '→ Reduces EPS',
        '→ Improves negative sx',
        '',
        'GABA interneuron loss',
        '→ Impaired cortical',
        'gamma oscillations',
        '→ Working memory ↓',
      ]
    },
  ];

  systems.forEach(({ name, icon, col, items }, ci) => {
    const x = 0.25 + ci * 3.25;
    s.addShape(pres.ShapeType.roundRect, { x, y: 0.65, w: 3.1, h: 4.8, fill: { color: C.dark }, line: { color: col, width: 1.5 }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.roundRect, { x, y: 0.65, w: 3.1, h: 0.58, fill: { color: col }, rectRadius: 0.1 });
    s.addText(`${icon}  ${name}`, { x: x + 0.08, y: 0.68, w: 2.94, h: 0.5, fontSize: 12, bold: true, color: C.dark, fontFace: 'Calibri', valign: 'middle', margin: 0 });
    const textItems = items.filter(t => t !== '').map((t, ii, arr) => ({
      text: t,
      options: {
        bullet: t ? { code: '25B8', color: col } : false,
        breakLine: ii < arr.length - 1,
        fontSize: 10.5,
        color: t.startsWith('→') ? C.textGray : C.white,
        fontFace: 'Calibri',
        paraSpaceBefore: 2,
        bold: t.includes('↑') || t.includes('↓') ? false : t === t.toUpperCase() && t.length > 3
      }
    }));
    const validItems = items.map((t, ii) => ({
      text: t || ' ',
      options: {
        bullet: t ? { code: '25B8', color: col } : false,
        breakLine: ii < items.length - 1,
        fontSize: 10.5,
        color: t.startsWith('→') ? C.textGray : C.white,
        fontFace: 'Calibri',
        paraSpaceBefore: 1,
      }
    }));
    s.addText(validItems, { x: x + 0.12, y: 1.3, w: 2.88, h: 4.05, fontFace: 'Calibri', fontSize: 10.5, valign: 'top' });
  });
}

// ─── SLIDE 6 — DOPAMINE PATHWAY DIAGRAM ──────────────────────────────────────
{
  const s = addSlide(C.dark);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.accent } });
  s.addText('DOPAMINE PATHWAY DIAGRAM — THE CORE MECHANISM', { x: 0.3, y: 0.08, w: 9.4, h: 0.38, fontSize: 17, bold: true, color: C.white, fontFace: 'Calibri', margin: 0 });

  // Central brain body
  s.addShape(pres.ShapeType.ellipse, { x: 3.5, y: 1.4, w: 3.0, h: 2.2, fill: { color: C.midBlue, transparency: 10 }, line: { color: C.accent, width: 2 } });
  s.addText('BRAIN\nVTA\n(Ventral Tegmental\nArea)', { x: 3.5, y: 1.4, w: 3.0, h: 2.2, fontSize: 11, bold: true, color: C.white, fontFace: 'Calibri', align: 'center', valign: 'middle' });

  // Pathway boxes
  const paths = [
    { x: 0.1, y: 0.7, label: 'MESOLIMBIC\nPATHWAY', sub: 'VTA → Nucleus\nAccumbens / Limbic', effect: '↑ DOPAMINE\n→ POSITIVE SX\n(Hallucinations\nDelusions)', col: C.red, arrow: 'right' },
    { x: 0.1, y: 3.3, label: 'MESOCORTICAL\nPATHWAY', sub: 'VTA → Prefrontal\nCortex (PFC)', effect: '↓ DOPAMINE\n→ NEGATIVE SX\n(Blunted affect\nCognitive deficits)', col: C.orange, arrow: 'right' },
    { x: 6.9, y: 0.7, label: 'NIGROSTRIATAL\nPATHWAY', sub: 'Substantia Nigra\n→ Striatum', effect: 'Drug-induced ↓\n→ EPS / Tardive\nDyskinesia', col: C.purple, arrow: 'left' },
    { x: 6.9, y: 3.3, label: 'TUBEROINFUNDIBULAR\nPATHWAY', sub: 'Hypothalamus\n→ Pituitary', effect: 'Drug-induced ↓\n→ ↑ Prolactin\nGalactorrhea', col: C.teal, arrow: 'left' },
  ];

  paths.forEach(({ x, y, label, sub, effect, col }) => {
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 2.9, h: 2.1, fill: { color: C.navy }, line: { color: col, width: 1.5 }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 2.9, h: 0.55, fill: { color: col, transparency: 15 }, rectRadius: 0.1 });
    s.addText(label, { x: x + 0.07, y: y + 0.04, w: 2.76, h: 0.48, fontSize: 10, bold: true, color: C.white, fontFace: 'Calibri', align: 'center', valign: 'middle', margin: 0 });
    s.addText(sub, { x: x + 0.07, y: y + 0.6, w: 2.76, h: 0.6, fontSize: 9.5, color: C.textGray, fontFace: 'Calibri', align: 'center' });
    s.addText(effect, { x: x + 0.07, y: y + 1.25, w: 2.76, h: 0.8, fontSize: 10, bold: true, color: col, fontFace: 'Calibri', align: 'center' });
  });

  // Arrows (simplified lines)
  // Left boxes → brain: horizontal lines
  s.addShape(pres.ShapeType.line, { x: 3.0, y: 1.75, w: 0.5, h: 0, line: { color: C.red, width: 2 } });
  s.addShape(pres.ShapeType.line, { x: 3.0, y: 4.35, w: 0.5, h: 0, line: { color: C.orange, width: 2 } });
  s.addShape(pres.ShapeType.line, { x: 6.5, y: 1.75, w: 0.4, h: 0, line: { color: C.purple, width: 2 } });
  s.addShape(pres.ShapeType.line, { x: 6.5, y: 4.35, w: 0.4, h: 0, line: { color: C.teal, width: 2 } });

  // Bottom note
  s.addText('KEY: VTA = Ventral Tegmental Area   EPS = Extrapyramidal Symptoms   SX = Symptoms', {
    x: 0.3, y: 5.25, w: 9.4, h: 0.28, fontSize: 9.5, color: C.textGray, fontFace: 'Calibri', italic: true
  });
}

// ─── SLIDE 7 — CLINICAL FEATURES ─────────────────────────────────────────────
{
  const s = addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.gold } });
  s.addText('CLINICAL FEATURES & SYMPTOM CLUSTERS', { x: 0.3, y: 0.08, w: 9.4, h: 0.38, fontSize: 18, bold: true, color: C.dark, fontFace: 'Calibri', margin: 0 });

  // Positive symptoms
  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 0.65, w: 3.0, h: 4.8, fill: { color: '1A0A0A' }, line: { color: C.red, width: 2 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 0.65, w: 3.0, h: 0.5, fill: { color: C.red }, rectRadius: 0.1 });
  s.addText('POSITIVE SYMPTOMS', { x: 0.3, y: 0.68, w: 2.8, h: 0.44, fontSize: 11, bold: true, color: C.white, fontFace: 'Calibri', align: 'center', margin: 0 });
  s.addText([
    { text: '(Added to normal function)', options: { fontSize: 9.5, italic: true, color: C.textGray, breakLine: true } },
    { text: 'Hallucinations', options: { bullet: { code: '25B8', color: C.red }, fontSize: 11, color: C.white, breakLine: true } },
    { text: '  Auditory (most common)', options: { fontSize: 10, color: C.textGray, italic: true, breakLine: true } },
    { text: '  Visual, olfactory, tactile', options: { fontSize: 10, color: C.textGray, italic: true, breakLine: true } },
    { text: 'Delusions', options: { bullet: { code: '25B8', color: C.red }, fontSize: 11, color: C.white, breakLine: true } },
    { text: '  Persecutory (most common)', options: { fontSize: 10, color: C.textGray, italic: true, breakLine: true } },
    { text: '  Grandiose, referential', options: { fontSize: 10, color: C.textGray, italic: true, breakLine: true } },
    { text: 'Disorganized speech', options: { bullet: { code: '25B8', color: C.red }, fontSize: 11, color: C.white, breakLine: true } },
    { text: '  Loose associations', options: { fontSize: 10, color: C.textGray, italic: true, breakLine: true } },
    { text: '  Word salad, tangentiality', options: { fontSize: 10, color: C.textGray, italic: true, breakLine: true } },
    { text: 'Disorganized behavior', options: { bullet: { code: '25B8', color: C.red }, fontSize: 11, color: C.white, breakLine: true } },
    { text: 'Catatonia', options: { bullet: { code: '25B8', color: C.red }, fontSize: 11, color: C.white, breakLine: true } },
  ], { x: 0.3, y: 1.22, w: 2.8, h: 4.15, fontFace: 'Calibri', valign: 'top' });

  // Negative symptoms
  s.addShape(pres.ShapeType.roundRect, { x: 3.5, y: 0.65, w: 3.0, h: 4.8, fill: { color: '0A1A0A' }, line: { color: C.orange, width: 2 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.roundRect, { x: 3.5, y: 0.65, w: 3.0, h: 0.5, fill: { color: C.orange }, rectRadius: 0.1 });
  s.addText('NEGATIVE SYMPTOMS', { x: 3.6, y: 0.68, w: 2.8, h: 0.44, fontSize: 11, bold: true, color: C.white, fontFace: 'Calibri', align: 'center', margin: 0 });
  s.addText([
    { text: '(Loss of normal function) — 1/3 of patients', options: { fontSize: 9.5, italic: true, color: C.textGray, breakLine: true } },
    { text: 'Avolition', options: { bullet: { code: '25B8', color: C.orange }, fontSize: 11, color: C.white, breakLine: true } },
    { text: '  Lack of motivation', options: { fontSize: 10, color: C.textGray, italic: true, breakLine: true } },
    { text: 'Anhedonia', options: { bullet: { code: '25B8', color: C.orange }, fontSize: 11, color: C.white, breakLine: true } },
    { text: '  Inability to feel pleasure', options: { fontSize: 10, color: C.textGray, italic: true, breakLine: true } },
    { text: 'Blunted / flat affect', options: { bullet: { code: '25B8', color: C.orange }, fontSize: 11, color: C.white, breakLine: true } },
    { text: 'Alogia', options: { bullet: { code: '25B8', color: C.orange }, fontSize: 11, color: C.white, breakLine: true } },
    { text: '  Poverty of speech', options: { fontSize: 10, color: C.textGray, italic: true, breakLine: true } },
    { text: 'Social withdrawal', options: { bullet: { code: '25B8', color: C.orange }, fontSize: 11, color: C.white, breakLine: true } },
    { text: 'Impaired concentration', options: { bullet: { code: '25B8', color: C.orange }, fontSize: 11, color: C.white, breakLine: true } },
    { text: 'Poor grooming/hygiene', options: { bullet: { code: '25B8', color: C.orange }, fontSize: 11, color: C.white, breakLine: true } },
    { text: '⚠ Poor prognosis, drug-resistant', options: { fontSize: 10, bold: true, color: C.gold, breakLine: true } },
  ], { x: 3.6, y: 1.22, w: 2.8, h: 4.15, fontFace: 'Calibri', valign: 'top' });

  // Cognitive symptoms
  s.addShape(pres.ShapeType.roundRect, { x: 6.8, y: 0.65, w: 3.0, h: 4.8, fill: { color: '0A0A1A' }, line: { color: C.purple, width: 2 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.roundRect, { x: 6.8, y: 0.65, w: 3.0, h: 0.5, fill: { color: C.purple }, rectRadius: 0.1 });
  s.addText('COGNITIVE SYMPTOMS', { x: 6.9, y: 0.68, w: 2.8, h: 0.44, fontSize: 11, bold: true, color: C.white, fontFace: 'Calibri', align: 'center', margin: 0 });
  s.addText([
    { text: '(Core disability component)', options: { fontSize: 9.5, italic: true, color: C.textGray, breakLine: true } },
    { text: 'Working memory ↓', options: { bullet: { code: '25B8', color: C.purple }, fontSize: 11, color: C.white, breakLine: true } },
    { text: 'Attention / concentration ↓', options: { bullet: { code: '25B8', color: C.purple }, fontSize: 11, color: C.white, breakLine: true } },
    { text: 'Processing speed ↓', options: { bullet: { code: '25B8', color: C.purple }, fontSize: 11, color: C.white, breakLine: true } },
    { text: 'Executive function ↓', options: { bullet: { code: '25B8', color: C.purple }, fontSize: 11, color: C.white, breakLine: true } },
    { text: 'Verbal learning ↓', options: { bullet: { code: '25B8', color: C.purple }, fontSize: 11, color: C.white, breakLine: true } },
    { text: 'Social cognition ↓', options: { bullet: { code: '25B8', color: C.purple }, fontSize: 11, color: C.white, breakLine: true } },
    { text: '', options: { breakLine: true } },
    { text: 'Major predictor of\nfunctional outcome', options: { fontSize: 11, bold: true, color: C.gold, breakLine: true } },
    { text: '', options: { breakLine: true } },
    { text: 'Onset: often BEFORE\npositive symptoms', options: { fontSize: 10.5, italic: true, color: C.textGray } },
  ], { x: 6.9, y: 1.22, w: 2.8, h: 4.15, fontFace: 'Calibri', valign: 'top' });
}

// ─── SLIDE 8 — DSM-5-TR CRITERIA ─────────────────────────────────────────────
{
  const s = addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.green } });
  s.addText('DSM-5-TR DIAGNOSTIC CRITERIA (2022)', { x: 0.3, y: 0.08, w: 9.4, h: 0.38, fontSize: 18, bold: true, color: C.dark, fontFace: 'Calibri', margin: 0 });

  // Criterion A box
  s.addShape(pres.ShapeType.roundRect, { x: 0.25, y: 0.65, w: 5.8, h: 2.7, fill: { color: C.dark }, line: { color: C.green, width: 1.5 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.roundRect, { x: 0.25, y: 0.65, w: 5.8, h: 0.48, fill: { color: C.green }, rectRadius: 0.1 });
  s.addText('CRITERION A — At least 2 of the following (≥1 month):', { x: 0.38, y: 0.67, w: 5.54, h: 0.44, fontSize: 11, bold: true, color: C.dark, fontFace: 'Calibri', margin: 0, valign: 'middle' });

  const criteriaA = [
    ['1', 'DELUSIONS', C.red],
    ['2', 'HALLUCINATIONS', C.orange],
    ['3', 'DISORGANIZED SPEECH', C.gold],
    ['4', 'GROSSLY DISORGANIZED / CATATONIC BEHAVIOR', C.purple],
    ['5', 'NEGATIVE SYMPTOMS (avolition/diminished expression)', C.teal],
  ];
  criteriaA.forEach(([num, text, col], i) => {
    const y = 1.2 + i * 0.41;
    s.addShape(pres.ShapeType.roundRect, { x: 0.38, y, w: 0.38, h: 0.34, fill: { color: col }, rectRadius: 0.05 });
    s.addText(num, { x: 0.38, y, w: 0.38, h: 0.34, fontSize: 12, bold: true, color: C.dark, fontFace: 'Calibri', align: 'center', valign: 'middle', margin: 0 });
    s.addText(text, { x: 0.84, y: y + 0.02, w: 5.1, h: 0.3, fontSize: 11, color: C.white, fontFace: 'Calibri', valign: 'middle' });
  });
  s.addText('★ At least 1 must be from criteria 1, 2, or 3', { x: 0.38, y: 3.2, w: 5.6, h: 0.28, fontSize: 10, bold: true, color: C.gold, fontFace: 'Calibri' });

  // Time criteria
  s.addShape(pres.ShapeType.roundRect, { x: 6.2, y: 0.65, w: 3.6, h: 2.7, fill: { color: C.dark }, line: { color: C.accent, width: 1.5 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.roundRect, { x: 6.2, y: 0.65, w: 3.6, h: 0.48, fill: { color: C.accent }, rectRadius: 0.1 });
  s.addText('TIME CRITERIA', { x: 6.32, y: 0.67, w: 3.36, h: 0.44, fontSize: 11, bold: true, color: C.white, fontFace: 'Calibri', margin: 0, valign: 'middle' });

  const timeCriteria = [
    ['B', 'Social/occupational dysfunction for significant period since onset', C.teal],
    ['C', 'Continuous signs ≥ 6 months (includes prodrome)', C.green],
    ['D', 'Exclude schizoaffective and mood disorders', C.orange],
    ['E', 'Exclude substance/medical condition', C.red],
    ['F', 'If autism spectrum: schizophrenia requires ≥1 month psychotic symptoms', C.purple],
  ];
  timeCriteria.forEach(([letter, text, col], i) => {
    const y = 1.2 + i * 0.41;
    s.addShape(pres.ShapeType.roundRect, { x: 6.32, y, w: 0.34, h: 0.32, fill: { color: col }, rectRadius: 0.05 });
    s.addText(letter, { x: 6.32, y, w: 0.34, h: 0.32, fontSize: 11, bold: true, color: C.dark, fontFace: 'Calibri', align: 'center', valign: 'middle', margin: 0 });
    s.addText(text, { x: 6.74, y: y + 0.01, w: 2.96, h: 0.32, fontSize: 9.5, color: C.white, fontFace: 'Calibri', valign: 'middle' });
  });

  // Related disorders row
  s.addText('RELATED DISORDERS (Differential)', { x: 0.25, y: 3.55, w: 9.6, h: 0.32, fontSize: 12, bold: true, color: C.gold, fontFace: 'Calibri' });
  const relDx = [
    ['Brief Psychotic\nDisorder', '< 1 month', C.accent],
    ['Schizophreniform\nDisorder', '1–6 months', C.purple],
    ['Schizoaffective\nDisorder', 'Schiz + mood', C.orange],
    ['Delusional\nDisorder', 'Delusions only\n≥1 month', C.teal],
    ['Schizotypal\nPersonality', 'Eccentric\nbehavior', C.green],
  ];
  relDx.forEach(([label, sub, col], i) => {
    const x = 0.25 + i * 1.93;
    s.addShape(pres.ShapeType.roundRect, { x, y: 3.9, w: 1.8, h: 1.62, fill: { color: C.midBlue }, line: { color: col, width: 1 }, rectRadius: 0.08 });
    s.addShape(pres.ShapeType.roundRect, { x, y: 3.9, w: 1.8, h: 0.45, fill: { color: col, transparency: 20 }, rectRadius: 0.08 });
    s.addText(label, { x: x + 0.07, y: 3.93, w: 1.66, h: 0.4, fontSize: 10, bold: true, color: C.white, fontFace: 'Calibri', align: 'center', valign: 'middle', margin: 0 });
    s.addText(sub, { x: x + 0.07, y: 4.38, w: 1.66, h: 1.1, fontSize: 10.5, color: col, fontFace: 'Calibri', align: 'center' });
  });
}

// ─── SLIDE 9 — PHARMACOLOGICAL TREATMENT ─────────────────────────────────────
{
  const s = addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.red } });
  s.addText('PHARMACOLOGICAL TREATMENT — ANTIPSYCHOTICS', { x: 0.3, y: 0.08, w: 9.4, h: 0.38, fontSize: 17, bold: true, color: C.white, fontFace: 'Calibri', margin: 0 });

  // FGA column
  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 0.65, w: 4.4, h: 4.85, fill: { color: C.dark }, line: { color: C.red, width: 1.5 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 0.65, w: 4.4, h: 0.52, fill: { color: C.red, transparency: 20 }, rectRadius: 0.1 });
  s.addText('1st GENERATION (Typical) Antipsychotics', { x: 0.32, y: 0.68, w: 4.16, h: 0.46, fontSize: 11, bold: true, color: C.white, fontFace: 'Calibri', valign: 'middle', margin: 0 });

  s.addText([
    { text: 'MECHANISM: Potent D2 receptor antagonism', options: { fontSize: 10.5, bold: true, color: C.gold, breakLine: true } },
    { text: 'Effect: Excellent for positive symptoms', options: { fontSize: 10.5, color: C.white, breakLine: true } },
    { text: 'Limitation: No benefit for negative/cognitive sx', options: { fontSize: 10.5, color: C.textGray, italic: true, breakLine: true, paraSpaceBefore: 4 } },
    { text: 'EXAMPLES:', options: { fontSize: 10.5, bold: true, color: C.teal, breakLine: true, paraSpaceBefore: 6 } },
    { text: 'Haloperidol (Haldol) — high potency', options: { bullet: { code: '25B8', color: C.red }, fontSize: 10.5, color: C.white, breakLine: true } },
    { text: 'Chlorpromazine — low potency, first ever AP', options: { bullet: { code: '25B8', color: C.red }, fontSize: 10.5, color: C.white, breakLine: true } },
    { text: 'Fluphenazine, Perphenazine, Thiothixene', options: { bullet: { code: '25B8', color: C.red }, fontSize: 10.5, color: C.white, breakLine: true, paraSpaceBefore: 2 } },
    { text: 'SIDE EFFECTS:', options: { fontSize: 10.5, bold: true, color: C.orange, breakLine: true, paraSpaceBefore: 6 } },
    { text: 'EPS (akathisia, dystonia, parkinsonism)', options: { bullet: { code: '25B8', color: C.orange }, fontSize: 10.5, color: C.white, breakLine: true } },
    { text: 'Tardive dyskinesia (long-term)', options: { bullet: { code: '25B8', color: C.orange }, fontSize: 10.5, color: C.white, breakLine: true } },
    { text: 'Hyperprolactinemia', options: { bullet: { code: '25B8', color: C.orange }, fontSize: 10.5, color: C.white, breakLine: true } },
    { text: 'NMS (Neuroleptic Malignant Syndrome) — EMERGENCY', options: { bullet: { code: '25B8', color: C.red }, fontSize: 10, bold: true, color: C.red, breakLine: true } },
    { text: 'Sedation, anticholinergic effects', options: { bullet: { code: '25B8', color: C.orange }, fontSize: 10.5, color: C.white } },
  ], { x: 0.32, y: 1.24, w: 4.18, h: 4.2, fontFace: 'Calibri', valign: 'top' });

  // SGA column
  s.addShape(pres.ShapeType.roundRect, { x: 4.9, y: 0.65, w: 4.9, h: 4.85, fill: { color: C.dark }, line: { color: C.green, width: 1.5 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.roundRect, { x: 4.9, y: 0.65, w: 4.9, h: 0.52, fill: { color: C.green, transparency: 20 }, rectRadius: 0.1 });
  s.addText('2nd GENERATION (Atypical) Antipsychotics — PREFERRED', { x: 5.02, y: 0.68, w: 4.66, h: 0.46, fontSize: 11, bold: true, color: C.white, fontFace: 'Calibri', valign: 'middle', margin: 0 });

  s.addText([
    { text: 'MECHANISM: D2 + 5-HT2A blockade; lower D2 occupancy → fewer EPS', options: { fontSize: 10.5, bold: true, color: C.gold, breakLine: true } },
    { text: 'EXAMPLES & NOTES:', options: { fontSize: 10.5, bold: true, color: C.teal, breakLine: true, paraSpaceBefore: 4 } },
    { text: 'Olanzapine — most effective; ↑ weight/metabolic risk', options: { bullet: { code: '25B8', color: C.green }, fontSize: 10.5, color: C.white, breakLine: true } },
    { text: 'Risperidone — commonly used; some EPS at high dose', options: { bullet: { code: '25B8', color: C.green }, fontSize: 10.5, color: C.white, breakLine: true } },
    { text: 'Quetiapine — sedating; low EPS; used in bipolar', options: { bullet: { code: '25B8', color: C.green }, fontSize: 10.5, color: C.white, breakLine: true } },
    { text: 'Clozapine — treatment-resistant schizophrenia ONLY', options: { bullet: { code: '25B8', color: C.gold }, fontSize: 10.5, color: C.gold, bold: true, breakLine: true } },
    { text: '  Requires weekly CBC (agranulocytosis risk)', options: { fontSize: 10, italic: true, color: C.textGray, breakLine: true } },
    { text: 'Aripiprazole — partial D2 agonist; low metabolic SE', options: { bullet: { code: '25B8', color: C.green }, fontSize: 10.5, color: C.white, breakLine: true } },
    { text: 'Ziprasidone — low weight gain; QTc prolongation', options: { bullet: { code: '25B8', color: C.green }, fontSize: 10.5, color: C.white, breakLine: true } },
    { text: 'Brexpiprazole, Cariprazine — newest partial agonists', options: { bullet: { code: '25B8', color: C.green }, fontSize: 10.5, color: C.white, breakLine: true } },
    { text: 'NEW 2025: Xanomeline + Trospium (KarXT)', options: { bullet: { code: '25B8', color: C.accent }, fontSize: 10.5, bold: true, color: C.accent, breakLine: true, paraSpaceBefore: 4 } },
    { text: '  Muscarinic agonist — NO D2 mechanism', options: { fontSize: 10, italic: true, color: C.textGray, breakLine: true } },
    { text: 'SIDE EFFECTS: Weight gain, diabetes, dyslipidemia,\nQTc prolongation, metabolic syndrome', options: { fontSize: 10.5, bold: false, color: C.orange, breakLine: true, paraSpaceBefore: 4 } },
  ], { x: 5.02, y: 1.24, w: 4.68, h: 4.2, fontFace: 'Calibri', valign: 'top' });
}

// ─── SLIDE 10 — TREATMENT ALGORITHM ─────────────────────────────────────────
{
  const s = addSlide(C.dark);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.purple } });
  s.addText('TREATMENT ALGORITHM — INTEGRATE 2025 / VA-DoD 2025', { x: 0.3, y: 0.08, w: 9.4, h: 0.38, fontSize: 16, bold: true, color: C.white, fontFace: 'Calibri', margin: 0 });

  const steps = [
    { label: 'STEP 1', title: 'Diagnosis & Baseline Assessment', color: C.accent, y: 0.65,
      detail: 'DSM-5-TR criteria • Exclude medical causes • CBC, CMP, TFTs, lipids, glucose, ECG, urine drug screen • Establish baseline weight/BMI' },
    { label: 'STEP 2', title: 'First Acute Episode — Start SGA', color: C.green, y: 1.45,
      detail: 'Prefer 2nd-gen antipsychotic • Adequate trial: 4–6 weeks at therapeutic dose • Monitor response at 2 weeks • LAI (long-acting injectable) if adherence concern' },
    { label: 'STEP 3', title: 'Inadequate Response — Switch SGA', color: C.gold, y: 2.25,
      detail: 'Switch to different SGA (different mechanism) • Reassess diagnosis • Address adherence, substance use, psychosocial stressors • Add CBTp' },
    { label: 'STEP 4', title: 'Treatment-Resistant Schizophrenia (TRS)', color: C.orange, y: 3.05,
      detail: 'Defined: failure of ≥2 adequate AP trials • CLOZAPINE is evidence-based standard • Monitor CBC weekly × 6 months, then bi-weekly × 6 months, then monthly' },
    { label: 'STEP 5', title: 'Maintenance & Relapse Prevention', color: C.teal, y: 3.85,
      detail: 'Indefinite maintenance after 2+ episodes • Psychoeducation • Family involvement • LAI preferred • Regular metabolic monitoring' },
  ];

  steps.forEach(({ label, title, color, y, detail }) => {
    // left label
    s.addShape(pres.ShapeType.roundRect, { x: 0.2, y, w: 1.0, h: 0.72, fill: { color }, rectRadius: 0.08 });
    s.addText(label, { x: 0.2, y, w: 1.0, h: 0.72, fontSize: 11, bold: true, color: C.dark, fontFace: 'Calibri', align: 'center', valign: 'middle', margin: 0 });
    // connector
    s.addShape(pres.ShapeType.line, { x: 1.2, y: y + 0.36, w: 0.15, h: 0, line: { color, width: 2 } });
    // main box
    s.addShape(pres.ShapeType.roundRect, { x: 1.35, y, w: 8.45, h: 0.72, fill: { color: C.navy }, line: { color, width: 1 }, rectRadius: 0.08 });
    s.addText(title, { x: 1.48, y: y + 0.02, w: 8.2, h: 0.3, fontSize: 11, bold: true, color: C.white, fontFace: 'Calibri', margin: 0 });
    s.addText(detail, { x: 1.48, y: y + 0.33, w: 8.2, h: 0.36, fontSize: 9.5, color: C.textGray, fontFace: 'Calibri' });
    // arrow down (not last)
    if (y < 3.85) {
      s.addShape(pres.ShapeType.line, { x: 0.7, y: y + 0.72, w: 0, h: 0.1, line: { color, width: 2 } });
    }
  });

  s.addText('INTEGRATE = International Guidelines Algorithmic Treatment Evaluation (Lancet Psychiatry 2025)  |  VA/DoD CPG = Veterans Affairs / Dept of Defense Clinical Practice Guidelines 2025', {
    x: 0.2, y: 5.3, w: 9.6, h: 0.26, fontSize: 8.5, color: C.textGray, fontFace: 'Calibri', italic: true
  });
}

// ─── SLIDE 11 — NURSING ASSESSMENT ───────────────────────────────────────────
{
  const s = addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.teal } });
  s.addText('NURSING ASSESSMENT — COMPREHENSIVE EVALUATION', { x: 0.3, y: 0.08, w: 9.4, h: 0.38, fontSize: 17, bold: true, color: C.dark, fontFace: 'Calibri', margin: 0 });

  const cols = [
    {
      title: 'MENTAL STATUS\nEXAMINATION', col: C.accent, x: 0.2,
      items: ['Appearance & behavior', 'Level of consciousness', 'Orientation (time/place)', 'Speech: rate, tone, coherence', 'Mood & affect', 'Thought content (delusions)', 'Thought process (associations)', 'Perceptions (hallucinations)', 'Insight & judgment', 'Cognitive function (MMSE/MOCA)']
    },
    {
      title: 'SAFETY\nASSESSMENT', col: C.red, x: 3.45,
      items: ['Suicidal ideation (10% risk)', 'Homicidal ideation', 'Command hallucinations', 'History of violence/aggression', 'Substance use (cannabis, alcohol)', 'Access to means/weapons', 'Elopement risk', 'Self-neglect risk', 'Level of agitation', 'Protective factors (support)']
    },
    {
      title: 'PHYSICAL\nASSESSMENT', col: C.green, x: 6.7,
      items: ['Vital signs (BP, HR, temp)', 'Weight & BMI (baseline)', 'Metabolic screening: glucose, lipids', 'Neurological exam', 'EPS assessment (AIMS scale)', 'Medication side effects', 'Hydration & nutrition status', 'Sleep patterns', 'Cardiovascular (QTc if indicated)', 'Labs: CBC (if on clozapine)']
    },
  ];

  cols.forEach(({ title, col, x, items }) => {
    const w = 3.15;
    s.addShape(pres.ShapeType.roundRect, { x, y: 0.65, w, h: 4.85, fill: { color: C.dark }, line: { color: col, width: 1.5 }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.roundRect, { x, y: 0.65, w, h: 0.65, fill: { color: col, transparency: 15 }, rectRadius: 0.1 });
    s.addText(title, { x: x + 0.1, y: 0.68, w: w - 0.2, h: 0.6, fontSize: 11, bold: true, color: C.white, fontFace: 'Calibri', align: 'center', valign: 'middle', margin: 0 });
    const textItems = items.map((t, i) => ({
      text: t,
      options: { bullet: { code: '25B8', color: col }, breakLine: i < items.length - 1, fontSize: 10.5, color: C.white, fontFace: 'Calibri', paraSpaceBefore: 3 }
    }));
    s.addText(textItems, { x: x + 0.12, y: 1.38, w: w - 0.24, h: 4.05, fontFace: 'Calibri', valign: 'top' });
  });
}

// ─── SLIDE 12 — NURSING DIAGNOSES & CARE PLAN ────────────────────────────────
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  const s = addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.accent } });
  s.addText('NURSING DIAGNOSES & CARE PLANNING (NANDA-I)', { x: 0.3, y: 0.08, w: 9.4, h: 0.38, fontSize: 17, bold: true, color: C.white, fontFace: 'Calibri', margin: 0 });

  const nxDx = [
    {
      dx: 'Disturbed Sensory Perception r/t neurochemical imbalance', col: C.purple,
      inter: ['Stay calm, do not argue about hallucinations', 'Reality orientation — speak simply and clearly', 'Reduce environmental stimuli', 'Administer antipsychotics as prescribed, monitor response', 'Document hallucination frequency, content, triggers']
    },
    {
      dx: 'Social Isolation r/t altered thought processes, negative symptoms', col: C.orange,
      inter: ['Establish therapeutic nurse-patient relationship', 'Set small achievable social interaction goals', 'Group therapy participation — support attendance', 'Family education and involvement', 'Social skills training referral']
    },
    {
      dx: 'Risk for Violence (self/other) r/t command hallucinations, paranoia', col: C.red,
      inter: ['Assess for suicidal/homicidal ideation every shift', 'Secure environment — remove potential weapons', 'De-escalation techniques (calm tone, personal space)', 'PRN medications per protocol', 'Document mental status changes']
    },
    {
      dx: 'Impaired Medication Management r/t lack of insight (anosognosia)', col: C.gold,
      inter: ['Psychoeducation: explain why medication helps', 'Involve family in med management', 'Discuss LAI (long-acting injectable) as adherence aid', 'Monitor for side effects and address promptly', 'Motivational interviewing approach']
    },
  ];

  nxDx.forEach(({ dx, col, inter }, i) => {
    const y = 0.65 + i * 1.2;
    s.addShape(pres.ShapeType.roundRect, { x: 0.2, y, w: 9.6, h: 1.1, fill: { color: C.dark }, line: { color: col, width: 1 }, rectRadius: 0.08 });
    s.addShape(pres.ShapeType.roundRect, { x: 0.2, y, w: 3.0, h: 1.1, fill: { color: col, transparency: 25 }, rectRadius: 0.08 });
    s.addText(dx, { x: 0.32, y: y + 0.04, w: 2.76, h: 1.02, fontSize: 10, bold: true, color: C.white, fontFace: 'Calibri', valign: 'middle' });
    const textItems = inter.map((t, ii) => ({
      text: t,
      options: { bullet: { code: '25B8', color: col }, breakLine: ii < inter.length - 1, fontSize: 9.5, color: C.white, fontFace: 'Calibri', paraSpaceBefore: 1 }
    }));
    s.addText(textItems, { x: 3.32, y: y + 0.06, w: 6.36, h: 1.0, fontFace: 'Calibri', valign: 'top' });
  });

  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 5.4, w: 9.6, h: 0.18, fill: { color: C.midBlue }, line: { color: C.accent, width: 0.5 }, rectRadius: 0.05 });
  s.addText('Outcome Goal: Patient will demonstrate reduced psychotic symptoms, improved reality orientation, medication adherence, and safe behavior within treatment setting', {
    x: 0.35, y: 5.41, w: 9.3, h: 0.16, fontSize: 9, color: C.gold, fontFace: 'Calibri', italic: true
  });
}

// ─── SLIDE 13 — NON-PHARMACOLOGICAL INTERVENTIONS ────────────────────────────
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  const s = addSlide();
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  s.addText('NON-PHARMACOLOGICAL INTERVENTIONS', { x: 0.3, y: 0.08, w: 9.4, h: 0.38, fontSize: 17, bold: true, color: C.dark, fontFace: 'Calibri', margin: 0 });

  const interventions = [
    {
      title: 'Cognitive Behavioural\nTherapy for Psychosis\n(CBTp)', icon: '🧠', col: C.accent,
      points: ['Reduces positive symptoms', 'Evidence: Cochrane 2024 meta-analysis', 'Targets delusion distress', 'Addresses negative self-beliefs', '16–20 sessions typical']
    },
    {
      title: 'Family Psycho-\neducation (FPE)', icon: '👨‍👩‍👧', col: C.teal,
      points: ['Reduces relapse by 50%', 'Improves medication adherence', 'Teaches early warning signs', 'Reduces expressed emotion (EE)', 'NAMI Family-to-Family program']
    },
    {
      title: 'Supported\nEmployment\n(IPS Model)', icon: '💼', col: C.gold,
      points: ['Improves functional outcomes', 'Reduces hospitalization', 'Individual Placement & Support', 'Evidence-based (Level 1)', 'Reduces stigma & isolation']
    },
    {
      title: 'Aerobic Exercise\nProgram', icon: '🏃', col: C.green,
      points: ['Increases hippocampal volume', '2024 meta-analysis: positive effect', '150 min/week moderate intensity', 'Improves cognition & mood', 'Reduces metabolic complications']
    },
    {
      title: 'Social Skills\nTraining (SST)', icon: '🤝', col: C.purple,
      points: ['Improves interpersonal function', 'Role-playing & modeling', 'Addresses negative symptoms', 'Group format preferred', 'Nurse-facilitated groups']
    },
  ];

  interventions.forEach(({ title, icon, col, points }, i) => {
    const x = 0.2 + i * 1.93;
    const w = 1.78;
    s.addShape(pres.ShapeType.roundRect, { x, y: 0.65, w, h: 4.85, fill: { color: C.dark }, line: { color: col, width: 1.5 }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.roundRect, { x, y: 0.65, w, h: 1.15, fill: { color: col, transparency: 20 }, rectRadius: 0.1 });
    s.addText(icon, { x, y: 0.65, w, h: 0.55, fontSize: 24, align: 'center', valign: 'middle' });
    s.addText(title, { x: x + 0.06, y: 1.2, w: w - 0.12, h: 0.6, fontSize: 9.5, bold: true, color: C.white, fontFace: 'Calibri', align: 'center' });
    const textItems = points.map((t, ii) => ({
      text: t,
      options: { bullet: { code: '25B8', color: col }, breakLine: ii < points.length - 1, fontSize: 9.5, color: C.white, fontFace: 'Calibri', paraSpaceBefore: 3 }
    }));
    s.addText(textItems, { x: x + 0.08, y: 1.88, w: w - 0.16, h: 3.55, fontFace: 'Calibri', valign: 'top' });
  });
}

// ─── SLIDE 14 — SIDE EFFECTS & MONITORING ────────────────────────────────────
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  const s = addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.orange } });
  s.addText('ANTIPSYCHOTIC SIDE EFFECTS & NURSING MONITORING', { x: 0.3, y: 0.08, w: 9.4, h: 0.38, fontSize: 17, bold: true, color: C.dark, fontFace: 'Calibri', margin: 0 });

  // NMS emergency box
  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 0.65, w: 9.6, h: 1.45, fill: { color: '2A0000' }, line: { color: C.red, width: 2 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 0.65, w: 1.3, h: 1.45, fill: { color: C.red }, rectRadius: 0.1 });
  s.addText('⚠\nEMERG\nENCY', { x: 0.2, y: 0.65, w: 1.3, h: 1.45, fontSize: 12, bold: true, color: C.white, fontFace: 'Calibri', align: 'center', valign: 'middle' });
  s.addText('NEUROLEPTIC MALIGNANT SYNDROME (NMS) — LIFE-THREATENING', { x: 1.6, y: 0.72, w: 7.96, h: 0.32, fontSize: 11, bold: true, color: C.red, fontFace: 'Calibri' });
  s.addText([
    { text: 'Classic Tetrad: ', options: { bold: true, color: C.gold } },
    { text: 'Hyperthermia + Muscle Rigidity ("lead-pipe") + Altered Consciousness + Autonomic Instability', options: { color: C.white } },
    { text: '\nNursing Action: ', options: { bold: true, color: C.gold, breakLine: false } },
    { text: 'STOP antipsychotic immediately • IV fluids • Cooling measures • Dantrolene/bromocriptine • ICU transfer • Notify physician STAT', options: { color: C.white } }
  ], { x: 1.6, y: 1.06, w: 7.96, h: 0.97, fontSize: 10.5, fontFace: 'Calibri' });

  // Side effect grid
  const seBoxes = [
    {
      title: 'EXTRAPYRAMIDAL (EPS)', col: C.purple,
      items: ['Acute dystonia (early, hours–days)', 'Akathisia (restlessness)', 'Parkinsonism (tremor, rigidity)', 'Tardive dyskinesia (months–years)', 'Use AIMS scale to monitor', 'Treat: dose↓, anticholinergics (benztropine)']
    },
    {
      title: 'METABOLIC SYNDROME', col: C.orange,
      items: ['Weight gain (esp. olanzapine, clozapine)', 'Hyperglycemia / type 2 DM', 'Dyslipidemia (triglycerides ↑)', 'Monitor: weight, BMI, fasting glucose', 'Baseline & every 3 months', 'Diet & exercise counseling']
    },
    {
      title: 'CLOZAPINE-SPECIFIC', col: C.gold,
      items: ['Agranulocytosis (1–2%): FATAL', 'CBC monitoring: weekly × 6 months', 'Then bi-weekly × 6 months', 'Then monthly indefinitely', 'Myocarditis (first 4 weeks)', 'Seizures (dose-dependent)']
    },
    {
      title: 'OTHER KEY SE', col: C.teal,
      items: ['QTc prolongation → arrhythmia risk', 'Sedation (antihistamine effect)', 'Orthostatic hypotension', 'Anticholinergic: dry mouth, retention', 'Hyperprolactinemia: galactorrhea', 'Photosensitivity (phenothiazines)']
    },
  ];

  seBoxes.forEach(({ title, col, items }, i) => {
    const x = 0.2 + (i % 2) * 4.85;
    const y = 2.2 + Math.floor(i / 2) * 1.7;
    const w = 4.65;
    s.addShape(pres.ShapeType.roundRect, { x, y, w, h: 1.6, fill: { color: C.dark }, line: { color: col, width: 1 }, rectRadius: 0.08 });
    s.addShape(pres.ShapeType.roundRect, { x, y, w, h: 0.38, fill: { color: col, transparency: 20 }, rectRadius: 0.08 });
    s.addText(title, { x: x + 0.1, y: y + 0.02, w: w - 0.2, h: 0.34, fontSize: 11, bold: true, color: C.white, fontFace: 'Calibri', valign: 'middle', margin: 0 });
    const textItems = items.map((t, ii) => ({
      text: t,
      options: { bullet: { code: '25B8', color: col }, breakLine: ii < items.length - 1, fontSize: 9.5, color: C.white, fontFace: 'Calibri', paraSpaceBefore: 1 }
    }));
    s.addText(textItems, { x: x + 0.12, y: y + 0.42, w: w - 0.24, h: 1.14, fontFace: 'Calibri', valign: 'top' });
  });
}

// ─── SLIDE 15 — COMPLICATIONS & PROGNOSIS ────────────────────────────────────
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  const s = addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.orange } });
  s.addText('COMPLICATIONS, PROGNOSIS & OUTCOMES', { x: 0.3, y: 0.08, w: 9.4, h: 0.38, fontSize: 17, bold: true, color: C.dark, fontFace: 'Calibri', margin: 0 });

  // Complications column
  boxedBullets(s, 0.2, 0.65, 4.5, 2.6, 'MAJOR COMPLICATIONS', [
    'Suicide: ~10% lifetime risk (leading preventable cause of death)',
    'Cardiovascular disease (metabolic effects + sedentary lifestyle)',
    'Substance use disorder (comorbid in 50%)',
    'Social isolation & homelessness',
    'Violence risk (small, but present with command hallucinations)',
    'Iatrogenic: tardive dyskinesia, metabolic syndrome from drugs',
    'Cognitive decline over time',
    'Increased infection risk (immunosuppression, poor self-care)',
  ], C.midBlue, C.red);

  // Prognosis column
  boxedBullets(s, 5.0, 0.65, 4.8, 2.6, 'PROGNOSIS (Rule of Thirds)', [
    '1/3 — Significant improvement / full recovery (WHO 2025)',
    '1/3 — Improvement with residual symptoms / moderate disability',
    '1/3 — Chronic, severe course, treatment-resistant',
    '',
    'Good prognostic factors: female sex, acute onset, older age at onset, good premorbid function, strong social support, early treatment',
    'Poor prognostic factors: male sex, insidious onset, early age at onset, prominent negative symptoms, family Hx, substance abuse',
  ], C.midBlue, C.green);

  // Course timeline
  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 3.35, w: 9.6, h: 0.36, fill: { color: C.dark }, line: { color: C.accent, width: 1 }, rectRadius: 0.08 });
  s.addText('ILLNESS COURSE TIMELINE', { x: 0.35, y: 3.38, w: 9.3, h: 0.3, fontSize: 11, bold: true, color: C.gold, fontFace: 'Calibri' });

  const phases = [
    ['PREMORBID\n(Childhood)', 'Subtle cognitive deficits, social difficulties', C.textGray],
    ['PRODROMAL\n(Months–Years)', 'Attenuated psychotic symptoms, social withdrawal, depression', C.teal],
    ['FIRST\nEPISODE', 'Acute positive symptoms, hospitalization', C.red],
    ['ACUTE\nTREATMENT', 'Antipsychotics, stabilization (4–8 weeks)', C.orange],
    ['RECOVERY\n& MAINTENANCE', 'Ongoing therapy, relapse prevention, rehabilitation', C.green],
  ];

  phases.forEach(([label, detail, col], i) => {
    const x = 0.2 + i * 1.93;
    s.addShape(pres.ShapeType.roundRect, { x, y: 3.78, w: 1.82, h: 1.73, fill: { color: C.dark }, line: { color: col, width: 1 }, rectRadius: 0.08 });
    s.addShape(pres.ShapeType.roundRect, { x, y: 3.78, w: 1.82, h: 0.46, fill: { color: col, transparency: 20 }, rectRadius: 0.08 });
    s.addText(label, { x: x + 0.07, y: 3.8, w: 1.68, h: 0.42, fontSize: 9.5, bold: true, color: C.white, fontFace: 'Calibri', align: 'center', valign: 'middle', margin: 0 });
    s.addText(detail, { x: x + 0.07, y: 4.28, w: 1.68, h: 1.2, fontSize: 9.5, color: C.textGray, fontFace: 'Calibri', align: 'center' });
    if (i < 4) {
      s.addShape(pres.ShapeType.line, { x: x + 1.82, y: 4.35, w: 0.11, h: 0, line: { color: col, width: 1.5 } });
    }
  });
}

// ─── SLIDE 16 — SPECIAL POPULATIONS ─────────────────────────────────────────
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  const s = addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.purple } });
  s.addText('SPECIAL POPULATIONS & NURSING CONSIDERATIONS', { x: 0.3, y: 0.08, w: 9.4, h: 0.38, fontSize: 17, bold: true, color: C.white, fontFace: 'Calibri', margin: 0 });

  const groups = [
    {
      title: 'PREGNANCY', col: C.teal, icon: '🤰',
      items: ['Risk vs benefit discussion required', 'Clozapine: avoid if possible', 'Haloperidol: relatively safer', 'Monitor for gestational diabetes', 'Neonatal withdrawal risk', 'Postpartum psychosis monitoring']
    },
    {
      title: 'ELDERLY', col: C.orange, icon: '👴',
      items: ['Increased EPS sensitivity', 'High fall & fracture risk', 'Cognitive overlap with dementia', 'Start low, go slow dosing', 'QTc monitoring more critical', 'Avoid anticholinergics']
    },
    {
      title: 'ADOLESCENTS', col: C.accent, icon: '🧑',
      items: ['Higher olanzapine weight gain risk', 'Cannabis use worsens psychosis', 'Early intervention crucial', 'School re-integration planning', 'Family education essential', 'Monitor growth & development']
    },
    {
      title: 'CO-MORBID\nSUBSTANCE USE', col: C.red, icon: '⚗️',
      items: ['50% comorbidity rate', 'Cannabis: doubles relapse risk', 'Alcohol: increases violence risk', 'Treat both simultaneously', 'Clozapine helps with substance use', 'Motivational interviewing']
    },
  ];

  groups.forEach(({ title, col, icon, items }, i) => {
    const x = 0.2 + (i % 2) * 4.85;
    const y = 0.65 + Math.floor(i / 2) * 2.5;
    const w = 4.65;
    s.addShape(pres.ShapeType.roundRect, { x, y, w, h: 2.35, fill: { color: C.dark }, line: { color: col, width: 1.5 }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.roundRect, { x, y, w, h: 0.55, fill: { color: col, transparency: 20 }, rectRadius: 0.1 });
    s.addText(`${icon}  ${title}`, { x: x + 0.1, y: y + 0.03, w: w - 0.2, h: 0.49, fontSize: 12, bold: true, color: C.white, fontFace: 'Calibri', valign: 'middle', margin: 0 });
    const textItems = items.map((t, ii) => ({
      text: t,
      options: { bullet: { code: '25B8', color: col }, breakLine: ii < items.length - 1, fontSize: 10.5, color: C.white, fontFace: 'Calibri', paraSpaceBefore: 3 }
    }));
    s.addText(textItems, { x: x + 0.12, y: y + 0.6, w: w - 0.24, h: 1.7, fontFace: 'Calibri', valign: 'top' });
  });
}

// ─── SLIDE 17 — KEY MNEMONICS & QUICK REFERENCE ──────────────────────────────
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  const s = addSlide(C.dark);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.55, fill: { color: C.gold } });
  s.addText('NURSING MNEMONICS & QUICK REFERENCE', { x: 0.3, y: 0.08, w: 9.4, h: 0.38, fontSize: 17, bold: true, color: C.dark, fontFace: 'Calibri', margin: 0 });

  // SCHIZO mnemonic
  s.addShape(pres.ShapeType.roundRect, { x: 0.2, y: 0.65, w: 4.6, h: 4.85, fill: { color: C.navy }, line: { color: C.gold, width: 1.5 }, rectRadius: 0.1 });
  s.addText('SCHIZO — Nursing Assessment Memory Aid', { x: 0.35, y: 0.72, w: 4.3, h: 0.4, fontSize: 12, bold: true, color: C.gold, fontFace: 'Calibri' });

  const mnemo = [
    ['S', 'Safety — assess suicide/homicide risk first', C.red],
    ['C', 'Communication — therapeutic, non-confrontational', C.teal],
    ['H', 'Hallucinations — document, do not reinforce', C.orange],
    ['I', 'Insight — assess patient\'s awareness of illness', C.purple],
    ['Z', 'Ziprasidone / Medications — monitor adherence & SE', C.green],
    ['O', 'Observation — continuous monitoring of behavior', C.accent],
  ];
  mnemo.forEach(([letter, text, col], i) => {
    const y = 1.18 + i * 0.68;
    s.addShape(pres.ShapeType.roundRect, { x: 0.35, y, w: 0.5, h: 0.55, fill: { color: col }, rectRadius: 0.06 });
    s.addText(letter, { x: 0.35, y, w: 0.5, h: 0.55, fontSize: 20, bold: true, color: C.dark, fontFace: 'Calibri', align: 'center', valign: 'middle', margin: 0 });
    s.addText(text, { x: 0.95, y: y + 0.06, w: 3.75, h: 0.43, fontSize: 11, color: C.white, fontFace: 'Calibri', valign: 'middle' });
  });

  // NMS mnemonic & quick monitor table
  s.addShape(pres.ShapeType.roundRect, { x: 5.0, y: 0.65, w: 4.8, h: 2.2, fill: { color: C.navy }, line: { color: C.red, width: 1.5 }, rectRadius: 0.1 });
  s.addText('NMS — HALT Mnemonic', { x: 5.15, y: 0.72, w: 4.5, h: 0.38, fontSize: 12, bold: true, color: C.red, fontFace: 'Calibri' });
  const halt = [
    ['H', 'Hyperthermia (T > 38.5°C)', C.red],
    ['A', 'Altered consciousness (confusion → coma)', C.orange],
    ['L', 'Lead-pipe Rigidity (muscle)', C.gold],
    ['T', 'Tachycardia / autonomic instability', C.purple],
  ];
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    const y = 1.16 + i * 0.42;
    s.addShape(pres.ShapeType.roundRect, { x: 5.15, y, w: 0.42, h: 0.35, fill: { color: col }, rectRadius: 0.05 });
    s.addText(letter, { x: 5.15, y, w: 0.42, h: 0.35, fontSize: 14, bold: true, color: C.dark, fontFace: 'Calibri', align: 'center', valign: 'middle', margin: 0 });
    s.addText(text, { x: 5.65, y: y + 0.03, w: 4.0, h: 0.3, fontSize: 11, color: C.white, fontFace: 'Calibri', valign: 'middle' });
  });

  // Monitoring schedule
  s.addShape(pres.ShapeType.roundRect, { x: 5.0, y: 2.95, w: 4.8, h: 2.55, fill: { color: C.navy }, line: { color: C.teal, width: 1.5 }, rectRadius: 0.1 });
  s.addText('METABOLIC MONITORING SCHEDULE', { x: 5.15, y: 3.02, w: 4.5, h: 0.36, fontSize: 11, bold: true, color: C.teal, fontFace: 'Calibri' });
  const monData = [
    ['Parameter', 'Baseline', '1 Mo', '3 Mo', 'Annually'],
    ['Weight/BMI', '✓', '✓', '✓', '✓'],
    ['Fasting glucose', '✓', '', '✓', '✓'],
    ['Lipid panel', '✓', '', '✓', '✓'],
    ['BP', '✓', '✓', '✓', '✓'],
    ['ECG (QTc)', '✓', '', '', '✓'],
  ];
  monData.forEach((row, ri) => {
    row.forEach((cell, ci) => {
      const cx = 5.1 + ci * 0.92;
      const cy = 3.45 + ri * 0.33;
      const isHeader = ri === 0;
      s.addShape(pres.ShapeType.rect, {
        x: cx, y: cy, w: 0.9, h: 0.32,
        fill: { color: isHeader ? C.midBlue : (ri % 2 === 0 ? C.dark : C.navy) },
        line: { color: C.midBlue, width: 0.5 }
      });
      s.addText(cell, {
        x: cx + 0.02, y: cy + 0.02, w: 0.86, h: 0.28,
        fontSize: 8.5, bold: isHeader, color: isHeader ? C.teal : (cell === '✓' ? C.green : C.textGray),
        fontFace: 'Calibri', align: 'center', valign: 'middle', margin: 0
      });
    });
  });
}

// ─── SLIDE 18 — SUMMARY & KEY TAKEAWAYS ──────────────────────────────────────
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.06, fill: { color: C.accent } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.565, w: 10, h: 0.06, fill: { color: C.gold } });

  s.addText('KEY TAKEAWAYS FOR NURSING PRACTICE', { x: 0.5, y: 0.18, w: 9, h: 0.5, fontSize: 22, bold: true, color: C.white, fontFace: 'Calibri', align: 'center' });
  s.addShape(pres.ShapeType.line, { x: 1, y: 0.72, w: 8, h: 0, line: { color: C.gold, width: 1 } });

  const takeaways = [
    ['🧠', 'PATHOPHYSIOLOGY', 'Dopamine hyperactivity (mesolimbic → positive sx) + hypoactivity (mesocortical → negative sx). NMDA hypofunction compounds cognitive deficits.', C.accent],
    ['🔍', 'ASSESS THOROUGHLY', 'Use MSE every interaction. Prioritize safety assessment. Negative symptoms predict poor prognosis and require targeted nursing interventions.', C.teal],
    ['💊', 'MEDICATION VIGILANCE', '2nd-gen antipsychotics are preferred. Clozapine = treatment-resistant only (mandatory CBC monitoring). Never miss NMS signs — HALT mnemonic.', C.orange],
    ['🤝', 'THERAPEUTIC ALLIANCE', 'Non-judgmental, consistent care. Do not argue with delusions. Motivational interviewing for medication adherence. Family involvement is essential.', C.green],
    ['📊', 'MONITOR & PREVENT', 'Metabolic syndrome is common. Monitor weight, glucose, lipids, QTc. Promote exercise (improves cognition + hippocampal volume). Early relapse detection.', C.purple],
    ['🌟', 'HOPE-BASED CARE', '≥1 in 3 patients achieves significant recovery (WHO 2025). Recovery is possible. Emphasize strengths-based, recovery-oriented nursing care.', C.gold],
  ];

  takeaways.forEach(([icon, label, text, col], i) => {
    const y = 0.82 + i * 0.78;
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  s.addText('Sources: Harrison\'s 22E (2025) | Goodman & Gilman\'s | Adams & Victor\'s Neurology | INTEGRATE Guidelines (Lancet Psychiatry 2025) | VA/DoD CPG 2025 | DSM-5-TR', {
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  });
}

// ─── WRITE FILE ───────────────────────────────────────────────────────────────
const outPath = '/home/daytona/workspace/schizophrenia-ppt/Schizophrenia_Nursing_Guide.pptx';
pres.writeFile({ fileName: outPath }).then(() => {
  console.log('SUCCESS: ' + outPath);
}).catch(err => {
  console.error('ERROR:', err);
});

Running Command

cd /home/daytona/workspace/schizophrenia-ppt && node schizophrenia.js 2>&1

Running Command

ls -lh /home/daytona/workspace/schizophrenia-ppt/Schizophrenia_Nursing_Guide.pptx

Your presentation is ready! Download it here:

Schizophrenia Nursing Guide

Presentation · PPTX

What's Inside — 18 Slides

The deck uses a professional dark navy / electric blue / gold palette throughout. Here is a slide-by-slide breakdown:

#	Slide	Highlights
1	Title	Brain icon, guideline citations, date
2	Contents	Color-coded 10-topic index
3	Definition & Overview	Harrison's 22E quote, 4 key stats (prevalence, onset, burden)
4	Epidemiology & Risk Factors	Genetic risk ladder (1% → 50% MZ twins), 10 risk factors
5	Pathophysiology	3-column diagram: Dopamine / Glutamate-NMDA / Serotonin-GABA mechanisms
6	Dopamine Pathway Diagram	All 4 pathways (mesolimbic, mesocortical, nigrostriatal, tuberoinfundibular) with clinical effects
7	Clinical Features	3-column: Positive / Negative / Cognitive symptoms (DSM-5-TR aligned)
8	DSM-5-TR Criteria	Criterion A (5 items), Criteria B–F, 5 related disorders
9	Pharmacological Treatment	FGA vs SGA comparison, new 2025 drug KarXT (xanomeline)
10	Treatment Algorithm	5-step INTEGRATE 2025 / VA-DoD 2025 flowchart
11	Nursing Assessment	MSE + Safety + Physical (3-column), AIMS scale, clozapine CBC
12	Nursing Diagnoses & Care Plan	4 NANDA-I diagnoses with nursing interventions
13	Non-Pharmacological Interventions	CBTp, Family Psychoeducation, IPS, Aerobic Exercise, SST
14	Side Effects & Monitoring	NMS emergency box (HALT), EPS, metabolic, clozapine-specific
15	Complications & Prognosis	Rule of Thirds, illness course timeline (5 phases)
16	Special Populations	Pregnancy, elderly, adolescents, substance use comorbidity
17	Mnemonics & Quick Reference	SCHIZO nursing mnemonic, HALT for NMS, metabolic monitoring schedule
18	Key Takeaways	6 evidence-based nursing practice points

Sources used: Harrison's Principles 22E (2025), Goodman & Gilman's Pharmacology, Adams & Victor's Neurology 12E, INTEGRATE International Guidelines (Lancet Psychiatry 2025), VA/DoD Clinical Practice Guidelines 2025, DSM-5-TR.

Create Ppt on schizophrenia in detail, using human brain diagram in pathophysiology and other needed areas, for nursing students, using recent guidelines

Reading File

Finding Sources

Searching the Web

human brain dopamine pathway diagram schizophrenia SVG anatomy labeled 2024

Running Command

node /home/daytona/skills/shared/scripts/fetch_images.js "https://www.researchgate.net/publication/351612736/figure/fig1/AS:1035449472651266@1623881800949/Schematic-representation-of-the-major-dopaminergic-pathways-in-the-brain-the.png" "https://upload.wikimedia.org/wikipedia/commons/0/02/Mesocortical_pathway.svg" "https://img.freepik.com/premium-vector/dopamine-pathway-human-brain-monoamine-neurotransmitter-motor-control-vector-illustration_206049-1149.jpg" 2>&1 | head -5

Reading File

Searching PubMed

"schizophrenia"[MeSH Terms] AND "treatment"[MeSH Terms]

Running Command

node /home/daytona/skills/shared/scripts/fetch_images.js "https://upload.wikimedia.org/wikipedia/commons/thumb/0/02/Mesocortical_pathway.svg/800px-Mesocortical_pathway.svg.png" 2>&1 | python3 -c "import sys,json; d=json.load(sys.stdin); print('OK' if not d[0]['error'] else d[0]['error']); print(d[0]['base64'][:60] if not d[0]['error'] else '')"

Reading File

Writing File

~/schizophrenia-ppt/schizophrenia_v2.js

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = 'LAYOUT_16x9';
pres.author = 'Orris Medical Education';
pres.title = 'Schizophrenia – Nursing Education';

// ─── PALETTE ─────────────────────────────────────────────────────────────────
const C = {
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  panel:    '112240',
  mid:      '1A3A5C',
  accent:   '3B9EE8',
  gold:     'F4B942',
  teal:     '00C9C8',
  green:    '48C98E',
  red:      'E84545',
  orange:   'F07B3F',
  purple:   '9B72CF',
  pink:     'E879A0',
  white:    'FFFFFF',
  lightGray:'C8D8EE',
  dim:      '7B97BB',
  mesolimbic:'E84545',
  mesocortical:'3B9EE8',
  nigrostriatal:'48C98E',
  tuberoinfundibular:'F4B942',
};

// ─── HELPERS ─────────────────────────────────────────────────────────────────
const S = pres.ShapeType;

function slide(bg) {
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}

function hdr(s, text, color) {
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}

function card(s, x, y, w, h, title, items, borderColor, titleBg) {
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}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = slide(C.bg);
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  // Brain silhouette (pure shapes)
  // outer brain
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  // frontal lobe bump
  s.addShape(S.ellipse, { x:6.65, y:0.5, w:1.4, h:1.2, fill:{ color:C.mid }, line:{ color:C.accent, width:1 } });
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  // title text
  s.addText('SCHIZOPHRENIA', { x:0.4, y:0.7, w:5.8, h:1.05, fontSize:48, bold:true, color:C.white, fontFace:'Calibri', charSpacing:3 });
  s.addText('A Comprehensive Guide for Nursing Students', { x:0.4, y:1.82, w:5.8, h:0.48, fontSize:18, color:C.accent, fontFace:'Calibri', italic:true });
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  s.addText([
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    { text:"Harrison's 22E (2025)  •  Goodman & Gilman's  •  Adams & Victor's Neurology 12E", options:{ color:C.white } }
  ], { x:0.4, y:2.55, w:5.8, h:0.36, fontSize:10.5, fontFace:'Calibri' });
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    { text:'INTEGRATE 2025 (Lancet Psychiatry)  •  VA/DoD CPG 2025  •  DSM-5-TR', options:{ color:C.white } }
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  s.addText('June 2026  |  Orris Medical Education', { x:0.4, y:4.9, w:5, h:0.28, fontSize:9.5, color:C.dim, fontFace:'Calibri' });
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// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — TABLE OF CONTENTS
// ═══════════════════════════════════════════════════════════════════════════════
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  const topics = [
    ['01','Definition & Overview',         C.accent],
    ['02','Epidemiology & Risk Factors',    C.teal],
    ['03','Pathophysiology – Brain Mechanisms', C.purple],
    ['04','Dopamine Pathway Diagram',       C.mesolimbic],
    ['05','Clinical Features (Symptoms)',   C.gold],
    ['06','DSM-5-TR Diagnostic Criteria',   C.green],
    ['07','Pharmacological Treatment',      C.orange],
    ['08','Treatment Algorithm 2025',       C.pink],
    ['09','Nursing Assessment & Diagnoses', C.teal],
    ['10','Nursing Interventions & Care',   C.accent],
    ['11','Side Effects & Monitoring',      C.red],
    ['12','Complications, Prognosis & Summary', C.gold],
  ];

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  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — DEFINITION & OVERVIEW
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = slide();
  hdr(s, '01  DEFINITION & OVERVIEW', C.accent);

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  s.addText(
    'Schizophrenia is a heterogeneous syndrome characterized by perturbations of language, perception, thinking, social activity, affect, and volition. It commonly begins in late adolescence with insidious onset, progressing from social withdrawal and perceptual distortions to recurrent delusions and hallucinations.',
    { x:0.55, y:0.7, w:9.0, h:1.05, fontSize:13, color:C.white, fontFace:'Calibri', italic:true, valign:'middle' }
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  // 4 key facts
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    ['🌍','World Prevalence','0.85 – 1.5%\nLifetime', C.accent],
    ['📅','Age of Onset','Late teens to\nearly 30s', C.teal],
    ['🇺🇸','USA: Acute Cases','~300,000\nepisodes/year', C.gold],
    ['💰','Economic Burden','$155.7 Billion\n(USA, direct+indirect)', C.red],
  ];
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  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — EPIDEMIOLOGY & RISK FACTORS
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = slide();
  hdr(s, '02  EPIDEMIOLOGY & RISK FACTORS', C.teal);

  // Genetic risk ladder
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    { label:'1st-Degree Relative',       risk:'6.6%', w:4.2, col:C.accent },
    { label:'One Parent Affected',       risk:'12%',  w:3.6, col:C.teal },
    { label:'Dizygotic (Fraternal) Twin',risk:'10%',  w:3.0, col:C.purple },
    { label:'Both Parents Affected',     risk:'40%',  w:2.4, col:C.orange },
    { label:'Monozygotic (Identical) Twin',risk:'50%',w:1.8, col:C.red },
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    'Copy number variants (CNVs)',
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    'Prenatal malnutrition (famine)',
    'In utero CNS infections',
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    'Cannabis use in adolescence (↑ 2×)',
    'Urban upbringing / social adversity',
    'Immigration (2nd generation risk ↑)',
    'Childhood trauma/abuse',
    'Low socioeconomic status',
    '"Downward drift" phenomenon',
    'Social isolation, disorganization',
  ], C.orange);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — PATHOPHYSIOLOGY (NEUROTRANSMITTER OVERVIEW)
// ═══════════════════════════════════════════════════════════════════════════════
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  const s = slide();
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      col: C.accent, title:'DOPAMINE HYPOTHESIS',
      sub:'(Revised Version III)',
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        'D2 receptor hyperactivity in STRIATUM',
        '→ Positive symptoms (hallucinations, delusions)',
        '',
        'D1/D2 hypoactivity in PREFRONTAL CORTEX',
        '→ Negative + cognitive symptoms',
        '',
        '4 Key Pathways Affected:',
        'Mesolimbic   ·  Mesocortical',
        'Nigrostriatal  ·  Tuberoinfundibular',
        '',
        'Basis of ALL antipsychotic drugs',
      ]
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    {
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      items:[
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        '→ Cognitive + negative symptoms',
        '',
        'PCP & Ketamine block NMDA',
        '→ Reproduce ALL symptoms of schizophrenia',
        '',
        'Disrupts GABAergic interneurons (PV+)',
        '→ Disinhibits pyramidal neurons',
        '→ Excess glutamate in cortex',
        '',
        'New target: mGluR2/3 agonists',
      ]
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    {
      col: C.teal, title:'SEROTONIN & GABA',
      sub:'Modulatory Systems',
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        '5-HT2A overactivity → visual/perceptual distortions',
        '5-HT2A blockade by atypical APs → ↓ EPS',
        '5-HT1A partial agonism → improved mood',
        '',
        'GABA interneuron loss:',
        '→ Impaired gamma oscillations (40 Hz)',
        '→ Working memory failure',
        '→ Sensory gating deficits',
        '',
        'Muscarinic M1/M4 — NEW TARGET',
        'KarXT (Xanomeline) approved 2024',
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}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — HUMAN BRAIN DOPAMINE PATHWAY DIAGRAM (drawn with shapes)
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = slide(C.bg);
  hdr(s, '04  HUMAN BRAIN — DOPAMINE PATHWAYS IN SCHIZOPHRENIA', C.purple);

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  // Frontal lobe protrusion
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  // Occipital lobe protrusion (back)
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  // Parietal
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  // Temporal lobe
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  // Cerebellum
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  // Cerebellum inner texture lines
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  s.addShape(S.line, { x:6.7, y:3.5, w:1.0, h:0, line:{ color:'1E4A70', width:0.6, dashType:'dash' } });
  // Brain stem
  s.addShape(S.roundRect, { x:5.8, y:3.8, w:0.75, h:1.5, fill:{ color:'0D2140' }, line:{ color:'4A7ABB', width:1.5 }, rectRadius:0.3 });
  // Corpus callosum (arching white band inside brain)
  // approximate arc using line
  s.addShape(S.line, { x:3.2, y:1.95, w:2.8, h:0, line:{ color:'6A9AC4', width:1.2, dashType:'sysDash' } });
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  // Central sulcus (fissure)
  s.addShape(S.line, { x:5.15, y:0.68, w:0.2, h:1.6, line:{ color:'4A7ABB', width:0.8, dashType:'sysDot' } });
  // Lateral fissure (Sylvian)
  s.addShape(S.line, { x:3.2, y:2.4, w:2.5, h:0, line:{ color:'4A7ABB', width:0.8, dashType:'sysDot' } });

  // ── BRAIN REGIONS LABELS ──────────────────────────────────────────────────
  s.addText('Prefrontal\nCortex', { x:2.3, y:0.75, w:1.4, h:0.58, fontSize:9, bold:true, color:C.accent, fontFace:'Calibri', align:'center' });
  s.addText('Parietal\nCortex',  { x:4.8, y:0.68, w:1.2, h:0.48, fontSize:8.5, color:C.lightGray, fontFace:'Calibri', align:'center' });
  s.addText('Occipital\nCortex', { x:6.5, y:1.65, w:1.3, h:0.48, fontSize:8.5, color:C.lightGray, fontFace:'Calibri', align:'center' });
  s.addText('Temporal\nCortex',  { x:3.0, y:2.62, w:1.5, h:0.48, fontSize:8.5, color:C.lightGray, fontFace:'Calibri', align:'center' });
  s.addText('Cerebellum',        { x:6.5, y:3.38, w:1.5, h:0.32, fontSize:9, color:C.dim, fontFace:'Calibri', align:'center' });
  s.addText('Brain\nStem',       { x:5.65, y:4.0, w:0.9, h:0.48, fontSize:9, color:C.dim, fontFace:'Calibri', align:'center' });

  // ── KEY BRAIN STRUCTURES (dots + labels) ─────────────────────────────────
  // Nucleus Accumbens (NAc) – mesolimbic target
  s.addShape(S.ellipse, { x:3.85, y:2.68, w:0.3, h:0.3, fill:{ color:C.mesolimbic }, line:{ color:C.white, width:0.8 } });
  s.addText('Nucleus\nAccumbens', { x:3.05, y:2.98, w:1.3, h:0.44, fontSize:8, bold:true, color:C.mesolimbic, fontFace:'Calibri', align:'center' });

  // Striatum
  s.addShape(S.ellipse, { x:4.45, y:2.05, w:0.36, h:0.28, fill:{ color:C.nigrostriatal }, line:{ color:C.white, width:0.8 } });
  s.addText('Striatum', { x:4.4, y:1.72, w:1.1, h:0.28, fontSize:8, bold:true, color:C.nigrostriatal, fontFace:'Calibri', align:'center' });

  // VTA – Ventral Tegmental Area
  s.addShape(S.ellipse, { x:5.1, y:3.38, w:0.34, h:0.28, fill:{ color:C.red }, line:{ color:C.white, width:1 } });
  s.addText('VTA', { x:4.7, y:3.25, w:0.4, h:0.22, fontSize:9, bold:true, color:C.red, fontFace:'Calibri', margin:0 });

  // Substantia Nigra
  s.addShape(S.ellipse, { x:5.5, y:3.65, w:0.32, h:0.24, fill:{ color:C.nigrostriatal }, line:{ color:C.white, width:0.8 } });
  s.addText('Subst.\nNigra', { x:5.82, y:3.55, w:0.85, h:0.44, fontSize:7.5, color:C.nigrostriatal, fontFace:'Calibri' });

  // Hypothalamus
  s.addShape(S.ellipse, { x:4.8, y:3.0, w:0.3, h:0.24, fill:{ color:C.tuberoinfundibular }, line:{ color:C.white, width:0.8 } });
  s.addText('Hypothalamus', { x:3.75, y:3.05, w:1.05, h:0.22, fontSize:7.5, bold:true, color:C.tuberoinfundibular, fontFace:'Calibri', align:'right' });

  // Pituitary
  s.addShape(S.ellipse, { x:4.78, y:3.55, w:0.24, h:0.24, fill:{ color:C.tuberoinfundibular, transparency:30 }, line:{ color:C.tuberoinfundibular, width:0.8 } });
  s.addText('Pituitary', { x:3.85, y:3.55, w:0.9, h:0.22, fontSize:7.5, color:C.tuberoinfundibular, fontFace:'Calibri', align:'right' });

  // Thalamus
  s.addShape(S.ellipse, { x:4.95, y:2.45, w:0.42, h:0.34, fill:{ color:'1E4A70' }, line:{ color:'5A8AB0', width:1 } });
  s.addText('Thalamus', { x:4.88, y:2.22, w:1.0, h:0.22, fontSize:8, color:C.dim, fontFace:'Calibri', align:'center' });

  // ── PATHWAYS (coloured lines with arrows) ─────────────────────────────────
  // 1) MESOLIMBIC: VTA → Nucleus Accumbens (red)
  s.addShape(S.line, { x:5.12, y:3.52, w:-1.0, h:-0.55, line:{ color:C.mesolimbic, width:2.5 } });

  // 2) MESOCORTICAL: VTA → Prefrontal Cortex (blue)
  s.addShape(S.line, { x:5.12, y:3.52, w:-2.0, h:-2.25, line:{ color:C.mesocortical, width:2.5 } });

  // 3) NIGROSTRIATAL: Substantia Nigra → Striatum (green)
  s.addShape(S.line, { x:5.52, y:3.65, w:-0.7, h:-1.35, line:{ color:C.nigrostriatal, width:2.5 } });

  // 4) TUBEROINFUNDIBULAR: Hypothalamus → Pituitary (gold)
  s.addShape(S.line, { x:4.83, y:3.12, w:0, h:0.43, line:{ color:C.tuberoinfundibular, width:2.5 } });

  // ── LEGEND (right side) ───────────────────────────────────────────────────
  const legend = [
    { col:C.mesolimbic,         label:'MESOLIMBIC',         detail:'VTA → Nucleus Accumbens',        effect:'↑ DA → Positive symptoms',         sym:'↑ DA' },
    { col:C.mesocortical,       label:'MESOCORTICAL',       detail:'VTA → Prefrontal Cortex',         effect:'↓ DA → Negative & Cognitive sx',   sym:'↓ DA' },
    { col:C.nigrostriatal,      label:'NIGROSTRIATAL',      detail:'Substantia Nigra → Striatum',     effect:'↓ DA → EPS (antipsychotic SE)',     sym:'↓ DA' },
    { col:C.tuberoinfundibular, label:'TUBEROINFUNDIBULAR', detail:'Hypothalamus → Pituitary',        effect:'↓ DA → Hyperprolactinemia',         sym:'↓ DA' },
  ];

  legend.forEach(({ col, label, detail, effect }, i) => {
    const y = 0.72 + i * 1.12;
    s.addShape(S.roundRect, { x:8.15, y, w:1.72, h:1.0, fill:{ color:C.panel }, line:{ color:col, width:1.5 }, rectRadius:0.08 });
    s.addShape(S.roundRect, { x:8.15, y, w:1.72, h:0.34, fill:{ color:col, transparency:25 }, rectRadius:0.08 });
    // color bar
    s.addShape(S.line, { x:8.15, y:y+0.03, w:0, h:0.94, line:{ color:col, width:3 } });
    s.addText(label, { x:8.22, y:y+0.02, w:1.58, h:0.3, fontSize:9.5, bold:true, color:C.white, fontFace:'Calibri', margin:0, valign:'middle' });
    s.addText(detail, { x:8.22, y:y+0.36, w:1.58, h:0.28, fontSize:8, color:C.lightGray, fontFace:'Calibri' });
    s.addText(effect, { x:8.22, y:y+0.62, w:1.58, h:0.33, fontSize:8.5, bold:true, color:col, fontFace:'Calibri' });
  });

  // Bottom note
  s.addText('VTA = Ventral Tegmental Area  |  DA = Dopamine  |  EPS = Extrapyramidal Symptoms  |  sx = symptoms', {
    x:0.25, y:5.35, w:7.7, h:0.22, fontSize:8.5, color:C.dim, fontFace:'Calibri', italic:true
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — ANTIPSYCHOTIC BRAIN MECHANISM DIAGRAM
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = slide();
  hdr(s, '04b  HOW ANTIPSYCHOTICS ACT ON THE BRAIN', C.purple);

  // Synapse diagram (drawn with shapes)
  // Pre-synaptic neuron body
  s.addShape(S.ellipse, { x:0.9, y:1.8, w:1.6, h:1.3, fill:{ color:C.mid }, line:{ color:C.accent, width:1.5 } });
  s.addText('Pre-synaptic\nNeuron\n(Dopaminergic)', { x:0.9, y:1.8, w:1.6, h:1.3, fontSize:9, color:C.white, fontFace:'Calibri', align:'center', valign:'middle' });
  // Axon terminal
  s.addShape(S.ellipse, { x:2.8, y:2.25, w:1.0, h:0.8, fill:{ color:C.mid }, line:{ color:C.accent, width:1.2 } });
  s.addText('Axon\nTerminal', { x:2.8, y:2.25, w:1.0, h:0.8, fontSize:8, color:C.white, fontFace:'Calibri', align:'center', valign:'middle' });
  // axon line
  s.addShape(S.line, { x:2.5, y:2.45, w:0.3, h:0, line:{ color:C.accent, width:1.5 } });

  // DA vesicles
  ['DA','DA','DA'].forEach((_, i) => {
    s.addShape(S.ellipse, { x:2.9+i*0.2, y:2.32, w:0.18, h:0.18, fill:{ color:C.accent }, line:{ color:C.white, width:0.5 } });
  });

  // Synaptic cleft
  s.addShape(S.rect, { x:3.82, y:2.25, w:0.55, h:0.8, fill:{ color:'0A1020' }, line:{ color:C.dim, width:0.8, dashType:'sysDash' } });
  s.addText('Synapse', { x:3.82, y:2.75, w:0.55, h:0.25, fontSize:7.5, color:C.dim, fontFace:'Calibri', align:'center' });

  // Post-synaptic neuron
  s.addShape(S.ellipse, { x:4.38, y:1.85, w:1.5, h:1.2, fill:{ color:C.mid }, line:{ color:C.teal, width:1.5 } });
  s.addText('Post-synaptic\nNeuron\n(D2 Receptor)', { x:4.38, y:1.85, w:1.5, h:1.2, fontSize:9, color:C.white, fontFace:'Calibri', align:'center', valign:'middle' });

  // DA arrows in cleft
  s.addShape(S.line, { x:3.82, y:2.5, w:-0.02, h:0, line:{ color:C.accent, width:1 } });

  // Normal state label
  s.addText('NORMAL STATE', { x:0.8, y:1.45, w:5.2, h:0.3, fontSize:11, bold:true, color:C.dim, fontFace:'Calibri', align:'center' });
  s.addShape(S.roundRect, { x:0.8, y:0.72, w:5.2, h:0.68, fill:{ color:C.panel }, line:{ color:C.dim, width:1 }, rectRadius:0.07 });
  s.addText('Dopamine released → binds D2 receptor → normal signalling', { x:0.9, y:0.78, w:5.0, h:0.56, fontSize:11, color:C.white, fontFace:'Calibri', valign:'middle' });

  // Schizophrenia state (right column - arrows and text)
  s.addShape(S.roundRect, { x:6.15, y:0.72, w:3.6, h:1.6, fill:{ color:'2A0A0A' }, line:{ color:C.red, width:1.5 }, rectRadius:0.08 });
  s.addShape(S.roundRect, { x:6.15, y:0.72, w:3.6, h:0.4, fill:{ color:C.red, transparency:30 }, rectRadius:0.08 });
  s.addText('IN SCHIZOPHRENIA (Mesolimbic)', { x:6.25, y:0.74, w:3.4, h:0.36, fontSize:11, bold:true, color:C.white, fontFace:'Calibri', margin:0, valign:'middle' });
  s.addText([
    { text:'↑ Excessive DA release', options:{ bullet:{ code:'25B8', color:C.red }, color:C.white, fontSize:11, breakLine:true } },
    { text:'↑ D2 receptor overstimulation', options:{ bullet:{ code:'25B8', color:C.red }, color:C.white, fontSize:11, breakLine:true } },
    { text:'→ Positive symptoms: hallucinations, delusions', options:{ color:C.dim, fontSize:10.5, breakLine:false } },
  ], { x:6.25, y:1.14, w:3.4, h:1.1, fontFace:'Calibri', valign:'top' });

  // Antipsychotic mechanism
  s.addShape(S.roundRect, { x:6.15, y:2.42, w:3.6, h:1.6, fill:{ color:'0A2A0A' }, line:{ color:C.green, width:1.5 }, rectRadius:0.08 });
  s.addShape(S.roundRect, { x:6.15, y:2.42, w:3.6, h:0.4, fill:{ color:C.green, transparency:30 }, rectRadius:0.08 });
  s.addText('ANTIPSYCHOTIC ACTION (FGA/SGA)', { x:6.25, y:2.44, w:3.4, h:0.36, fontSize:11, bold:true, color:C.white, fontFace:'Calibri', margin:0, valign:'middle' });
  s.addText([
    { text:'Blocks D2 receptor (FGA: high affinity)', options:{ bullet:{ code:'25B8', color:C.green }, color:C.white, fontSize:11, breakLine:true } },
    { text:'SGA: D2 + 5-HT2A blockade (fewer EPS)', options:{ bullet:{ code:'25B8', color:C.green }, color:C.white, fontSize:11, breakLine:true } },
    { text:'→ Reduces positive symptoms', options:{ color:C.dim, fontSize:10.5 } },
  ], { x:6.25, y:2.84, w:3.4, h:1.1, fontFace:'Calibri', valign:'top' });

  // D2 blockade symbol on synapse
  s.addShape(S.ellipse, { x:4.55, y:2.3, w:0.35, h:0.35, fill:{ color:C.red, transparency:30 }, line:{ color:C.red, width:1.5 } });
  s.addShape(S.line, { x:4.57, y:2.32, w:0.31, h:0.31, line:{ color:C.red, width:1.5 } });
  s.addText('D2\nBlock', { x:4.95, y:2.22, w:0.8, h:0.4, fontSize:8.5, bold:true, color:C.red, fontFace:'Calibri' });

  // Clozapine box
  s.addShape(S.roundRect, { x:6.15, y:4.12, w:3.6, h:1.38, fill:{ color:'0A0A2A' }, line:{ color:C.gold, width:1.5 }, rectRadius:0.08 });
  s.addShape(S.roundRect, { x:6.15, y:4.12, w:3.6, h:0.38, fill:{ color:C.gold, transparency:30 }, rectRadius:0.08 });
  s.addText('CLOZAPINE (Treatment-Resistant)', { x:6.25, y:4.14, w:3.4, h:0.34, fontSize:10.5, bold:true, color:C.white, fontFace:'Calibri', margin:0, valign:'middle' });
  s.addText([
    { text:'Multi-receptor: D1-D4, 5-HT2A, α1, M1, H1', options:{ bullet:{ code:'25B8', color:C.gold }, color:C.white, fontSize:10, breakLine:true } },
    { text:'Very low D2 affinity → almost no EPS', options:{ bullet:{ code:'25B8', color:C.gold }, color:C.white, fontSize:10, breakLine:true } },
    { text:'Risk: Agranulocytosis → mandatory CBC monitoring', options:{ bullet:{ code:'25B8', color:C.red }, color:C.red, fontSize:10, bold:true } },
  ], { x:6.25, y:4.54, w:3.4, h:0.92, fontFace:'Calibri', valign:'top' });

  // Aripiprazole note
  s.addShape(S.roundRect, { x:0.25, y:4.12, w:5.7, h:1.38, fill:{ color:C.panel }, line:{ color:C.teal, width:1.5 }, rectRadius:0.08 });
  s.addShape(S.roundRect, { x:0.25, y:4.12, w:5.7, h:0.38, fill:{ color:C.teal, transparency:30 }, rectRadius:0.08 });
  s.addText('PARTIAL AGONISTS (Aripiprazole, Cariprazine, Brexpiprazole)', { x:0.35, y:4.14, w:5.5, h:0.34, fontSize:10.5, bold:true, color:C.white, fontFace:'Calibri', margin:0, valign:'middle' });
  s.addText([
    { text:'Partial D2 agonist: reduces excess DA in striatum (positive sx) AND stimulates DA in PFC (negative/cognitive sx)', options:{ bullet:{ code:'25B8', color:C.teal }, color:C.white, fontSize:10.5, breakLine:true } },
    { text:'Cariprazine: D3>D2 affinity → pro-cognitive effects', options:{ bullet:{ code:'25B8', color:C.teal }, color:C.white, fontSize:10.5 } },
  ], { x:0.35, y:4.54, w:5.5, h:0.9, fontFace:'Calibri', valign:'top' });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — CLINICAL FEATURES
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = slide();
  hdr(s, '05  CLINICAL FEATURES — SYMPTOM CLUSTERS', C.gold);

  card(s, 0.2, 0.62, 3.1, 4.88, 'POSITIVE SYMPTOMS', [
    'Added to normal function',
    'Hallucinations (most common: auditory)',
    '  "Hearing voices that command"',
    'Delusions',
    '  Persecutory, grandiose, referential',
    '  Thought insertion / broadcasting',
    'Disorganized Speech (thought disorder)',
    '  Loose associations, word salad',
    '  Tangentiality, circumstantiality',
    'Disorganized Behaviour',
    '  Inappropriate dress/conduct',
    'Catatonia',
    '  Stupor, mutism, waxy flexibility',
  ], C.red);

  card(s, 3.45, 0.62, 3.1, 4.88, 'NEGATIVE SYMPTOMS', [
    'Loss of normal function',
    '1/3 of patients — poor prognosis',
    'Drug-resistant symptoms',
    'Avolition (lack of motivation)',
    'Anhedonia (no pleasure)',
    'Alogia (poverty of speech)',
    'Affective flattening / blunted affect',
    'Social withdrawal / isolation',
    'Diminished emotional expression',
    'Impaired social functioning',
    'Poor self-care & hygiene',
    'Asociality',
    '⚠ Predictors of poor outcome',
  ], C.orange);

  card(s, 6.7, 0.62, 3.1, 4.88, 'COGNITIVE SYMPTOMS', [
    'Core disability — often overlooked',
    'May PRECEDE psychosis by years',
    'Working memory ↓',
    'Verbal learning & memory ↓',
    'Attention & vigilance ↓',
    'Processing speed ↓',
    'Executive function ↓',
    '  Planning, abstraction, set-shifting',
    'Social cognition ↓',
    '  Reading facial emotions',
    'Predict functional outcomes',
    'Poorly treated by antipsychotics',
    '→ Target: CBT, cognitive training',
  ], C.purple);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — DSM-5-TR DIAGNOSTIC CRITERIA
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = slide();
  hdr(s, '06  DSM-5-TR DIAGNOSTIC CRITERIA (2022)', C.green);

  // Criterion A
  s.addShape(S.roundRect, { x:0.2, y:0.62, w:5.9, h:3.0, fill:{ color:C.panel }, line:{ color:C.green, width:1.5 }, rectRadius:0.1 });
  s.addShape(S.roundRect, { x:0.2, y:0.62, w:5.9, h:0.46, fill:{ color:C.green, transparency:25 }, rectRadius:0.1 });
  s.addText('CRITERION A — At least 2 present for ≥ 1 month (≥1 from 1, 2, or 3)', { x:0.32, y:0.64, w:5.66, h:0.42, fontSize:11, bold:true, color:C.white, fontFace:'Calibri', margin:0, valign:'middle' });

  const crA = [
    ['1','DELUSIONS',                                     C.red],
    ['2','HALLUCINATIONS',                                C.orange],
    ['3','DISORGANIZED SPEECH',                           C.gold],
    ['4','GROSSLY DISORGANIZED / CATATONIC BEHAVIOUR',    C.purple],
    ['5','NEGATIVE SYMPTOMS (avolition / diminished expression)', C.teal],
  ];
  crA.forEach(([n, text, col], i) => {
    const y = 1.16 + i*0.44;
    s.addShape(S.roundRect, { x:0.32, y, w:0.38, h:0.36, fill:{ color:col }, rectRadius:0.05 });
    s.addText(n, { x:0.32, y, w:0.38, h:0.36, fontSize:13, bold:true, color:C.bg, fontFace:'Calibri', align:'center', valign:'middle', margin:0 });
    s.addText(text, { x:0.78, y:y+0.03, w:5.2, h:0.3, fontSize:11, color:C.white, fontFace:'Calibri', valign:'middle' });
  });
  s.addShape(S.line, { x:0.32, y:3.42, w:5.66, h:0, line:{ color:C.green, width:0.8 } });
  s.addText('★  At least ONE symptom MUST be criterion 1, 2, or 3', { x:0.32, y:3.46, w:5.66, h:0.28, fontSize:10.5, bold:true, color:C.gold, fontFace:'Calibri' });

  // Criteria B-F
  s.addShape(S.roundRect, { x:6.3, y:0.62, w:3.5, h:3.0, fill:{ color:C.panel }, line:{ color:C.accent, width:1.5 }, rectRadius:0.1 });
  s.addShape(S.roundRect, { x:6.3, y:0.62, w:3.5, h:0.46, fill:{ color:C.accent, transparency:25 }, rectRadius:0.1 });
  s.addText('CRITERIA B – F (Time & Exclusions)', { x:6.42, y:0.64, w:3.26, h:0.42, fontSize:11, bold:true, color:C.white, fontFace:'Calibri', margin:0, valign:'middle' });
  const crBF = [
    ['B','Social / occupational dysfunction since onset',    C.teal],
    ['C','Continuous signs ≥ 6 months (prodrome incl.)',     C.green],
    ['D','Exclude schizoaffective + mood disorder',          C.gold],
    ['E','Exclude substance use or medical condition',       C.orange],
    ['F','If ASD: add ≥1 month prominent psychotic sx',     C.purple],
  ];
  crBF.forEach(([n, text, col], i) => {
    const y = 1.16 + i*0.44;
    s.addShape(S.roundRect, { x:6.42, y, w:0.34, h:0.34, fill:{ color:col }, rectRadius:0.05 });
    s.addText(n, { x:6.42, y, w:0.34, h:0.34, fontSize:11, bold:true, color:C.bg, fontFace:'Calibri', align:'center', valign:'middle', margin:0 });
    s.addText(text, { x:6.84, y:y+0.03, w:2.84, h:0.3, fontSize:10, color:C.white, fontFace:'Calibri', valign:'middle' });
  });

  // Related disorders
  s.addText('RELATED PSYCHOTIC DISORDERS', { x:0.2, y:3.82, w:9.6, h:0.32, fontSize:12, bold:true, color:C.gold, fontFace:'Calibri' });
  const rel = [
    ['Brief Psychotic\nDisorder',      '< 1 month',         C.accent],
    ['Schizophreniform\nDisorder',     '1–6 months',        C.purple],
    ['Schizoaffective\nDisorder',      'Schiz + mood',      C.orange],
    ['Delusional Disorder',            'Delusions only,\n≥1 month', C.teal],
    ['Schizotypal\nPersonality',       'Eccentric,\nsocial deficits', C.green],
  ];
  rel.forEach(([label, sub, col], i) => {
    const x = 0.2 + i*1.94;
    s.addShape(S.roundRect, { x, y:4.18, w:1.82, h:1.35, fill:{ color:C.panel }, line:{ color:col, width:1 }, rectRadius:0.08 });
    s.addShape(S.roundRect, { x, y:4.18, w:1.82, h:0.4, fill:{ color:col, transparency:25 }, rectRadius:0.08 });
    s.addText(label, { x:x+0.07, y:4.2, w:1.68, h:0.36, fontSize:10, bold:true, color:C.white, fontFace:'Calibri', align:'center', margin:0, valign:'middle' });
    s.addText(sub, { x:x+0.07, y:4.6, w:1.68, h:0.9, fontSize:10.5, color:col, fontFace:'Calibri', align:'center' });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — PHARMACOLOGICAL TREATMENT
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = slide();
  hdr(s, '07  PHARMACOLOGICAL TREATMENT — ANTIPSYCHOTICS', C.orange);

  // FGA
  s.addShape(S.roundRect, { x:0.2, y:0.62, w:4.5, h:4.88, fill:{ color:C.panel }, line:{ color:C.red, width:1.5 }, rectRadius:0.1 });
  s.addShape(S.roundRect, { x:0.2, y:0.62, w:4.5, h:0.5, fill:{ color:C.red, transparency:25 }, rectRadius:0.1 });
  s.addText('1st GENERATION (TYPICAL / FGA)', { x:0.32, y:0.64, w:4.26, h:0.46, fontSize:12, bold:true, color:C.white, fontFace:'Calibri', margin:0, valign:'middle' });
  s.addText([
    { text:'MECHANISM: Potent D2 receptor antagonism', options:{ bold:true, color:C.gold, fontSize:11.5, breakLine:true } },
    { text:'✓ Excellent for POSITIVE symptoms', options:{ color:C.green, fontSize:11, breakLine:true, bold:true } },
    { text:'✗ No benefit for negative/cognitive sx', options:{ color:C.red, fontSize:11, breakLine:true, italic:true } },
    { text:' ', options:{ breakLine:true, fontSize:6 } },
    { text:'DRUGS (low → high potency):', options:{ bold:true, color:C.teal, fontSize:11, breakLine:true } },
    { text:'Chlorpromazine 100–1000 mg/day', options:{ bullet:{ code:'25B8', color:C.red }, color:C.white, fontSize:11, breakLine:true } },
    { text:'Perphenazine 4–64 mg/day', options:{ bullet:{ code:'25B8', color:C.red }, color:C.white, fontSize:11, breakLine:true } },
    { text:'Haloperidol 1–40 mg/day (high potency)', options:{ bullet:{ code:'25B8', color:C.red }, color:C.white, fontSize:11, breakLine:true } },
    { text:'Fluphenazine, Trifluoperazine', options:{ bullet:{ code:'25B8', color:C.red }, color:C.white, fontSize:11, breakLine:true } },
    { text:' ', options:{ breakLine:true, fontSize:6 } },
    { text:'SIDE EFFECTS:', options:{ bold:true, color:C.orange, fontSize:11, breakLine:true } },
    { text:'EPS: akathisia, dystonia, parkinsonism', options:{ bullet:{ code:'25B8', color:C.orange }, color:C.white, fontSize:11, breakLine:true } },
    { text:'Tardive dyskinesia (chronic use)', options:{ bullet:{ code:'25B8', color:C.orange }, color:C.white, fontSize:11, breakLine:true } },
    { text:'Hyperprolactinemia, galactorrhea', options:{ bullet:{ code:'25B8', color:C.orange }, color:C.white, fontSize:11, breakLine:true } },
    { text:'NMS — LIFE THREATENING (see Slide 11)', options:{ bullet:{ code:'25B8', color:C.red }, color:C.red, fontSize:11, bold:true, breakLine:true } },
    { text:'Sedation, anticholinergic effects', options:{ bullet:{ code:'25B8', color:C.orange }, color:C.white, fontSize:11 } },
  ], { x:0.32, y:1.18, w:4.26, h:4.26, fontFace:'Calibri', valign:'top' });

  // SGA
  s.addShape(S.roundRect, { x:4.92, y:0.62, w:4.88, h:4.88, fill:{ color:C.panel }, line:{ color:C.green, width:1.5 }, rectRadius:0.1 });
  s.addShape(S.roundRect, { x:4.92, y:0.62, w:4.88, h:0.5, fill:{ color:C.green, transparency:25 }, rectRadius:0.1 });
  s.addText('2nd GENERATION (ATYPICAL / SGA) — PREFERRED', { x:5.04, y:0.64, w:4.64, h:0.46, fontSize:12, bold:true, color:C.white, fontFace:'Calibri', margin:0, valign:'middle' });
  s.addText([
    { text:'MECHANISM: D2 + 5-HT2A blockade; lower D2 occupancy', options:{ bold:true, color:C.gold, fontSize:11.5, breakLine:true } },
    { text:'✓ Fewer EPS  ✓ Better negative sx  ✓ Improved cognition', options:{ color:C.green, fontSize:11, breakLine:true, bold:true } },
    { text:' ', options:{ breakLine:true, fontSize:6 } },
    { text:'KEY DRUGS:', options:{ bold:true, color:C.teal, fontSize:11, breakLine:true } },
    { text:'Olanzapine 5–20 mg — most effective, ↑ weight/DM risk', options:{ bullet:{ code:'25B8', color:C.green }, color:C.white, fontSize:10.5, breakLine:true } },
    { text:'Risperidone 2–8 mg — commonly used; some EPS', options:{ bullet:{ code:'25B8', color:C.green }, color:C.white, fontSize:10.5, breakLine:true } },
    { text:'Quetiapine 150–800 mg — sedating, mood stabiliser', options:{ bullet:{ code:'25B8', color:C.green }, color:C.white, fontSize:10.5, breakLine:true } },
    { text:'Clozapine — TREATMENT-RESISTANT only (mandatory CBC)', options:{ bullet:{ code:'25B8', color:C.gold }, color:C.gold, fontSize:10.5, bold:true, breakLine:true } },
    { text:'Aripiprazole 10–30 mg — partial D2 agonist; low metabolic SE', options:{ bullet:{ code:'25B8', color:C.green }, color:C.white, fontSize:10.5, breakLine:true } },
    { text:'Ziprasidone 80–160 mg — low weight gain; QTc risk', options:{ bullet:{ code:'25B8', color:C.green }, color:C.white, fontSize:10.5, breakLine:true } },
    { text:'Cariprazine — D3/D2 partial agonist; pro-cognitive', options:{ bullet:{ code:'25B8', color:C.green }, color:C.white, fontSize:10.5, breakLine:true } },
    { text:' ', options:{ breakLine:true, fontSize:6 } },
    { text:'NEW 2024/25 — KarXT (Xanomeline + Trospium):', options:{ bold:true, color:C.accent, fontSize:11, breakLine:true } },
    { text:'Muscarinic M1/M4 agonist — NO dopamine mechanism', options:{ bullet:{ code:'25B8', color:C.accent }, color:C.accent, fontSize:10.5, breakLine:true } },
    { text:'SIDE EFFECTS: Metabolic syndrome, weight gain, QTc prolongation, diabetes, dyslipidemia', options:{ bold:false, color:C.orange, fontSize:10.5 } },
  ], { x:5.04, y:1.18, w:4.64, h:4.26, fontFace:'Calibri', valign:'top' });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — TREATMENT ALGORITHM 2025
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = slide();
  hdr(s, '08  TREATMENT ALGORITHM — INTEGRATE 2025 / VA-DoD 2025', C.pink);

  const steps = [
    { n:'01', col:C.accent,  label:'FIRST ACUTE EPISODE', body:'Start 2nd-gen antipsychotic (SGA). Adequate trial = 4–6 weeks at therapeutic dose. Assess response at 2 weeks. Consider LAI if adherence concerns.' },
    { n:'02', col:C.teal,   label:'MONITORING',           body:'Monitor metabolic parameters at baseline, 1 month, 3 months then annually: weight/BMI, fasting glucose, lipid panel, BP, QTc (ECG), CBC if on clozapine.' },
    { n:'03', col:C.gold,   label:'INADEQUATE RESPONSE',  body:'Switch to a different SGA (different receptor profile). Reassess diagnosis. Address adherence, substance use, psychosocial stressors. Add CBTp.' },
    { n:'04', col:C.orange, label:'TREATMENT-RESISTANT SCHIZOPHRENIA (TRS)', body:'Defined: failure of ≥2 adequate AP trials. CLOZAPINE is the evidence-based gold standard. Monitor CBC: weekly ×6 months, bi-weekly ×6 months, then monthly.' },
    { n:'05', col:C.green,  label:'MAINTENANCE THERAPY',  body:'Indefinite maintenance after 2+ episodes. LAI preferred for adherence. Psychoeducation. Family therapy. Regular metabolic monitoring. Exercise program.' },
  ];

  steps.forEach(({ n, col, label, body }, i) => {
    const y = 0.68 + i*0.94;
    s.addShape(S.roundRect, { x:0.2, y, w:0.8, h:0.82, fill:{ color:col }, rectRadius:0.08 });
    s.addText(n, { x:0.2, y, w:0.8, h:0.82, fontSize:16, bold:true, color:C.bg, fontFace:'Calibri', align:'center', valign:'middle', margin:0 });
    s.addShape(S.line, { x:1.0, y:y+0.41, w:0.18, h:0, line:{ color:col, width:2 } });
    s.addShape(S.roundRect, { x:1.18, y, w:8.6, h:0.82, fill:{ color:C.panel }, line:{ color:col, width:1 }, rectRadius:0.08 });
    s.addText(label, { x:1.3, y:y+0.02, w:8.36, h:0.3, fontSize:11.5, bold:true, color:C.white, fontFace:'Calibri', margin:0 });
    s.addText(body, { x:1.3, y:y+0.34, w:8.36, h:0.45, fontSize:10, color:C.dim, fontFace:'Calibri' });
    if (i < 4) {
      s.addShape(S.line, { x:0.6, y:y+0.82, w:0, h:0.12, line:{ color:col, width:2 } });
    }
  });

  s.addText('INTEGRATE = International Guidelines Algorithmic Treatment Evaluation, Lancet Psychiatry, March 2025  |  VA/DoD CPG = Veterans Affairs / Department of Defense Clinical Practice Guidelines 2025', {
    x:0.2, y:5.4, w:9.6, h:0.2, fontSize:8, color:C.dim, fontFace:'Calibri', italic:true
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — NURSING ASSESSMENT
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = slide();
  hdr(s, '09  NURSING ASSESSMENT — COMPREHENSIVE EVALUATION', C.teal);

  card(s, 0.2, 0.62, 3.1, 4.88, 'MENTAL STATUS EXAM (MSE)', [
    'Appearance & general behaviour',
    'Level of consciousness',
    'Orientation: time, place, person',
    'Speech: rate, tone, coherence',
    'Mood (subjective) & Affect (objective)',
    'Thought content (delusions?)',
    'Thought process (associations?)',
    'Perceptions (hallucinations?)',
    'Insight into illness (anosognosia)',
    'Judgement & impulse control',
    'Cognitive screen: MMSE / MoCA',
    'PANSS scale (positive & negative)',
  ], C.accent);

  card(s, 3.45, 0.62, 3.1, 4.88, 'SAFETY ASSESSMENT', [
    'Suicidal ideation (10% lifetime risk)',
    '  SI: plan, intent, means, timeline',
    'Homicidal / violent ideation',
    'Command hallucinations (act on?)',
    'History of aggression / violence',
    'Substance use (cannabis, alcohol)',
    'Access to weapons/means',
    'Elopement / absconding risk',
    'Self-neglect: nutrition, hygiene',
    'Level of agitation (BARS scale)',
    'Protective factors:',
    '  Social support, reasons to live',
    '  Insight, medication compliance',
  ], C.red);

  card(s, 6.7, 0.62, 3.1, 4.88, 'PHYSICAL ASSESSMENT', [
    'Vital signs (BP, HR, Temp, RR)',
    'Weight & BMI (baseline + regular)',
    'Waist circumference',
    'Metabolic: fasting glucose, lipids',
    'Neurological exam (tremor, rigidity)',
    'EPS assessment (AIMS scale)',
    'Medication side effects review',
    'Hydration & nutritional status',
    'Sleep pattern assessment',
    'Cardiovascular: QTc if indicated',
    'Labs per medication:',
    '  CBC weekly (clozapine)',
    '  LFTs, renal function, prolactin',
  ], C.green);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 — NURSING DIAGNOSES & INTERVENTIONS
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = slide();
  hdr(s, '10  NURSING DIAGNOSES & KEY INTERVENTIONS (NANDA-I)', C.accent);

  const nxDx = [
    {
      dx:'Disturbed Sensory Perception r/t neurochemical imbalance (hallucinations)',
      col:C.purple,
      inter:['Stay calm; do not argue about or reinforce hallucinations', 'Orient to reality — simple, clear, short sentences', 'Reduce environmental stimuli (quiet room, dim lighting)', 'Administer antipsychotics as prescribed; monitor response', 'Document: frequency, content, triggers of hallucinations']
    },
    {
      dx:'Risk for Violence (self/other) r/t command hallucinations, paranoid ideation',
      col:C.red,
      inter:['Assess SI/HI every shift using structured tool (C-SSRS)', 'De-escalation: calm tone, maintain personal space, offer choices', 'Secure environment — remove sharps, ligature risks', 'PRN medications per protocol after de-escalation attempt', 'Document mental status changes every shift']
    },
    {
      dx:'Social Isolation r/t altered thought processes, negative symptoms, stigma',
      col:C.orange,
      inter:['Establish therapeutic nurse-patient relationship (trust)', 'Set small achievable social interaction goals daily', 'Facilitate group therapy participation; support attendance', 'Family psychoeducation — reduce expressed emotion (EE)', 'Social skills training referral (SST program)']
    },
    {
      dx:'Impaired Medication Management r/t lack of insight (anosognosia)',
      col:C.gold,
      inter:['Psychoeducation: explain benefits and how medication helps', 'Discuss LAI (long-acting injectable) as adherence option', 'Address side effect concerns promptly to improve adherence', 'Motivational interviewing — explore patient\'s own goals', 'Involve family/caregiver in medication management plan']
    },
  ];

  nxDx.forEach(({ dx, col, inter }, i) => {
    const y = 0.62 + i*1.2;
    s.addShape(S.roundRect, { x:0.2, y, w:9.6, h:1.1, fill:{ color:C.panel }, line:{ color:col, width:1 }, rectRadius:0.08 });
    s.addShape(S.roundRect, { x:0.2, y, w:3.2, h:1.1, fill:{ color:col, transparency:30 }, rectRadius:0.08 });
    s.addText(dx, { x:0.32, y:y+0.04, w:2.96, h:1.02, fontSize:10, bold:true, color:C.white, fontFace:'Calibri', valign:'middle' });
    const arr = inter.map((t, ii) => ({
      text: t,
      options:{ bullet:{ code:'25B8', color:col }, breakLine: ii<inter.length-1, fontSize:10, color:C.white, fontFace:'Calibri', paraSpaceBefore:2 }
    }));
    s.addText(arr, { x:3.52, y:y+0.06, w:6.16, h:1.0, fontFace:'Calibri', valign:'top' });
  });

  s.addShape(S.roundRect, { x:0.2, y:5.42, w:9.6, h:0.17, fill:{ color:C.mid }, rectRadius:0.05 });
  s.addText('OUTCOME GOAL: Patient demonstrates reduced psychotic symptoms, improved reality orientation, medication adherence and safe behaviour within the treatment setting', {
    x:0.32, y:5.43, w:9.36, h:0.15, fontSize:9, color:C.gold, fontFace:'Calibri', italic:true
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 — SIDE EFFECTS & MONITORING
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = slide();
  hdr(s, '11  ANTIPSYCHOTIC SIDE EFFECTS & NURSING MONITORING', C.red);

  // NMS Emergency box
  s.addShape(S.roundRect, { x:0.2, y:0.62, w:9.6, h:1.5, fill:{ color:'200505' }, line:{ color:C.red, width:2.5 }, rectRadius:0.1 });
  s.addShape(S.roundRect, { x:0.2, y:0.62, w:1.5, h:1.5, fill:{ color:C.red }, rectRadius:0.1 });
  s.addText('⚠\nEMER-\nGENCY', { x:0.2, y:0.62, w:1.5, h:1.5, fontSize:13, bold:true, color:C.white, fontFace:'Calibri', align:'center', valign:'middle' });
  s.addText('NEUROLEPTIC MALIGNANT SYNDROME (NMS) — POTENTIALLY FATAL', { x:1.82, y:0.7, w:7.86, h:0.34, fontSize:12, bold:true, color:C.red, fontFace:'Calibri' });
  s.addText([
    { text:'HALT Mnemonic: ', options:{ bold:true, color:C.gold } },
    { text:'Hyperthermia  •  Altered consciousness  •  Lead-pipe Rigidity  •  Tachycardia / autonomic instability', options:{ color:C.white } },
    { text:'\nNursing Action: ', options:{ bold:true, color:C.gold, breakLine:false } },
    { text:'STOP antipsychotic IMMEDIATELY  •  IV fluids  •  Cooling blankets  •  Dantrolene/Bromocriptine  •  ICU transfer  •  Notify physician STAT', options:{ color:C.white } }
  ], { x:1.82, y:1.07, w:7.86, h:1.0, fontSize:10.5, fontFace:'Calibri' });

  const seBoxes = [
    { title:'EXTRAPYRAMIDAL SYMPTOMS (EPS)', col:C.purple,
      items:['Acute dystonia (hours–days after start)', 'Akathisia: subjective restlessness, pacing', 'Parkinsonism: tremor, rigidity, bradykinesia', 'Tardive dyskinesia (months–years; may persist)', 'Use AIMS scale to monitor regularly', 'Treat: dose↓, switch SGA, benztropine (EPS)'] },
    { title:'METABOLIC SYNDROME', col:C.orange,
      items:['Weight gain (esp. olanzapine, clozapine)', 'Type 2 Diabetes / hyperglycemia', 'Dyslipidaemia (triglycerides ↑, HDL ↓)', 'Monitor: weight, waist, glucose, lipids', 'Baseline & every 3 months × 1 yr, then annually', 'Lifestyle: diet counseling + exercise program'] },
    { title:'CLOZAPINE-SPECIFIC', col:C.gold,
      items:['Agranulocytosis (1–2%): FATAL if missed', 'CBC: weekly ×6 months; bi-weekly ×6 months; then monthly', 'HOLD clozapine if ANC < 1000/mm³', 'Myocarditis (watch first 4 weeks: troponin, ECG)', 'Seizures (dose-dependent, >600 mg/day risk)', 'Hypersalivation, constipation, orthostasis'] },
    { title:'OTHER KEY SIDE EFFECTS', col:C.teal,
      items:['QTc prolongation → torsades de pointes risk', 'Orthostatic hypotension (fall risk — esp. elderly)', 'Sedation (antihistamine H1 blockade)', 'Anticholinergic: urinary retention, dry mouth, constipation', 'Hyperprolactinemia: galactorrhea, amenorrhea', 'Photosensitivity (chlorpromazine / phenothiazines)'] },
  ];

  seBoxes.forEach(({ title, col, items }, i) => {
    const x = 0.2 + (i%2)*4.88;
    const y = 2.22 + Math.floor(i/2)*1.66;
    s.addShape(S.roundRect, { x, y, w:4.7, h:1.58, fill:{ color:C.panel }, line:{ color:col, width:1 }, rectRadius:0.08 });
    s.addShape(S.roundRect, { x, y, w:4.7, h:0.4, fill:{ color:col, transparency:25 }, rectRadius:0.08 });
    s.addText(title, { x:x+0.1, y:y+0.02, w:4.5, h:0.36, fontSize:11, bold:true, color:C.white, fontFace:'Calibri', margin:0, valign:'middle' });
    const arr = items.map((t,ii) => ({
      text:t,
      options:{ bullet:{ code:'25B8', color:col }, breakLine: ii<items.length-1, fontSize:9.5, color:C.white, fontFace:'Calibri', paraSpaceBefore:1 }
    }));
    s.addText(arr, { x:x+0.12, y:y+0.44, w:4.5, h:1.1, fontFace:'Calibri', valign:'top' });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 — NON-PHARMACOLOGICAL INTERVENTIONS
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = slide();
  hdr(s, '09b  NON-PHARMACOLOGICAL INTERVENTIONS', C.green);

  const npI = [
    { title:'Cognitive Behavioural\nTherapy for Psychosis\n(CBTp)', icon:'🧠', col:C.accent,
      items:['Evidence: Cochrane 2024 meta-analysis', 'Reduces positive symptom distress', 'Targets delusional beliefs gently', 'Improves insight into illness', '16–20 sessions; nurse co-facilitated'] },
    { title:'Family Psycho-\neducation (FPE)', icon:'👨‍👩‍👧', col:C.teal,
      items:['Reduces relapse rate by ~50%', 'Improves medication adherence', 'Teaches early warning signs', 'Reduces expressed emotion (EE)', 'NAMI Family-to-Family program'] },
    { title:'Supported Employment\n(IPS Model)', icon:'💼', col:C.gold,
      items:['Individual Placement & Support', 'Evidence-based (Level 1)', 'Competitive employment focus', 'Reduces hospitalization', 'Improves self-esteem / recovery'] },
    { title:'Aerobic Exercise\nProgram', icon:'🏃', col:C.green,
      items:['Increases hippocampal volume (2024)', '150 min/week moderate intensity', 'Improves cognitive function', 'Reduces metabolic complications', 'Nurse role: motivate + monitor'] },
    { title:'Social Skills\nTraining (SST)', icon:'🤝', col:C.purple,
      items:['Role-play, modelling, feedback', 'Improves communication skills', 'Addresses negative symptoms', 'Group format (nurse-facilitated)', 'Integrated rehabilitation program'] },
  ];

  npI.forEach(({ title, icon, col, items }, i) => {
    const x = 0.18 + i*1.95;
    s.addShape(S.roundRect, { x, y:0.62, w:1.8, h:4.88, fill:{ color:C.panel }, line:{ color:col, width:1.5 }, rectRadius:0.1 });
    s.addShape(S.roundRect, { x, y:0.62, w:1.8, h:1.1, fill:{ color:col, transparency:25 }, rectRadius:0.1 });
    s.addText(icon, { x, y:0.65, w:1.8, h:0.5, fontSize:24, align:'center', valign:'middle' });
    s.addText(title, { x:x+0.07, y:1.17, w:1.66, h:0.54, fontSize:9.5, bold:true, color:C.white, fontFace:'Calibri', align:'center' });
    const arr = items.map((t,ii) => ({
      text:t,
      options:{ bullet:{ code:'25B8', color:col }, breakLine: ii<items.length-1, fontSize:10, color:C.white, fontFace:'Calibri', paraSpaceBefore:3 }
    }));
    s.addText(arr, { x:x+0.08, y:1.78, w:1.65, h:3.65, fontFace:'Calibri', valign:'top' });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 16 — PROGNOSIS, COMPLICATIONS & KEY TAKEAWAYS
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = slide(C.bg);
  s.addShape(S.rect, { x:0, y:0, w:10, h:0.05, fill:{ color:C.accent } });
  s.addShape(S.rect, { x:0, y:5.575, w:10, h:0.05, fill:{ color:C.gold } });
  hdr(s, '12  COMPLICATIONS, PROGNOSIS & NURSING TAKEAWAYS', C.gold);

  // Prognosis "rule of thirds"
  s.addText('PROGNOSIS — RULE OF THIRDS (WHO 2025)', { x:0.25, y:0.6, w:5.5, h:0.34, fontSize:12, bold:true, color:C.gold, fontFace:'Calibri' });
  const thirds = [
    { label:'1/3 Recover\nSignificantly', pct:33, col:C.green, detail:'Full / near-full recovery possible' },
    { label:'1/3 Improve with\nResidual Symptoms', pct:33, col:C.gold, detail:'Moderate disability, manageable' },
    { label:'1/3 Chronic\nSevere Course', pct:34, col:C.red, detail:'Treatment-resistant, high burden' },
  ];
  thirds.forEach(({ label, pct, col, detail }, i) => {
    const x = 0.25 + i*1.88;
    s.addShape(S.roundRect, { x, y:0.98, w:1.75, h:2.0, fill:{ color:C.panel }, line:{ color:col, width:1.5 }, rectRadius:0.1 });
    s.addShape(S.roundRect, { x, y:0.98, w:1.75, h:0.88, fill:{ color:col, transparency:25 }, rectRadius:0.1 });
    s.addText(`${pct}%`, { x, y:0.98, w:1.75, h:0.88, fontSize:30, bold:true, color:C.white, fontFace:'Calibri', align:'center', valign:'middle' });
    s.addText(label, { x:x+0.07, y:1.9, w:1.6, h:0.58, fontSize:10, bold:true, color:col, fontFace:'Calibri', align:'center' });
    s.addText(detail, { x:x+0.07, y:2.52, w:1.6, h:0.4, fontSize:9.5, color:C.dim, fontFace:'Calibri', align:'center' });
  });

  // Complications
  card(s, 5.85, 0.6, 3.95, 2.38, '⚠  MAJOR COMPLICATIONS', [
    'Suicide: ~10% lifetime (leading preventable cause)',
    'Cardiovascular disease (metabolic+sedentary)',
    'Substance use disorder (50% comorbidity)',
    'Homelessness & social isolation',
    'Tardive dyskinesia (irreversible EPS)',
    'Cognitive decline over time',
  ], C.red);

  // Course timeline
  s.addText('ILLNESS COURSE TIMELINE', { x:0.25, y:3.08, w:9.5, h:0.32, fontSize:12, bold:true, color:C.teal, fontFace:'Calibri' });
  const phases = [
    ['PREMORBID','Subtle cognitive\n& social deficits', C.dim],
    ['PRODROMAL','Attenuated psychotic\nsymptoms, withdrawal', C.teal],
    ['FIRST\nEPISODE','Acute positive\nsymptoms; admit', C.red],
    ['ACUTE\nTREATMENT','Antipsychotics\n4–8 weeks stabilise', C.orange],
    ['MAINTENANCE','Ongoing therapy,\nrelapse prevention', C.green],
  ];
  phases.forEach(([label, detail, col], i) => {
    const x = 0.25 + i*1.93;
    s.addShape(S.roundRect, { x, y:3.44, w:1.82, h:1.6, fill:{ color:C.panel }, line:{ color:col, width:1 }, rectRadius:0.08 });
    s.addShape(S.roundRect, { x, y:3.44, w:1.82, h:0.42, fill:{ color:col, transparency:25 }, rectRadius:0.08 });
    s.addText(label, { x:x+0.07, y:3.46, w:1.68, h:0.38, fontSize:10, bold:true, color:C.white, fontFace:'Calibri', align:'center', valign:'middle', margin:0 });
    s.addText(detail, { x:x+0.07, y:3.9, w:1.68, h:1.1, fontSize:10, color:C.dim, fontFace:'Calibri', align:'center' });
    if (i<4) s.addShape(S.line, { x:x+1.82, y:4.24, w:0.11, h:0, line:{ color:col, width:1.5 } });
  });

  // Takeaways
  s.addText('Sources: Harrison\'s 22E (2025)  |  Goodman & Gilman\'s Pharmacology  |  Adams & Victor\'s Neurology 12E  |  INTEGRATE Guidelines (Lancet Psychiatry 2025)  |  VA/DoD CPG 2025  |  DSM-5-TR (2022)  |  WHO 2025', {
    x:0.2, y:5.38, w:9.6, h:0.22, fontSize:8, color:C.dim, fontFace:'Calibri', italic:true, align:'center'
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// WRITE FILE
// ═══════════════════════════════════════════════════════════════════════════════
const out = '/home/daytona/workspace/schizophrenia-ppt/Schizophrenia_Nursing_BrainDiagram.pptx';
pres.writeFile({ fileName: out }).then(() => {
  console.log('SUCCESS:', out);
}).catch(err => {
  console.error('ERROR:', err);
  process.exit(1);
});

Running Command

cd /home/daytona/workspace/schizophrenia-ppt && node schizophrenia_v2.js 2>&1

Running Command

ls -lh /home/daytona/workspace/schizophrenia-ppt/Schizophrenia_Nursing_BrainDiagram.pptx

Your presentation is ready! Download it here:

Schizophrenia Nursing BrainDiagram

Presentation · PPTX

What's Inside — 16 Slides

The deck uses a deep navy/electric blue/gold palette with all diagrams drawn programmatically (no external images needed).

#	Slide	Key Features
1	Title	Brain silhouette built from shapes (frontal/temporal/occipital lobes, cerebellum, VTA dot)
2	Table of Contents	Color-coded 12-topic index
3	Definition & Overview	Harrison's 22E quote + 4 stat boxes (prevalence, onset, USA cases, economic burden)
4	Epidemiology & Risk	Genetic risk ladder (1% → 50% MZ twins) + biological & environmental risk columns
5	Pathophysiology	3-column: Dopamine Hypothesis / Glutamate-NMDA / Serotonin-GABA
6	🧠 Human Brain Diagram	Full sagittal brain cross-section drawn in shapes — labeled frontal, parietal, temporal, occipital, cerebellum, brainstem, corpus callosum, VTA, nucleus accumbens, striatum, substantia nigra, hypothalamus, pituitary, thalamus — with all 4 dopamine pathways drawn as color-coded lines
7	Synapse Mechanism Diagram	Pre/post-synaptic neuron + DA vesicles drawn as shapes; shows normal state, schizophrenia (excess DA), FGA/SGA action, clozapine, partial agonists
8	Clinical Features	3 columns: Positive / Negative / Cognitive symptoms
9	DSM-5-TR Criteria	Criterion A (5 items numbered), Criteria B-F, 5 related disorders row
10	Pharmacological Treatment	FGA vs SGA comparison table + KarXT 2024 new drug
11	Treatment Algorithm 2025	5-step INTEGRATE 2025 / VA-DoD CPG flowchart
12	Nursing Assessment	MSE + Safety Assessment + Physical Assessment (3 columns)
13	Nursing Diagnoses & Care	4 NANDA-I diagnoses with 5 interventions each
14	Side Effects & Monitoring	NMS emergency HALT box + 4 SE categories (EPS, metabolic, clozapine, other)
15	Non-Pharmacological Interventions	CBTp, Family Psychoeducation, IPS, Exercise, SST
16	Prognosis & Summary	Rule of Thirds, complications, illness course timeline (5 phases)

Brain diagram (Slide 6) shows all 4 dopamine pathways as distinct colored lines:

🔴 Mesolimbic (VTA → Nucleus Accumbens) - positive symptoms
🔵 Mesocortical (VTA → Prefrontal Cortex) - negative/cognitive symptoms
🟢 Nigrostriatal (Substantia Nigra → Striatum) - EPS side effects
🟡 Tuberoinfundibular (Hypothalamus → Pituitary) - hyperprolactinemia

Create Ppt on schizophrenia in detail, using human brain diagram in pathophysiology and other needed areas, for nursing students, using recent guidelines

Reading File

Searching the Web

schizophrenia 2025 INTEGRATE guidelines treatment algorithm nursing

Running Command

mkdir -p /home/daytona/workspace/schiz-v3 && ls /home/daytona/workspace/schiz-v3/

Writing File

~/schiz-v3/build.js

/**
 * SCHIZOPHRENIA FOR NURSING STUDENTS
 * Comprehensive PPT — June 2026
 * Sources: Harrison's 22E, Goodman & Gilman's, Adams & Victor's,
 *          INTEGRATE 2025 (Lancet Psychiatry), VA/DoD CPG 2025, DSM-5-TR
 */

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Orris Medical Education";
pres.title  = "Schizophrenia – Nursing Students Guide 2025";

// ─── MASTER PALETTE ───────────────────────────────────────────────────────────
const P = {
  bg      : "07111E",   // very dark navy
  panel   : "0E2038",   // card background
  mid     : "163356",   // lighter navy
  border  : "1E4A7A",   // subtle border
  accent  : "2B90E0",   // electric blue
  teal    : "00C4C8",
  green   : "3EC98A",
  gold    : "F5C842",
  orange  : "F07C3A",
  red     : "E84040",
  purple  : "9B6FD4",
  pink    : "D966B0",
  white   : "FFFFFF",
  lgray   : "BDD3EE",
  dim     : "6A8CAE",
  // dopamine pathway colours (vivid, distinct)
  DA_ml   : "FF4545",   // mesolimbic  – red
  DA_mc   : "3B9EE8",   // mesocortical – blue
  DA_ns   : "3EC98A",   // nigrostriatal – green
  DA_ti   : "F5C842",   // tuberoinfundibular – gold
};

const T = pres.ShapeType;

// ─── UTILITY FUNCTIONS ────────────────────────────────────────────────────────
function newSlide(bgColor) {
  const s = pres.addSlide();
  s.background = { color: bgColor || P.bg };
  return s;
}

// Top header bar
function hdr(s, text, barColor, textDark) {
  const bc = barColor || P.accent;
  s.addShape(T.rect, { x:0, y:0, w:10, h:0.55, fill:{ color:bc } });
  s.addText(text, { x:0.3, y:0.07, w:9.4, h:0.41, fontSize:17, bold:true,
    color: textDark ? P.bg : P.white, fontFace:"Calibri", margin:0, valign:"middle" });
}

// Rounded card with title stripe
function rcard(s, x, y, w, h, title, borderColor, titleBg, titleTextColor) {
  const bc = borderColor || P.accent;
  s.addShape(T.roundRect, { x, y, w, h,
    fill:{ color:P.panel }, line:{ color:bc, width:1.5 }, rectRadius:0.1 });
  s.addShape(T.roundRect, { x, y, w, h:0.46,
    fill:{ color: titleBg||bc, transparency:22 }, rectRadius:0.1 });
  s.addText(title, { x:x+0.1, y:y+0.03, w:w-0.2, h:0.4,
    fontSize:12, bold:true, color: titleTextColor||P.white, fontFace:"Calibri",
    align:"center", valign:"middle", margin:0 });
}

// Bullet list inside a card (call after rcard)
function bullets(s, x, y, w, h, items, dotColor) {
  const dc = dotColor || P.accent;
  const arr = items.map((t, i) => ({
    text: t || " ",
    options: {
      bullet: t && !t.startsWith("  ") && !t.startsWith("→") && t !== " "
        ? { code:"25B8", color:dc } : false,
      breakLine: i < items.length - 1,
      fontSize: 10.5,
      color: t.startsWith("→") || t.startsWith("  ") ? P.dim
           : t.match(/^[⚠✓✗★]/) ? P.gold : P.white,
      fontFace: "Calibri",
      bold: t.startsWith("⚠") || t.startsWith("★"),
      paraSpaceBefore: 2,
    }
  }));
  s.addText(arr, { x, y, w, h, fontFace:"Calibri", valign:"top" });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — COVER
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide(P.bg);

  // Right decorative panel
  s.addShape(T.rect, { x:6.2, y:0, w:3.8, h:5.625,
    fill:{ color:P.mid, transparency:45 } });

  // Top and bottom rule lines
  s.addShape(T.rect, { x:0, y:0,     w:10, h:0.06, fill:{ color:P.accent } });
  s.addShape(T.rect, { x:0, y:5.565, w:10, h:0.06, fill:{ color:P.gold } });

  // ── Brain shape (sagittal) ──────────────────────────────────────────────
  // outer brain body
  s.addShape(T.ellipse, { x:6.6, y:0.65, w:3.0, h:2.5,
    fill:{ color:P.mid, transparency:10 }, line:{ color:P.accent, width:2 } });
  // frontal lobe bump (top-left)
  s.addShape(T.ellipse, { x:6.5, y:0.55, w:1.5, h:1.3,
    fill:{ color:P.mid }, line:{ color:P.accent, width:1.5 } });
  // parietal (top-right)
  s.addShape(T.ellipse, { x:7.8, y:0.5, w:1.3, h:1.1,
    fill:{ color:P.mid }, line:{ color:P.accent, width:1.2 } });
  // temporal (bottom-left)
  s.addShape(T.ellipse, { x:6.5, y:2.1, w:1.4, h:1.0,
    fill:{ color:P.mid }, line:{ color:P.accent, width:1.2 } });
  // occipital (right)
  s.addShape(T.ellipse, { x:8.4, y:1.5, w:1.2, h:1.2,
    fill:{ color:P.mid }, line:{ color:P.accent, width:1.2 } });
  // cerebellum
  s.addShape(T.ellipse, { x:8.3, y:2.65, w:1.35, h:1.0,
    fill:{ color:"0D2140" }, line:{ color:P.teal, width:1.2 } });
  // cerebellum folds
  s.addShape(T.line, { x:8.35, y:2.95, w:1.2, h:0, line:{ color:P.border, width:0.7, dashType:"dash" } });
  s.addShape(T.line, { x:8.4,  y:3.15, w:1.0, h:0, line:{ color:P.border, width:0.7, dashType:"dash" } });
  // brain stem
  s.addShape(T.roundRect, { x:7.7, y:3.4, w:0.65, h:1.4,
    fill:{ color:P.panel }, line:{ color:P.accent, width:1.5 }, rectRadius:0.28 });
  // sulcus lines (gyri texture)
  s.addShape(T.line, { x:7.2, y:1.0, w:1.2, h:0, line:{ color:P.border, width:0.8, dashType:"sysDot" } });
  s.addShape(T.line, { x:7.0, y:1.5, w:1.8, h:0, line:{ color:P.border, width:0.8, dashType:"sysDot" } });
  s.addShape(T.line, { x:7.3, y:2.0, w:1.4, h:0, line:{ color:P.border, width:0.8, dashType:"sysDot" } });
  // VTA glow dot
  s.addShape(T.ellipse, { x:7.95, y:2.98, w:0.24, h:0.24,
    fill:{ color:P.red }, line:{ color:P.white, width:0.8 } });
  s.addText("VTA", { x:7.62, y:2.94, w:0.34, h:0.22,
    fontSize:7.5, bold:true, color:P.red, fontFace:"Calibri", margin:0, align:"right" });

  // ── Title text ─────────────────────────────────────────────────────────
  s.addText("SCHIZOPHRENIA", {
    x:0.4, y:0.7, w:5.7, h:1.1,
    fontSize:50, bold:true, color:P.white, fontFace:"Calibri", charSpacing:3 });
  s.addText("A Comprehensive Guide for Nursing Students", {
    x:0.4, y:1.88, w:5.7, h:0.5,
    fontSize:18, color:P.accent, fontFace:"Calibri", italic:true });

  s.addShape(T.line, { x:0.4, y:2.5, w:5.5, h:0, line:{ color:P.gold, width:1.5 } });

  s.addText([
    { text:"Based on: ", options:{ bold:true, color:P.gold } },
    { text:"Harrison's 22E (2025)  ·  Goodman & Gilman's  ·  Adams & Victor's Neurology 12E",
      options:{ color:P.white } }
  ], { x:0.4, y:2.62, w:5.7, h:0.36, fontSize:10.5, fontFace:"Calibri" });

  s.addText([
    { text:"Guidelines: ", options:{ bold:true, color:P.gold } },
    { text:"INTEGRATE 2025 (Lancet Psychiatry)  ·  VA/DoD CPG 2025  ·  DSM-5-TR 2022",
      options:{ color:P.white } }
  ], { x:0.4, y:3.02, w:5.7, h:0.36, fontSize:10.5, fontFace:"Calibri" });

  s.addText("June 2026", {
    x:0.4, y:4.9, w:3, h:0.28, fontSize:9.5, color:P.dim, fontFace:"Calibri" });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — TABLE OF CONTENTS
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide();
  hdr(s, "TABLE OF CONTENTS", P.accent);

  const items = [
    ["01","Definition & Overview",                 P.accent],
    ["02","Epidemiology & Risk Factors",            P.teal],
    ["03","Pathophysiology – Overview",             P.purple],
    ["04","BRAIN DIAGRAM – Dopamine Pathways",      P.DA_ml],
    ["05","Dopamine Pathway – Clinical Effects",    P.DA_mc],
    ["06","Clinical Features (Symptom Clusters)",   P.gold],
    ["07","DSM-5-TR Diagnostic Criteria",           P.green],
    ["08","Differential Diagnosis",                 P.orange],
    ["09","Pharmacological Treatment",              P.red],
    ["10","Treatment Algorithm 2025",               P.pink],
    ["11","Nursing Assessment & Diagnoses",         P.teal],
    ["12","Nursing Interventions",                  P.accent],
    ["13","Side Effects & Monitoring",              P.orange],
    ["14","Non-Pharmacological Interventions",      P.green],
    ["15","Prognosis, Complications & Takeaways",   P.gold],
  ];

  items.forEach(([num, title, col], i) => {
    const right = i >= 8;
    const x = right ? 5.1 : 0.25;
    const row = right ? i - 8 : i;
    const y = 0.7 + row * 0.575;
    s.addShape(T.roundRect, { x, y, w:4.75, h:0.5,
      fill:{ color:P.panel }, line:{ color:col, width:1 }, rectRadius:0.07 });
    s.addShape(T.roundRect, { x:x+0.06, y:y+0.06, w:0.42, h:0.38,
      fill:{ color:col }, rectRadius:0.05 });
    s.addText(num, { x:x+0.06, y:y+0.06, w:0.42, h:0.38,
      fontSize:12, bold:true, color:P.bg, fontFace:"Calibri",
      align:"center", valign:"middle", margin:0 });
    s.addText(title, { x:x+0.57, y:y+0.08, w:4.1, h:0.34,
      fontSize:12.5, color:P.white, fontFace:"Calibri", valign:"middle" });
  });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — DEFINITION & OVERVIEW
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide();
  hdr(s, "01  DEFINITION & OVERVIEW", P.accent);

  // Quote box
  s.addShape(T.roundRect, { x:0.25, y:0.63, w:9.5, h:1.72,
    fill:{ color:P.mid, transparency:15 }, line:{ color:P.accent, width:2 }, rectRadius:0.1 });
  s.addText('"', { x:0.35, y:0.56, w:0.55, h:0.9,
    fontSize:60, bold:true, color:P.gold, fontFace:"Georgia" });
  s.addText(
    "Schizophrenia is a heterogeneous syndrome characterized by perturbations of language, perception, thinking, social activity, affect, and volition. It commonly begins in late adolescence with an insidious onset, progressing from social withdrawal and perceptual distortions to recurrent delusions and hallucinations. There are no pathognomonic features.",
    { x:0.6, y:0.72, w:9.0, h:1.1, fontSize:13.5, color:P.white,
      fontFace:"Calibri", italic:true, valign:"middle" });
  s.addText("— Harrison's Principles of Internal Medicine 22E (2025)", {
    x:0.6, y:1.78, w:9.0, h:0.26, fontSize:9.5, color:P.dim,
    fontFace:"Calibri", italic:true, align:"right" });

  // Key stats
  const stats = [
    ["🌍","World\nPrevalence","0.85 – 1.5%\nLifetime",P.accent],
    ["📅","Typical\nOnset","Late teens –\nearly 30s",P.teal],
    ["♂♀","Sex\nRatio","Equal in males\nand females",P.green],
    ["🇺🇸","USA Acute\nEpisodes","~300,000\nper year",P.gold],
    ["💰","Economic\nBurden","$155.7 Billion\n(USA)",P.red],
  ];
  stats.forEach(([icon, label, val, col], i) => {
    const x = 0.25 + i * 1.91;
    s.addShape(T.roundRect, { x, y:2.48, w:1.78, h:3.06,
      fill:{ color:P.panel }, line:{ color:col, width:1.5 }, rectRadius:0.1 });
    s.addShape(T.roundRect, { x, y:2.48, w:1.78, h:0.54,
      fill:{ color:col, transparency:25 }, rectRadius:0.1 });
    s.addText(icon, { x, y:2.48, w:1.78, h:0.54, fontSize:24,
      align:"center", valign:"middle" });
    s.addText(label, { x:x+0.07, y:3.06, w:1.64, h:0.44,
      fontSize:11, bold:true, color:col, fontFace:"Calibri", align:"center" });
    s.addText(val, { x:x+0.07, y:3.54, w:1.64, h:1.75,
      fontSize:14.5, bold:true, color:P.white, fontFace:"Calibri",
      align:"center", valign:"top" });
  });
  s.addText("⚠  Approximately 10% of patients with schizophrenia die by suicide  (Harrison's 22E)", {
    x:0.25, y:5.38, w:9.5, h:0.2,
    fontSize:9, bold:true, color:P.gold, fontFace:"Calibri", align:"center" });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — EPIDEMIOLOGY
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide();
  hdr(s, "02  EPIDEMIOLOGY & RISK FACTORS", P.teal, true);

  // Genetic risk ladder
  s.addText("GENETIC RISK — LADDER OF HERITABILITY", {
    x:0.25, y:0.63, w:5.45, h:0.3,
    fontSize:11.5, bold:true, color:P.teal, fontFace:"Calibri" });

  const gen = [
    { lbl:"General population",          risk:"~1%",  w:5.0, col:P.border },
    { lbl:"1st-degree relative affected", risk:"6.6%", w:4.4, col:P.accent },
    { lbl:"Dizygotic (fraternal) twin",   risk:"10%",  w:3.8, col:P.teal },
    { lbl:"One parent affected",          risk:"12%",  w:3.2, col:P.purple },
    { lbl:"Both parents affected",        risk:"40%",  w:2.6, col:P.orange },
    { lbl:"Monozygotic (identical) twin", risk:"50%",  w:2.0, col:P.red },
  ];
  gen.forEach(({ lbl, risk, w, col }, i) => {
    const y = 1.0 + i * 0.68;
    s.addShape(T.roundRect, { x:0.25, y, w, h:0.57,
      fill:{ color:col, transparency:20 },
      line:{ color:col, width:1 }, rectRadius:0.06 });
    s.addText(`${lbl}   →   ${risk}`, {
      x:0.38, y:y+0.08, w:w-0.25, h:0.42,
      fontSize:11, bold: i >= 4, color:P.white, fontFace:"Calibri", valign:"middle" });
  });
  s.addText("Overall heritability: ~80%  |  GWAS: 100s of risk loci identified (incl. immune, inflammation, cell-signalling pathways)", {
    x:0.25, y:5.08, w:5.4, h:0.32,
    fontSize:9.5, bold:true, color:P.gold, fontFace:"Calibri" });

  // Two risk boxes on right
  rcard(s, 5.75, 0.63, 4.05, 2.38, "BIOLOGICAL RISK FACTORS", P.purple);
  bullets(s, 5.85, 1.16, 3.85, 1.78, [
    "Genetic variants / CNVs (22q11.2 deletion)",
    "Epigenetic dysregulation",
    "Winter/spring birth (viral exposure in utero)",
    "Advanced paternal age",
    "Obstetric complications, perinatal hypoxia",
    "Prenatal malnutrition (Dutch Hunger Winter data)",
    "In utero CNS infections (Influenza, Toxoplasma)",
  ], P.purple);

  rcard(s, 5.75, 3.1, 4.05, 2.38, "ENVIRONMENTAL RISK FACTORS", P.orange);
  bullets(s, 5.85, 3.63, 3.85, 1.78, [
    "Cannabis use in adolescence (↑ risk 2–4×)",
    "Urban upbringing",
    "Immigration — 2nd generation higher risk",
    "Childhood trauma and adversity",
    "Social isolation / disorganization",
    "Low socioeconomic status ('downward drift')",
    "Psychosocial stress, discrimination",
  ], P.orange);
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — PATHOPHYSIOLOGY OVERVIEW
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide();
  hdr(s, "03  PATHOPHYSIOLOGY — NEUROTRANSMITTER MECHANISMS", P.purple);

  // 3 columns
  const cols = [
    {
      col:P.DA_ml, title:"DOPAMINE HYPOTHESIS", sub:"Version III (revised)",
      items:[
        "Striatal D2 hyperactivity → Positive sx",
        "Prefrontal D1/D2 hypoactivity → Negative sx",
        "4 key pathways disrupted:",
        "  Mesolimbic · Mesocortical",
        "  Nigrostriatal · Tuberoinfundibular",
        " ",
        "Basis: ALL antipsychotics block D2",
        "2–4 week delay in clinical response",
        "→ secondary neurochemical cascades",
        " ",
        "Presynaptic striatal hyperdopaminergia",
        "→ abnormal dopamine synthesis capacity",
        "(PET imaging evidence)",
      ]
    },
    {
      col:P.purple, title:"GLUTAMATE / NMDA", sub:"Hypofunction Model",
      items:[
        "NMDA receptor hypofunction",
        "→ Cognitive + negative symptoms",
        "PCP / Ketamine block NMDA",
        "→ Reproduce full schizophrenia picture",
        " ",
        "Disrupts PV+ GABAergic interneurons",
        "→ Disinhibits pyramidal neurons",
        "→ Excess cortical glutamate release",
        "→ Impaired gamma oscillations (40 Hz)",
        " ",
        "New therapeutic targets:",
        "  mGluR2/3 agonists",
        "  Glycine site modulators (D-serine)",
      ]
    },
    {
      col:P.teal, title:"SEROTONIN & OTHER", sub:"Modulatory Systems",
      items:[
        "5-HT2A overactivity",
        "→ Perceptual distortions, hallucinations",
        "5-HT2A blockade (SGAs) → ↓ EPS",
        "5-HT1A partial agonism → improved mood",
        " ",
        "GABA interneuron loss:",
        "→ Impaired gamma oscillations",
        "→ Working memory failure",
        "→ Sensory gating deficits (P50, MMN)",
        " ",
        "★ NEW 2024: Muscarinic M1/M4 system",
        "KarXT (Xanomeline + Trospium)",
        "→ FDA approved 2024 (1st non-DA drug)",
      ]
    },
  ];

  cols.forEach(({ col, title, sub, items }, i) => {
    const x = 0.18 + i * 3.27;
    const w = 3.1;
    s.addShape(T.roundRect, { x, y:0.63, w, h:4.88,
      fill:{ color:P.panel }, line:{ color:col, width:1.5 }, rectRadius:0.1 });
    s.addShape(T.roundRect, { x, y:0.63, w, h:0.7,
      fill:{ color:col, transparency:22 }, rectRadius:0.1 });
    s.addText(title, { x:x+0.1, y:0.65, w:w-0.2, h:0.38,
      fontSize:12, bold:true, color:P.white, fontFace:"Calibri", align:"center", margin:0 });
    s.addText(sub, { x:x+0.1, y:1.03, w:w-0.2, h:0.26,
      fontSize:9.5, color:col, fontFace:"Calibri", italic:true, align:"center", margin:0 });
    bullets(s, x+0.12, 1.37, w-0.24, 4.07, items, col);
  });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — HUMAN BRAIN DOPAMINE PATHWAY DIAGRAM (the big diagram slide)
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide(P.bg);
  hdr(s, "04  HUMAN BRAIN — DOPAMINE PATHWAYS IN SCHIZOPHRENIA", P.purple);

  // ── BRAIN SILHOUETTE (detailed sagittal view) ───────────────────────────
  // Outer brain body (large ellipse)
  s.addShape(T.ellipse, { x:2.2, y:0.65, w:5.4, h:4.0,
    fill:{ color:"0B1D35" }, line:{ color:"3A6A9A", width:2.2 } });

  // Frontal lobe (left protrusion)
  s.addShape(T.ellipse, { x:2.1, y:0.6, w:2.1, h:2.2,
    fill:{ color:"0C1F38" }, line:{ color:"3A6A9A", width:1.8 } });

  // Parietal lobe (top)
  s.addShape(T.ellipse, { x:3.8, y:0.52, w:2.2, h:1.5,
    fill:{ color:"0B1D35" }, line:{ color:"3A6A9A", width:1.5 } });

  // Occipital lobe (right protrusion)
  s.addShape(T.ellipse, { x:6.5, y:1.3, w:1.6, h:1.6,
    fill:{ color:"0C1F38" }, line:{ color:"3A6A9A", width:1.5 } });

  // Temporal lobe (bottom left)
  s.addShape(T.ellipse, { x:2.3, y:2.6, w:2.3, h:1.5,
    fill:{ color:"0C2040" }, line:{ color:"3A6A9A", width:1.5 } });

  // Cerebellum (bottom right)
  s.addShape(T.ellipse, { x:6.35, y:3.1, w:1.8, h:1.3,
    fill:{ color:"09182C" }, line:{ color:"2A5880", width:1.8 } });
  // cerebellum folia (detail lines)
  for(let cl=0; cl<5; cl++){
    s.addShape(T.line, { x:6.42, y:3.28+cl*0.18, w:1.62, h:0,
      line:{ color:"1A3A60", width:0.6, dashType:"dash" }});
  }

  // Brain stem
  s.addShape(T.roundRect, { x:5.85, y:4.1, w:0.75, h:1.48,
    fill:{ color:"0A1A30" }, line:{ color:"2A5880", width:1.8 }, rectRadius:0.32 });

  // ── INTERNAL STRUCTURES (gyri/sulci texture lines) ──────────────────────
  const sulciLines = [
    [2.5, 1.1, 1.8],[2.4, 1.6, 2.2],[2.5, 2.1, 2.0],[3.0, 2.5, 1.6],
    [3.8, 0.9, 1.8],[4.5, 1.2, 1.6],[5.0, 1.8, 1.4],[4.2, 2.2, 1.8],
  ];
  sulciLines.forEach(([x, y, w]) => {
    s.addShape(T.line, { x, y, w, h:0,
      line:{ color:"163050", width:0.9, dashType:"sysDot" }});
  });

  // Corpus callosum (arched line inside brain)
  s.addShape(T.line, { x:3.0, y:2.05, w:2.8, h:0,
    line:{ color:"406080", width:1.4, dashType:"sysDash" }});
  s.addText("Corpus\nCallosum", { x:3.0, y:1.72, w:2.0, h:0.34,
    fontSize:8, color:"5080A8", fontFace:"Calibri", italic:true });

  // ── LOBE LABELS ─────────────────────────────────────────────────────────
  s.addText("FRONTAL\nLOBE",   { x:2.05, y:0.85, w:1.55, h:0.5, fontSize:9.5, bold:true, color:P.accent,  fontFace:"Calibri", align:"center" });
  s.addText("PARIETAL\nLOBE",  { x:4.1,  y:0.62, w:1.6,  h:0.5, fontSize:9.5, bold:true, color:P.lgray,   fontFace:"Calibri", align:"center" });
  s.addText("OCCIPITAL\nLOBE", { x:6.6,  y:1.55, w:1.4,  h:0.5, fontSize:9.5, bold:true, color:P.lgray,   fontFace:"Calibri", align:"center" });
  s.addText("TEMPORAL\nLOBE",  { x:2.5,  y:2.82, w:1.5,  h:0.5, fontSize:9.5, bold:true, color:P.lgray,   fontFace:"Calibri", align:"center" });
  s.addText("CEREBELLUM",      { x:6.42, y:3.52, w:1.6,  h:0.3, fontSize:8.5, bold:true, color:P.dim,     fontFace:"Calibri", align:"center" });
  s.addText("BRAIN\nSTEM",     { x:5.72, y:4.28, w:0.95, h:0.44,fontSize:8.5, bold:true, color:P.dim,     fontFace:"Calibri", align:"center" });

  // ── KEY STRUCTURES (dots + labels) ─────────────────────────────────────
  // dot helper
  function dot(x, y, col, r) {
    r = r || 0.22;
    s.addShape(T.ellipse, { x:x-r/2, y:y-r/2, w:r, h:r,
      fill:{ color:col }, line:{ color:P.white, width:0.9 }});
  }

  // VTA — Ventral Tegmental Area (origin of mesolimbic + mesocortical)
  dot(5.0, 3.48, P.red, 0.30);
  s.addText("VTA", { x:4.62, y:3.35, w:0.38, h:0.22,
    fontSize:9.5, bold:true, color:P.red, fontFace:"Calibri", align:"right", margin:0 });
  s.addText("(Ventral\nTegmental)", { x:4.25, y:3.55, w:0.75, h:0.36,
    fontSize:7.5, color:P.red, fontFace:"Calibri", align:"right" });

  // Nucleus Accumbens (NAc) — mesolimbic target
  dot(3.95, 3.02, P.DA_ml, 0.26);
  s.addText("Nucleus\nAccumbens", { x:3.05, y:3.08, w:0.9, h:0.4,
    fontSize:8, bold:true, color:P.DA_ml, fontFace:"Calibri", align:"right" });

  // Prefrontal Cortex label area (mesocortical target)
  s.addShape(T.roundRect, { x:2.15, y:0.72, w:1.5, h:0.4,
    fill:{ color:P.DA_mc, transparency:60 }, line:{ color:P.DA_mc, width:1 }, rectRadius:0.06 });
  s.addText("Prefrontal\nCortex (PFC)", { x:2.15, y:0.72, w:1.5, h:0.4,
    fontSize:8.5, bold:true, color:P.white, fontFace:"Calibri", align:"center", margin:0, valign:"middle" });

  // Striatum / Caudate-Putamen (nigrostriatal target)
  dot(4.7, 2.35, P.DA_ns, 0.28);
  s.addText("Striatum", { x:4.75, y:2.12, w:1.1, h:0.24,
    fontSize:8.5, bold:true, color:P.DA_ns, fontFace:"Calibri" });

  // Substantia Nigra (origin of nigrostriatal)
  dot(5.55, 3.72, P.DA_ns, 0.24);
  s.addText("Substantia\nNigra", { x:5.78, y:3.6, w:0.95, h:0.38,
    fontSize:7.5, bold:true, color:P.DA_ns, fontFace:"Calibri" });

  // Hypothalamus (origin of tuberoinfundibular)
  dot(4.55, 3.15, P.DA_ti, 0.22);
  s.addText("Hypothala-\nmus", { x:3.55, y:3.1, w:1.0, h:0.36,
    fontSize:7.5, bold:true, color:P.DA_ti, fontFace:"Calibri", align:"right" });

  // Pituitary gland (tuberoinfundibular target)
  dot(4.55, 3.75, P.DA_ti, 0.2);
  s.addText("Pituitary\nGland", { x:3.55, y:3.7, w:1.0, h:0.36,
    fontSize:7.5, bold:true, color:P.DA_ti, fontFace:"Calibri", align:"right" });

  // Thalamus
  dot(5.18, 2.62, "4A7ABB", 0.28);
  s.addText("Thalamus", { x:5.28, y:2.54, w:1.1, h:0.24,
    fontSize:8.5, color:"5A8ABB", fontFace:"Calibri" });

  // Amygdala
  dot(3.3, 2.95, "8A60BB", 0.22);
  s.addText("Amygdala", { x:2.3, y:2.9, w:1.0, h:0.24,
    fontSize:7.5, color:"8A60BB", fontFace:"Calibri", align:"right" });

  // Hippocampus
  dot(3.7, 3.42, "6A88CC", 0.22);
  s.addText("Hippo-\ncampus", { x:2.65, y:3.36, w:1.05, h:0.36,
    fontSize:7.5, color:"6A88CC", fontFace:"Calibri", align:"right" });

  // ── DOPAMINE PATHWAYS (coloured arrows) ────────────────────────────────
  // 1) MESOLIMBIC: VTA(5.0,3.48) → NAc(3.95,3.02)
  s.addShape(T.line, { x:3.95+0.13, y:3.02, w:5.0-0.13-3.95-0.13, h:3.48-3.02,
    line:{ color:P.DA_ml, width:3.0 }});

  // 2) MESOCORTICAL: VTA(5.0,3.48) → PFC area (3.0, 1.1)
  s.addShape(T.line, { x:3.0, y:1.12, w:5.0-3.0, h:3.48-1.12,
    line:{ color:P.DA_mc, width:3.0 }});

  // 3) NIGROSTRIATAL: SN(5.55,3.72) → Striatum(4.7,2.35)
  s.addShape(T.line, { x:4.7+0.14, y:2.35, w:5.55-4.7-0.14-0.12, h:3.72-2.35,
    line:{ color:P.DA_ns, width:2.8 }});

  // 4) TUBEROINFUNDIBULAR: Hypothalamus(4.55,3.15) → Pituitary(4.55,3.75)
  s.addShape(T.line, { x:4.55, y:3.15+0.11, w:0, h:3.75-3.15-0.22,
    line:{ color:P.DA_ti, width:2.8 }});

  // ── LEGEND PANEL (right side) ───────────────────────────────────────────
  const legend = [
    { col:P.DA_ml, name:"MESOLIMBIC",          from:"VTA → Nucleus Accumbens",      effect:"↑ DA → POSITIVE SYMPTOMS\n(hallucinations, delusions)" },
    { col:P.DA_mc, name:"MESOCORTICAL",        from:"VTA → Prefrontal Cortex",      effect:"↓ DA → NEGATIVE & COGNITIVE\n(alogia, avolition, working memory ↓)" },
    { col:P.DA_ns, name:"NIGROSTRIATAL",       from:"Substantia Nigra → Striatum",  effect:"↓ DA → EPS side effects\n(antipsychotic-induced)" },
    { col:P.DA_ti, name:"TUBEROINFUNDIBULAR",  from:"Hypothalamus → Pituitary",     effect:"↓ DA → Hyperprolactinemia\n(galactorrhea, amenorrhea)" },
  ];

  legend.forEach(({ col, name, from, effect }, i) => {
    const y = 0.67 + i * 1.18;
    s.addShape(T.roundRect, { x:8.15, y, w:1.78, h:1.08,
      fill:{ color:P.panel }, line:{ color:col, width:1.8 }, rectRadius:0.09 });
    // colour bar
    s.addShape(T.rect, { x:8.15, y:y+0.04, w:0.06, h:1.0, fill:{ color:col } });
    s.addText(name, { x:8.25, y:y+0.03, w:1.62, h:0.28,
      fontSize:9.5, bold:true, color:P.white, fontFace:"Calibri", margin:0 });
    s.addText(from, { x:8.25, y:y+0.32, w:1.62, h:0.24,
      fontSize:8, color:P.lgray, fontFace:"Calibri" });
    s.addText(effect, { x:8.25, y:y+0.56, w:1.62, h:0.46,
      fontSize:8.5, bold:true, color:col, fontFace:"Calibri" });
  });

  // Bottom legend note
  s.addText("VTA = Ventral Tegmental Area  |  DA = Dopamine  |  EPS = Extrapyramidal Symptoms  |  PFC = Prefrontal Cortex", {
    x:0.2, y:5.36, w:7.8, h:0.22,
    fontSize:8.5, color:P.dim, fontFace:"Calibri", italic:true });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — DOPAMINE PATHWAYS CLINICAL EFFECTS (table)
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide();
  hdr(s, "05  DOPAMINE PATHWAYS — CLINICAL EFFECTS & ANTIPSYCHOTIC IMPACT", P.DA_ml);

  const rows = [
    {
      pathway:"MESOLIMBIC", col:P.DA_ml,
      origin:"VTA", target:"Nucleus Accumbens\n/ Limbic System",
      schiz:"↑ Dopamine\n(HYPERACTIVE)", sx:"POSITIVE SYMPTOMS:\nHallucinations, delusions,\nconceptual disorganization",
      ap:"D2 blockade reduces\npositive symptoms\n✓ RESPONDS WELL"
    },
    {
      pathway:"MESOCORTICAL", col:P.DA_mc,
      origin:"VTA", target:"Prefrontal Cortex",
      schiz:"↓ Dopamine\n(HYPOACTIVE)", sx:"NEGATIVE & COGNITIVE:\nAvolition, alogia, blunted\naffect, working memory ↓",
      ap:"Antipsychotics may\nworsen or not help\n✗ TREATMENT-REFRACTORY"
    },
    {
      pathway:"NIGROSTRIATAL", col:P.DA_ns,
      origin:"Substantia\nNigra", target:"Striatum\n(Caudate-Putamen)",
      schiz:"Not primarily\naltered in schiz.", sx:"Normal motor control\n(when intact)",
      ap:"D2 blockade here\ncauses EPS:\nTD, parkinsonism, dystonia"
    },
    {
      pathway:"TUBERO-\nINFUNDIBULAR", col:P.DA_ti,
      origin:"Hypothalamus", target:"Anterior Pituitary",
      schiz:"Not primarily\naltered in schiz.", sx:"Normally inhibits\nprolactin secretion",
      ap:"D2 blockade here:\n↑ Prolactin →\ngalactorrhea, amenorrhea"
    },
  ];

  // Column headers
  const colHdrs = ["PATHWAY","ORIGIN","TARGET","IN SCHIZOPHRENIA","CLINICAL SYMPTOMS","ANTIPSYCHOTIC EFFECT"];
  const colX    = [0.2, 1.58, 2.45, 3.5, 4.8, 6.6];
  const colW    = [1.3, 0.82, 1.0,  1.2, 1.7, 3.2];
  colHdrs.forEach((h, ci) => {
    s.addShape(T.rect, { x:colX[ci], y:0.62, w:colW[ci], h:0.42,
      fill:{ color:P.mid } });
    s.addText(h, { x:colX[ci]+0.05, y:0.63, w:colW[ci]-0.1, h:0.4,
      fontSize:9, bold:true, color:P.teal, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });
  });

  rows.forEach(({ pathway, col, origin, target, schiz, sx, ap }, ri) => {
    const y = 1.1 + ri * 1.12;
    const vals = [pathway, origin, target, schiz, sx, ap];
    vals.forEach((v, ci) => {
      s.addShape(T.roundRect, { x:colX[ci], y, w:colW[ci], h:1.06,
        fill:{ color: ci===0 ? col : P.panel, transparency: ci===0 ? 20 : 0 },
        line:{ color: ci===0 ? col : P.border, width: ci===0 ? 1.2 : 0.6 },
        rectRadius:0.06 });
      s.addText(v, { x:colX[ci]+0.05, y:y+0.06, w:colW[ci]-0.1, h:0.94,
        fontSize: ci===0 ? 10.5 : 10,
        bold: ci===0,
        color: ci===5 && v.includes("✗") ? P.red
             : ci===5 && v.includes("✓") ? P.green
             : ci===0 ? P.white : P.lgray,
        fontFace:"Calibri", valign:"middle", align: ci===0 ? "center" : "left" });
    });
  });

  s.addText("Source: Goodman & Gilman's Pharmacological Basis of Therapeutics  |  Harrison's 22E (2025)", {
    x:0.2, y:5.43, w:9.6, h:0.18,
    fontSize:8, color:P.dim, fontFace:"Calibri", italic:true });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — CLINICAL FEATURES
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide();
  hdr(s, "06  CLINICAL FEATURES — THREE SYMPTOM DOMAINS", P.gold, true);

  const domains = [
    {
      col:P.DA_ml, title:"POSITIVE SYMPTOMS",
      sub:"Added to normal function",
      items:[
        "HALLUCINATIONS",
        "  Auditory — most common: 'voices'",
        "  Command hallucinations (act on?)",
        "  Visual, olfactory, tactile",
        "DELUSIONS",
        "  Persecutory — most common",
        "  Grandiose, referential, somatic",
        "  Thought insertion / broadcasting",
        "  Thought withdrawal",
        "DISORGANIZED SPEECH",
        "  Loose associations",
        "  Word salad, tangentiality",
        "  Neologisms, clang associations",
        "DISORGANIZED BEHAVIOUR",
        "  Inappropriate conduct/dress",
        "CATATONIA",
        "  Stupor, mutism, waxy flexibility",
        "  Stereotypy, echolalia",
      ]
    },
    {
      col:P.orange, title:"NEGATIVE SYMPTOMS",
      sub:"Loss of normal function — 1/3 of patients",
      items:[
        "AVOLITION",
        "  Lack of motivation / goal-directed",
        "  Unable to initiate activities",
        "ANHEDONIA",
        "  Inability to feel pleasure",
        "ALOGIA",
        "  Poverty of speech / content",
        "AFFECTIVE FLATTENING",
        "  Blunted / flat affect",
        "  Reduced facial expression",
        "ASOCIALITY",
        "  Social withdrawal",
        "  Disinterest in relationships",
        "POOR SELF-CARE",
        "  Neglect of hygiene, nutrition",
        "⚠ Drug-resistant",
        "⚠ Predictor of POOR prognosis",
        "⚠ Major functional impairment",
      ]
    },
    {
      col:P.purple, title:"COGNITIVE SYMPTOMS",
      sub:"Core disability — often overlooked",
      items:[
        "May PRECEDE psychosis by years",
        "WORKING MEMORY ↓",
        "  Prefrontal cortex dysfunction",
        "VERBAL LEARNING & MEMORY ↓",
        "ATTENTION & VIGILANCE ↓",
        "PROCESSING SPEED ↓",
        "EXECUTIVE FUNCTION ↓",
        "  Planning, abstraction",
        "  Set-shifting, decision-making",
        "SOCIAL COGNITION ↓",
        "  Reading facial expressions",
        "  Theory of mind deficits",
        " ",
        "★ Best predictors of",
        "  functional outcomes",
        "★ Poorly treated by APs",
        "★ Target: CBT, cognitive rehab",
        "★ AIMS scale for monitoring",
      ]
    },
  ];

  domains.forEach(({ col, title, sub, items }, i) => {
    const x = 0.2 + i * 3.27;
    const w = 3.1;
    s.addShape(T.roundRect, { x, y:0.63, w, h:4.88,
      fill:{ color:P.panel }, line:{ color:col, width:1.5 }, rectRadius:0.1 });
    s.addShape(T.roundRect, { x, y:0.63, w, h:0.68,
      fill:{ color:col, transparency:22 }, rectRadius:0.1 });
    s.addText(title, { x:x+0.1, y:0.65, w:w-0.2, h:0.36,
      fontSize:12, bold:true, color:P.white, fontFace:"Calibri", align:"center", margin:0 });
    s.addText(sub, { x:x+0.1, y:1.01, w:w-0.2, h:0.26,
      fontSize:9, color:col, fontFace:"Calibri", italic:true, align:"center", margin:0 });
    bullets(s, x+0.12, 1.36, w-0.24, 4.08, items, col);
  });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — DSM-5-TR CRITERIA
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide();
  hdr(s, "07  DSM-5-TR DIAGNOSTIC CRITERIA (2022)", P.green, true);

  // Criterion A
  s.addShape(T.roundRect, { x:0.2, y:0.63, w:5.85, h:3.02,
    fill:{ color:P.panel }, line:{ color:P.green, width:1.5 }, rectRadius:0.1 });
  s.addShape(T.roundRect, { x:0.2, y:0.63, w:5.85, h:0.46,
    fill:{ color:P.green, transparency:22 }, rectRadius:0.1 });
  s.addText("CRITERION A — At least 2 of the following present for ≥ 1 month", {
    x:0.32, y:0.65, w:5.61, h:0.42,
    fontSize:11, bold:true, color:P.white, fontFace:"Calibri", margin:0, valign:"middle" });

  const crA = [
    ["1","DELUSIONS",                                         P.DA_ml],
    ["2","HALLUCINATIONS",                                    P.orange],
    ["3","DISORGANIZED SPEECH (e.g. incoherence)",            P.gold],
    ["4","GROSSLY DISORGANIZED OR CATATONIC BEHAVIOUR",       P.purple],
    ["5","NEGATIVE SYMPTOMS (diminished expression/avolition)",P.teal],
  ];
  crA.forEach(([n, text, col], i) => {
    const y = 1.16 + i * 0.44;
    s.addShape(T.roundRect, { x:0.32, y, w:0.38, h:0.36,
      fill:{ color:col }, rectRadius:0.05 });
    s.addText(n, { x:0.32, y, w:0.38, h:0.36,
      fontSize:13, bold:true, color:P.bg, fontFace:"Calibri",
      align:"center", valign:"middle", margin:0 });
    s.addText(text, { x:0.78, y:y+0.03, w:5.15, h:0.3,
      fontSize:11, color:P.white, fontFace:"Calibri", valign:"middle" });
  });
  s.addShape(T.line, { x:0.32, y:3.39, w:5.61, h:0, line:{ color:P.green, width:0.8 }});
  s.addText("★  At minimum: ONE symptom must be criterion 1, 2, or 3", {
    x:0.32, y:3.43, w:5.61, h:0.28,
    fontSize:10.5, bold:true, color:P.gold, fontFace:"Calibri" });

  // Criteria B–F
  s.addShape(T.roundRect, { x:6.25, y:0.63, w:3.55, h:3.02,
    fill:{ color:P.panel }, line:{ color:P.accent, width:1.5 }, rectRadius:0.1 });
  s.addShape(T.roundRect, { x:6.25, y:0.63, w:3.55, h:0.46,
    fill:{ color:P.accent, transparency:22 }, rectRadius:0.1 });
  s.addText("CRITERIA B – F (Duration & Exclusions)", {
    x:6.37, y:0.65, w:3.31, h:0.42,
    fontSize:11, bold:true, color:P.white, fontFace:"Calibri", margin:0, valign:"middle" });
  const crBF = [
    ["B","Social/occupational dysfunction since onset",P.teal],
    ["C","Continuous signs ≥ 6 months (prodrome incl.)",P.green],
    ["D","Rule out schizoaffective/mood disorders",P.gold],
    ["E","Rule out substance use or medical cause",P.orange],
    ["F","If ASD: ≥1 month of prominent psychotic sx",P.purple],
  ];
  crBF.forEach(([n, text, col], i) => {
    const y = 1.16 + i*0.44;
    s.addShape(T.roundRect, { x:6.37, y, w:0.34, h:0.34, fill:{ color:col }, rectRadius:0.04 });
    s.addText(n, { x:6.37, y, w:0.34, h:0.34,
      fontSize:11, bold:true, color:P.bg, fontFace:"Calibri", align:"center", valign:"middle", margin:0 });
    s.addText(text, { x:6.79, y:y+0.03, w:2.89, h:0.3,
      fontSize:10, color:P.white, fontFace:"Calibri", valign:"middle" });
  });

  // Differential / Related disorders
  s.addText("RELATED PSYCHOTIC DISORDERS (Differential)", {
    x:0.2, y:3.78, w:9.6, h:0.3,
    fontSize:12, bold:true, color:P.gold, fontFace:"Calibri" });

  const relDx = [
    ["Brief Psychotic\nDisorder",      "< 1 month",          P.accent],
    ["Schizopheniform\nDisorder",      "1–6 months",         P.purple],
    ["Schizoaffective\nDisorder",      "Schiz + mood\nepisodes", P.orange],
    ["Delusional\nDisorder",           "Delusions only,\n≥1 month, non-bizarre", P.teal],
    ["Schizotypal\nPersonality Disorder","Eccentric, odd\nbut NO psychosis", P.green],
  ];
  relDx.forEach(([label, sub, col], i) => {
    const x = 0.2 + i*1.93;
    s.addShape(T.roundRect, { x, y:4.12, w:1.82, h:1.42,
      fill:{ color:P.panel }, line:{ color:col, width:1 }, rectRadius:0.08 });
    s.addShape(T.roundRect, { x, y:4.12, w:1.82, h:0.42,
      fill:{ color:col, transparency:25 }, rectRadius:0.08 });
    s.addText(label, { x:x+0.07, y:4.14, w:1.68, h:0.38,
      fontSize:10, bold:true, color:P.white, fontFace:"Calibri",
      align:"center", valign:"middle", margin:0 });
    s.addText(sub, { x:x+0.07, y:4.58, w:1.68, h:0.9,
      fontSize:10.5, color:col, fontFace:"Calibri", align:"center" });
  });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — PHARMACOLOGICAL TREATMENT
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide();
  hdr(s, "09  PHARMACOLOGICAL TREATMENT — ANTIPSYCHOTIC MEDICATIONS", P.red);

  // FGA column
  rcard(s, 0.2, 0.63, 4.45, 4.88, "1st GENERATION (TYPICAL / FGA)", P.red);
  bullets(s, 0.3, 1.16, 4.25, 4.28, [
    "MECHANISM: Potent D2 receptor antagonism",
    "  First drug: Chlorpromazine (1952)",
    " ",
    "✓ Excellent for POSITIVE symptoms",
    "✗ No benefit for negative/cognitive sx",
    " ",
    "DRUGS (low → high potency):",
    "Chlorpromazine 100–1000 mg/day  [low]",
    "Perphenazine 4–64 mg/day  [mid]",
    "Haloperidol 1–40 mg/day  [high]",
    "Fluphenazine, Trifluoperazine  [high]",
    " ",
    "SIDE EFFECTS:",
    "EPS: acute dystonia, akathisia, parkinsonism",
    "Tardive dyskinesia (chronic, may be irreversible)",
    "Hyperprolactinemia → galactorrhea, amenorrhea",
    "⚠ NMS — Neuroleptic Malignant Syndrome (FATAL)",
    "Sedation, anticholinergic effects",
    "QTc prolongation (thioridazine)",
  ], P.red);

  // SGA column
  rcard(s, 4.87, 0.63, 4.93, 4.88, "2nd GENERATION (ATYPICAL / SGA)  ✓ PREFERRED", P.green);
  bullets(s, 4.97, 1.16, 4.73, 4.28, [
    "MECHANISM: D2 + 5-HT2A dual blockade",
    "  Faster D2 dissociation → lower EPS",
    "  Partial agonists (aripiprazole, cariprazine)",
    " ",
    "✓ Fewer EPS   ✓ Better negative sx coverage",
    " ",
    "DRUGS & KEY NOTES:",
    "Olanzapine 5–20 mg — most effective; ↑ weight/DM",
    "Risperidone 2–8 mg — common 1st line; some EPS",
    "Quetiapine 150–800 mg — sedating, mood stabiliser",
    "Clozapine — TREATMENT-RESISTANT only (CBC req.)",
    "Aripiprazole 10–30 mg — partial D2 agonist; low SE",
    "Ziprasidone 80–160 mg — low weight; QTc risk",
    "Cariprazine 1.5–6 mg — D3/D2, pro-cognitive",
    "Brexpiprazole 1–4 mg — low metabolic burden",
    " ",
    "★ NEW 2024: KarXT (Xanomeline-Trospium)",
    "  Muscarinic M1/M4 agonist — NO dopamine action",
    "  FDA approved Sept 2024 (1st non-DA antipsychotic)",
    " ",
    "SIDE EFFECTS: Metabolic syndrome (weight gain,",
    "  hyperglycemia, dyslipidemia), QTc prolongation",
  ], P.green);
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — TREATMENT ALGORITHM 2025
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide();
  hdr(s, "10  TREATMENT ALGORITHM — INTEGRATE 2025 / VA-DoD CPG 2025", P.pink);

  const steps = [
    {
      n:"STEP 1", col:P.accent,
      label:"BASELINE ASSESSMENT & DIAGNOSIS",
      body:"Confirm DSM-5-TR criteria · Exclude medical causes (CBC, CMP, TFTs, lipids, fasting glucose, ECG, urine drug screen) · Establish baseline weight, BMI, waist circumference · Assess suicide/violence risk · Social and functional assessment"
    },
    {
      n:"STEP 2", col:P.green,
      label:"FIRST ACUTE EPISODE — START SGA",
      body:"Prefer 2nd-generation antipsychotic (SGA) · Adequate trial = 4–6 weeks at therapeutic dose · Assess response at 2 weeks · Consider LAI (long-acting injectable) if adherence concern · Add psychoeducation from day 1"
    },
    {
      n:"STEP 3", col:P.gold,
      label:"INADEQUATE RESPONSE — OPTIMIZE & SWITCH",
      body:"Switch to different SGA (different receptor profile) · Reassess diagnosis · Address adherence, substance use, psychosocial stressors · Add CBT for psychosis (CBTp) · Consider LAI if oral adherence poor"
    },
    {
      n:"STEP 4", col:P.orange,
      label:"TREATMENT-RESISTANT SCHIZOPHRENIA (TRS)",
      body:"Definition: Failure of ≥2 adequate AP trials · CLOZAPINE is the gold-standard evidence-based treatment · CBC monitoring: weekly ×6 months → bi-weekly ×6 months → monthly indefinitely · Address tardive dyskinesia if present (switch, VMAT2 inhibitor)"
    },
    {
      n:"STEP 5", col:P.teal,
      label:"MAINTENANCE THERAPY & RELAPSE PREVENTION",
      body:"Indefinite maintenance after ≥2 episodes · LAI preferred · Regular metabolic monitoring (weight, glucose, lipids, BP) · Family psychoeducation · CBTp · Aerobic exercise program · AIMS scale every 6 months for tardive dyskinesia screening"
    },
  ];

  steps.forEach(({ n, col, label, body }, i) => {
    const y = 0.67 + i * 0.96;
    s.addShape(T.roundRect, { x:0.2, y, w:0.92, h:0.84,
      fill:{ color:col }, rectRadius:0.09 });
    s.addText(n, { x:0.2, y, w:0.92, h:0.84,
      fontSize:10, bold:true, color:P.bg, fontFace:"Calibri",
      align:"center", valign:"middle", margin:0 });
    s.addShape(T.line, { x:1.12, y:y+0.42, w:0.18, h:0, line:{ color:col, width:2 }});
    s.addShape(T.roundRect, { x:1.3, y, w:8.5, h:0.84,
      fill:{ color:P.panel }, line:{ color:col, width:1.2 }, rectRadius:0.08 });
    s.addText(label, { x:1.42, y:y+0.02, w:8.26, h:0.3,
      fontSize:11.5, bold:true, color:P.white, fontFace:"Calibri", margin:0 });
    s.addText(body, { x:1.42, y:y+0.34, w:8.26, h:0.48,
      fontSize:9.5, color:P.lgray, fontFace:"Calibri" });
    if (i < 4) {
      s.addShape(T.line, { x:0.66, y:y+0.84, w:0, h:0.12, line:{ color:col, width:2 }});
    }
  });

  s.addText("INTEGRATE = International Guidelines for Algorithmic Treatment of Schizophrenia, Lancet Psychiatry, March 31 2025  |  VA/DoD CPG = Veterans Affairs / Department of Defense Clinical Practice Guidelines 2025", {
    x:0.2, y:5.44, w:9.6, h:0.18,
    fontSize:7.5, color:P.dim, fontFace:"Calibri", italic:true });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — NURSING ASSESSMENT
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide();
  hdr(s, "11  NURSING ASSESSMENT — COMPREHENSIVE EVALUATION", P.teal, true);

  const cols3 = [
    {
      title:"MENTAL STATUS EXAM (MSE)", col:P.accent,
      items:[
        "Appearance & general behaviour",
        "Level of consciousness",
        "Orientation: time, place, person",
        "Speech: rate, tone, coherence",
        "Mood (subjective) & Affect (objective)",
        "Thought CONTENT — delusions?",
        "  Type: persecutory, grandiose…",
        "Thought PROCESS — associations?",
        "  Loose, tangential, flight of ideas",
        "Perceptions — hallucinations?",
        "  Auditory, visual, command type",
        "Insight into illness (anosognosia)",
        "Judgment & impulse control",
        "Cognitive screen: MMSE / MoCA",
        "Use PANSS scale (positive/negative)",
      ]
    },
    {
      title:"SAFETY ASSESSMENT", col:P.red,
      items:[
        "Suicidal ideation — 10% lifetime risk",
        "  C-SSRS: plan, intent, means",
        "  Access to weapons or means",
        "Homicidal / violent ideation",
        "Command hallucinations?",
        "  'Do the voices tell you to harm?'",
        "History of violence / aggression",
        "Substance use (cannabis ↑↑ risk)",
        "Elopement / absconding risk",
        "Self-neglect: nutrition, hygiene",
        "Agitation level (BARS scale)",
        "Protective factors:",
        "  Social support, reasons to live",
        "  Insight, medication compliance",
        "⚠ Document every shift",
      ]
    },
    {
      title:"PHYSICAL ASSESSMENT", col:P.green,
      items:[
        "Vital signs: BP, HR, Temp, RR, SpO2",
        "Weight, BMI — baseline & regular",
        "Waist circumference",
        "Metabolic: fasting glucose, lipids",
        "Neurological exam",
        "  Tremor, rigidity, dyskinesia",
        "EPS assessment — AIMS scale",
        "  Abnormal Involuntary Movements",
        "Medication side effects review",
        "Hydration & nutritional status",
        "Sleep pattern (quality, quantity)",
        "Cardiovascular: QTc if indicated",
        "Labs by medication:",
        "  CBC weekly — clozapine",
        "  LFTs, renal, prolactin level",
      ]
    },
  ];

  cols3.forEach(({ title, col, items }, i) => {
    const x = 0.2 + i * 3.27;
    const w = 3.1;
    rcard(s, x, 0.63, w, 4.88, title, col);
    bullets(s, x+0.12, 1.16, w-0.24, 4.28, items, col);
  });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 13 — NURSING DIAGNOSES & INTERVENTIONS
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide();
  hdr(s, "12  NURSING DIAGNOSES & INTERVENTIONS (NANDA-I)", P.accent);

  const nxDx = [
    {
      dx:"Disturbed Sensory Perception r/t neurochemical imbalance AEB hallucinations",
      col:P.purple,
      inter:["Stay calm; do NOT argue about or reinforce hallucinations",
             "Orient to reality — simple, clear, short sentences",
             "Reduce environmental stimuli (quiet room, low lighting)",
             "Administer antipsychotics as prescribed; monitor & document response",
             "Document frequency, content, triggers of hallucinations"]
    },
    {
      dx:"Risk for Violence (self/other) r/t command hallucinations, paranoia, poor impulse control",
      col:P.red,
      inter:["Assess SI/HI every shift using structured tool (C-SSRS)",
             "De-escalation: calm tone, maintain safe personal space, offer choices",
             "Secure the environment — remove sharps, ligature risks",
             "PRN medications per protocol after de-escalation attempt",
             "Document mental status changes and any incidents"]
    },
    {
      dx:"Social Isolation r/t altered thought processes, negative symptoms, stigma, mistrust",
      col:P.orange,
      inter:["Build therapeutic nurse-patient relationship (consistency, trust)",
             "Set small achievable daily social interaction goals",
             "Facilitate and encourage group therapy attendance",
             "Family psychoeducation — reduce expressed emotion (EE)",
             "Social skills training (SST) referral"]
    },
    {
      dx:"Non-Adherence to Medication r/t lack of insight (anosognosia), side effects, mistrust",
      col:P.gold,
      inter:["Psychoeducation: explain illness + how medication helps recovery",
             "Discuss LAI (long-acting injectable) as adherence support option",
             "Address side effect concerns promptly to improve willingness",
             "Motivational interviewing — align with patient's own goals",
             "Involve family/caregiver in medication management plan"]
    },
  ];

  nxDx.forEach(({ dx, col, inter }, i) => {
    const y = 0.63 + i * 1.22;
    s.addShape(T.roundRect, { x:0.2, y, w:9.6, h:1.12,
      fill:{ color:P.panel }, line:{ color:col, width:1 }, rectRadius:0.08 });
    s.addShape(T.roundRect, { x:0.2, y, w:3.2, h:1.12,
      fill:{ color:col, transparency:28 }, rectRadius:0.08 });
    s.addText(dx, { x:0.3, y:y+0.05, w:2.98, h:1.02,
      fontSize:10, bold:true, color:P.white, fontFace:"Calibri", valign:"middle" });
    const arr = inter.map((t, ii) => ({
      text:t,
      options:{ bullet:{ code:"25B8", color:col }, breakLine: ii < inter.length-1,
        fontSize:10, color:P.white, fontFace:"Calibri", paraSpaceBefore:2 }
    }));
    s.addText(arr, { x:3.52, y:y+0.06, w:6.16, h:1.0, fontFace:"Calibri", valign:"top" });
  });

  s.addShape(T.roundRect, { x:0.2, y:5.52, w:9.6, h:0.09,
    fill:{ color:P.mid }, line:{ color:P.accent, width:0.5 }, rectRadius:0.04 });
  s.addText("Outcome Goal: Patient demonstrates reduced psychosis, improved orientation, medication adherence, and safe behaviour within treatment setting", {
    x:0.3, y:5.53, w:9.3, h:0.08,
    fontSize:8.5, color:P.gold, fontFace:"Calibri", italic:true });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 14 — SIDE EFFECTS & MONITORING
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide();
  hdr(s, "13  ANTIPSYCHOTIC SIDE EFFECTS & NURSING MONITORING", P.red);

  // NMS emergency banner
  s.addShape(T.roundRect, { x:0.2, y:0.63, w:9.6, h:1.52,
    fill:{ color:"1E0505" }, line:{ color:P.red, width:2.5 }, rectRadius:0.1 });
  s.addShape(T.roundRect, { x:0.2, y:0.63, w:1.5, h:1.52,
    fill:{ color:P.red }, rectRadius:0.1 });
  s.addText("⚠\nEMER-\nGENCY", { x:0.2, y:0.63, w:1.5, h:1.52,
    fontSize:14, bold:true, color:P.white, fontFace:"Calibri",
    align:"center", valign:"middle" });
  s.addText("NEUROLEPTIC MALIGNANT SYNDROME (NMS) — POTENTIALLY FATAL", {
    x:1.82, y:0.7, w:7.86, h:0.3,
    fontSize:12, bold:true, color:P.red, fontFace:"Calibri" });
  s.addText([
    { text:"HALT: ", options:{ bold:true, color:P.gold } },
    { text:"Hyperthermia  ·  Altered consciousness  ·  Lead-pipe muscle Rigidity  ·  Tachycardia/autonomic instability", options:{ color:P.white } },
  ], { x:1.82, y:1.03, w:7.86, h:0.28, fontSize:11, fontFace:"Calibri" });
  s.addText([
    { text:"Nursing Action: ", options:{ bold:true, color:P.gold } },
    { text:"STOP antipsychotic IMMEDIATELY · IV fluids · Cooling measures · Dantrolene / Bromocriptine · ICU transfer · Notify physician STAT", options:{ color:P.white } },
  ], { x:1.82, y:1.34, w:7.86, h:0.28, fontSize:10.5, fontFace:"Calibri" });

  // 4 SE boxes
  const seBoxes = [
    {
      title:"EXTRAPYRAMIDAL SYMPTOMS (EPS)", col:P.purple,
      items:["Acute dystonia: hours–days after starting",
             "Akathisia: subjective restlessness, pacing",
             "Parkinsonism: tremor, rigidity, bradykinesia",
             "Tardive dyskinesia: months–years; may be irreversible",
             "Monitor with AIMS scale every 6 months",
             "Manage: dose ↓, switch SGA, benztropine (acute EPS)"]
    },
    {
      title:"METABOLIC SYNDROME", col:P.orange,
      items:["Weight gain (olanzapine & clozapine highest risk)",
             "Type 2 Diabetes / hyperglycemia",
             "Dyslipidaemia: ↑ triglycerides, ↓ HDL",
             "Hypertension → cardiovascular risk",
             "Monitor: weight, waist, glucose, lipids, BP",
             "Baseline & every 3 months × 1 yr, then annually"]
    },
    {
      title:"CLOZAPINE-SPECIFIC RISKS", col:P.gold,
      items:["AGRANULOCYTOSIS (1–2%): FATAL if missed",
             "CBC mandatory: weekly ×6 months",
             "  Bi-weekly ×6 months, then monthly",
             "HOLD if ANC < 1000/mm³ → notify prescriber",
             "Myocarditis (first 4 weeks: troponin, CRP, ECG)",
             "Seizures (dose-dependent, > 600 mg/day)"]
    },
    {
      title:"OTHER KEY SIDE EFFECTS", col:P.teal,
      items:["QTc prolongation → torsades risk (ziprasidone)",
             "Orthostatic hypotension → falls risk (esp. elderly)",
             "Sedation (H1 antihistamine blockade)",
             "Anticholinergic: urinary retention, dry mouth, constipation",
             "Hyperprolactinemia: galactorrhea, amenorrhea, osteoporosis",
             "Photosensitivity (chlorpromazine / phenothiazines)"]
    },
  ];

  seBoxes.forEach(({ title, col, items }, i) => {
    const x = 0.2 + (i%2) * 4.88;
    const y = 2.24 + Math.floor(i/2) * 1.7;
    rcard(s, x, y, 4.7, 1.6, title, col);
    bullets(s, x+0.12, y+0.52, 4.5, 1.04, items, col);
  });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 15 — NON-PHARMACOLOGICAL
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide();
  hdr(s, "14  NON-PHARMACOLOGICAL INTERVENTIONS", P.green, true);

  const npI = [
    {
      icon:"🧠", col:P.accent,
      title:"CBT for\nPsychosis (CBTp)",
      items:["Cochrane 2024: reduces positive sx", "Targets delusional distress", "Improves insight into illness", "16–20 sessions", "Nurse co-facilitation helpful"]
    },
    {
      icon:"👨‍👩‍👧", col:P.teal,
      title:"Family\nPsychoeducation",
      items:["Reduces relapse rate by ~50%", "Improves medication adherence", "Teaches early warning signs", "Reduces expressed emotion", "NAMI Family-to-Family program"]
    },
    {
      icon:"💼", col:P.gold,
      title:"Supported\nEmployment (IPS)",
      items:["Individual Placement & Support", "Level 1 evidence base", "Competitive employment focus", "Reduces hospitalisation", "Improves self-esteem & recovery"]
    },
    {
      icon:"🏃", col:P.green,
      title:"Aerobic\nExercise",
      items:["↑ Hippocampal volume (2024 meta-analysis)", "150 min/week moderate intensity", "Improves cognition & mood", "Reduces metabolic complications", "Nurse role: motivate + monitor"]
    },
    {
      icon:"🤝", col:P.purple,
      title:"Social Skills\nTraining (SST)",
      items:["Role-play, modelling, feedback", "Improves communication skills", "Targets negative symptoms", "Group format (nurse-facilitated)", "Community integration focus"]
    },
  ];

  npI.forEach(({ icon, col, title, items }, i) => {
    const x = 0.18 + i * 1.95;
    const w = 1.82;
    s.addShape(T.roundRect, { x, y:0.63, w, h:4.88,
      fill:{ color:P.panel }, line:{ color:col, width:1.5 }, rectRadius:0.1 });
    s.addShape(T.roundRect, { x, y:0.63, w, h:1.12,
      fill:{ color:col, transparency:22 }, rectRadius:0.1 });
    s.addText(icon, { x, y:0.65, w, h:0.52,
      fontSize:26, align:"center", valign:"middle" });
    s.addText(title, { x:x+0.07, y:1.18, w:w-0.14, h:0.56,
      fontSize:10, bold:true, color:P.white, fontFace:"Calibri", align:"center" });
    bullets(s, x+0.09, 1.8, w-0.18, 3.65, items, col);
  });
}

// ═════════════════════════════════════════════════════════════════════════════
// SLIDE 16 — PROGNOSIS, COMPLICATIONS & SUMMARY
// ═════════════════════════════════════════════════════════════════════════════
{
  const s = newSlide(P.bg);
  s.addShape(T.rect, { x:0, y:0,     w:10, h:0.05, fill:{ color:P.accent } });
  s.addShape(T.rect, { x:0, y:5.575, w:10, h:0.05, fill:{ color:P.gold } });
  hdr(s, "15  PROGNOSIS, COMPLICATIONS & KEY NURSING TAKEAWAYS", P.gold, true);

  // Rule of thirds
  s.addText("PROGNOSIS — RULE OF THIRDS  (WHO 2025)", {
    x:0.25, y:0.62, w:5.5, h:0.3,
    fontSize:12, bold:true, color:P.gold, fontFace:"Calibri" });

  const thirds = [
    { pct:"~33%", label:"Recover\nSignificantly", detail:"Full/near-full recovery\npossible with treatment", col:P.green },
    { pct:"~33%", label:"Improve with\nResidual Symptoms", detail:"Moderate disability;\nmanageable with support", col:P.gold },
    { pct:"~34%", label:"Chronic\nSevere Course", detail:"Treatment-resistant;\nhigh disability burden", col:P.red },
  ];
  thirds.forEach(({ pct, label, detail, col }, i) => {
    const x = 0.25 + i * 1.9;
    s.addShape(T.roundRect, { x, y:0.97, w:1.78, h:2.08,
      fill:{ color:P.panel }, line:{ color:col, width:1.5 }, rectRadius:0.1 });
    s.addShape(T.roundRect, { x, y:0.97, w:1.78, h:0.82,
      fill:{ color:col, transparency:22 }, rectRadius:0.1 });
    s.addText(pct, { x, y:0.97, w:1.78, h:0.82,
      fontSize:28, bold:true, color:P.white, fontFace:"Calibri",
      align:"center", valign:"middle" });
    s.addText(label, { x:x+0.07, y:1.83, w:1.64, h:0.56,
      fontSize:10, bold:true, color:col, fontFace:"Calibri", align:"center" });
    s.addText(detail, { x:x+0.07, y:2.42, w:1.64, h:0.6,
      fontSize:9.5, color:P.lgray, fontFace:"Calibri", align:"center" });
  });

  // Complications
  rcard(s, 5.95, 0.62, 3.85, 2.43, "MAJOR COMPLICATIONS", P.red);
  bullets(s, 6.05, 1.15, 3.65, 1.83, [
    "Suicide: ~10% lifetime risk",
    "Cardiovascular disease (metabolic+sedentary)",
    "Substance use disorder (50% comorbidity)",
    "Homelessness & social isolation",
    "Tardive dyskinesia (EPS from long-term AP)",
    "Cognitive decline over years",
    "Increased infection risk (self-neglect)",
  ], P.red);

  // Course timeline
  s.addText("ILLNESS COURSE TIMELINE", {
    x:0.25, y:3.14, w:9.5, h:0.3,
    fontSize:11.5, bold:true, color:P.teal, fontFace:"Calibri" });

  const phases = [
    { label:"PREMORBID",     detail:"Subtle cognitive\n& social deficits",       col:P.dim },
    { label:"PRODROMAL",     detail:"Attenuated psychotic\nsymptoms, withdrawal", col:P.teal },
    { label:"FIRST\nEPISODE",detail:"Acute positive\nsymptoms; admit",           col:P.red },
    { label:"ACUTE\nTREATMENT",detail:"Antipsychotics\n4–8 weeks stabilise",     col:P.orange },
    { label:"MAINTENANCE",   detail:"Ongoing therapy,\nrelapse prevention",       col:P.green },
  ];
  phases.forEach(({ label, detail, col }, i) => {
    const x = 0.25 + i * 1.93;
    s.addShape(T.roundRect, { x, y:3.48, w:1.82, h:1.6,
      fill:{ color:P.panel }, line:{ color:col, width:1 }, rectRadius:0.08 });
    s.addShape(T.roundRect, { x, y:3.48, w:1.82, h:0.42,
      fill:{ color:col, transparency:22 }, rectRadius:0.08 });
    s.addText(label, { x:x+0.07, y:3.5, w:1.68, h:0.38,
      fontSize:10, bold:true, color:P.white, fontFace:"Calibri",
      align:"center", valign:"middle", margin:0 });
    s.addText(detail, { x:x+0.07, y:3.94, w:1.68, h:1.1,
      fontSize:10, color:P.lgray, fontFace:"Calibri", align:"center" });
    if (i<4) {
      s.addShape(T.line, { x:x+1.82, y:4.28, w:0.11, h:0,
        line:{ color:col, width:1.5 }});
    }
  });

  s.addText("Sources: Harrison's 22E (2025)  ·  Goodman & Gilman's Pharmacology  ·  Adams & Victor's Neurology 12E  ·  INTEGRATE (Lancet Psychiatry 2025)  ·  VA/DoD CPG 2025  ·  DSM-5-TR 2022  ·  WHO 2025", {
    x:0.2, y:5.41, w:9.6, h:0.2,
    fontSize:7.5, color:P.dim, fontFace:"Calibri", italic:true, align:"center" });
}

// ═════════════════════════════════════════════════════════════════════════════
// WRITE FILE
// ═════════════════════════════════════════════════════════════════════════════
const OUT = "/home/daytona/workspace/schiz-v3/Schizophrenia_Nursing_Complete.pptx";
pres.writeFile({ fileName: OUT })
  .then(() => console.log("SUCCESS:", OUT))
  .catch(e => { console.error("FAIL:", e); process.exit(1); });

Running Command

cd /home/daytona/workspace/schiz-v3 && node build.js 2>&1

Running Command

ls -lh /home/daytona/workspace/schiz-v3/Schizophrenia_Nursing_Complete.pptx

Your presentation is ready. Download it here:

Schizophrenia Nursing Complete

Presentation · PPTX

What's Inside — 16 Slides

Design: Deep navy background, electric blue/gold/teal accents, fully dark-mode professional theme throughout.

#	Slide	What makes it distinctive
1	Title	Brain silhouette with labeled VTA dot, frontal/temporal/parietal/occipital lobes drawn in shapes
2	Table of Contents	15 color-coded topics with numbered badges
3	Definition & Overview	Harrison's 22E quote + 5 stat cards (prevalence, onset, sex ratio, USA burden, cost)
4	Epidemiology	Genetic risk ladder (1% → 50% MZ twins, heritability 80%) + biological and environmental risk factor columns
5	Pathophysiology	3-column: Dopamine Hypothesis v.III / Glutamate-NMDA / Serotonin+GABA with KarXT 2024 noted
6	🧠 Human Brain Diagram	Detailed sagittal brain with gyri/sulci texture, labeled lobes (frontal, parietal, temporal, occipital), cerebellum, brainstem, corpus callosum, and 9 labeled structures: VTA, Nucleus Accumbens, PFC, Striatum, Substantia Nigra, Hypothalamus, Pituitary, Thalamus, Amygdala, Hippocampus — all 4 dopamine pathways drawn as vivid colored arrows
7	Dopamine Pathways Table	Row-by-row comparison: pathway → origin → target → in schizophrenia → clinical symptoms → antipsychotic impact
8	Clinical Features	3-column: Positive / Negative / Cognitive symptoms (18 items each)
9	DSM-5-TR Criteria	Criterion A (color-coded 1–5), Criteria B-F, 5 related disorders row
10	Pharmacological Treatment	FGA vs SGA with full drug list, KarXT 2024 FDA approval highlighted
11	Treatment Algorithm 2025	5-step INTEGRATE 2025 / VA-DoD CPG 2025 flowchart with connector arrows
12	Nursing Assessment	3 columns: MSE / Safety (C-SSRS) / Physical (AIMS, labs)
13	Nursing Diagnoses	4 NANDA-I diagnoses with 5 nursing interventions each
14	Side Effects & Monitoring	NMS emergency HALT banner + 4 SE boxes (EPS, metabolic, clozapine-specific, other)
15	Non-Pharmacological	CBTp, Family Psychoeducation, IPS, Aerobic Exercise, SST — 5 columns
16	Prognosis & Summary	Rule of Thirds (WHO 2025), complications, 5-phase illness timeline

Create a print-friendly PDF version of this PPT for easy distribution to students

Reading File

Running Command

ls -lh /home/daytona/workspace/schiz-v3/ && which libreoffice && libreoffice --version

Running Command

cd /home/daytona/workspace/schiz-v3 && libreoffice --headless --convert-to pdf --outdir /home/daytona/workspace/schiz-v3/ Schizophrenia_Nursing_Complete.pptx 2>&1

Running Command

libreoffice --headless --convert-to pdf --outdir /tmp/ /home/daytona/workspace/schiz-v3/Schizophrenia_Nursing_Complete.pptx 2>&1

Running Command

cp /tmp/Schizophrenia_Nursing_Complete.pdf /home/daytona/workspace/schiz-v3/Schizophrenia_Nursing_Complete.pdf && ls -lh /home/daytona/workspace/schiz-v3/Schizophrenia_Nursing_Complete.pdf

Your print-ready PDF is ready:

Schizophrenia Nursing Complete

PDF Document · PDF

378 KB — 16 pages, one slide per page, converted directly from the PPTX using LibreOffice 25.2.

Printing tips for distribution:

Colour printing — prints exactly as designed (dark navy background, coloured diagrams). Best on laser printers for colour accuracy.
To save ink (greyscale): In your printer settings, choose Grayscale or Black & White — the high-contrast white text on dark backgrounds still reads clearly.
Handout format (6 slides per page): If you want a compact handout, open the PDF in Adobe Acrobat or any PDF viewer → Print → Multiple pages per sheet → select 2 or 4 per page.
Paper size: A4 or Letter both work — the 16:9 ratio will add small margins on either size.
Digital sharing: The PDF is self-contained and works on all devices without needing PowerPoint installed — ideal for sharing via email, LMS (Moodle/Canvas), or WhatsApp.

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