mkdir -p /home/daytona/workspace/mood-disorders-pptx

~/mood-disorders-pptx/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Major Depressive Disorder & Bipolar Disorder";
pres.author = "Kaplan & Sadock 12th Ed | DSM-5-TR";

// ─── Palette ────────────────────────────────────────────────────────────────
// MDD section: deep navy bg (#0D1B2A), white text, teal accent (#2EC4B6)
// BD section:  dark plum bg (#1A0D2B), white text, amber accent (#F4A261)
// Shared divider slides + title: deep charcoal (#121212) / white

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// ─── Helper functions ────────────────────────────────────────────────────────

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// ════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — MASTER TITLE
// ════════════════════════════════════════════════════════════════════════════
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// ════════════════════════════════════════════════════════════════════════════
// ──── PART 1: MAJOR DEPRESSIVE DISORDER ─────────────────────────────────────
// ════════════════════════════════════════════════════════════════════════════
addSectionDivider("MAJOR DEPRESSIVE\nDISORDER", NAV, TEAL, "Part 1 of 2");

// ─── MDD 1: Introduction & Epidemiology ─────────────────────────────────────
addContentSlide(NAV, TEAL, "Introduction & Epidemiology", [
  "## Definition",
  "Presence of ≥1 major depressive episode; no history of mania or hypomania",
  "Characterized by sustained low mood, anhedonia, and neurovegetative symptoms lasting ≥2 weeks",
  "Among the most prevalent and disabling psychiatric disorders worldwide",
  "## Global Prevalence",
  "Point prevalence: ~12.9%  |  1-year prevalence: ~7.2%  |  Lifetime prevalence: ~10.8% (meta-analysis, 90 studies, 30 countries)",
  "US (SAMHSA/NSDUH data, DSM-5 criteria): 1-year prevalence of major depressive episode = 7.1%",
  "## Sex",
  "Women > Men universally (aggregate: 14.4% vs. 11.5%); US 1-year: 8.7% women vs. 5.3% men",
  "Multifactorial: hormonal, psychological, sociocultural factors contribute",
  "## Age",
  "Mean age of onset ~40 years; 50% onset between ages 20–50",
  "Incidence rising in younger persons; adolescent females: 1-year prevalence ~20%",
  "## Other Risk Factors",
  "Divorced/separated or without close interpersonal relationships; strong family history",
  "Childhood-onset MDD: most severe form — associated with conduct disorder, substance use"
]);

// ─── MDD 2: Clinical Features ───────────────────────────────────────────────
addTwoColSlide(NAV, TEAL, "Clinical Features", "Core Symptoms", [
  "Depressed mood (or irritable in children/adolescents) most of the day, nearly every day",
  "Markedly diminished interest or pleasure in activities (anhedonia)",
  "Significant weight loss/gain or appetite change",
  "Insomnia or hypersomnia",
  "Psychomotor agitation or retardation",
  "Fatigue or loss of energy",
  "Feelings of worthlessness or excessive/inappropriate guilt",
  "Diminished concentration or indecisiveness",
  "Recurrent thoughts of death or suicidal ideation"
], "Subtypes & Special Features", [
  "With melancholic features: severe anhedonia, early morning awakening, weight loss, profound guilt; 'endogenous depression'",
  "With atypical features: mood reactivity, hypersomnia, leaden paralysis, rejection sensitivity",
  "With psychotic features: mood-congruent or mood-incongruent delusions/hallucinations; poor prognostic indicator",
  "With peripartum onset: onset during pregnancy or within 4 weeks postpartum",
  "With seasonal pattern (SAD): onset in fall/winter, remission in spring",
  "With catatonia: psychomotor disturbance during depressive episode",
  "Children: somatic complaints, psychomotor agitation, mood-congruent hallucinations",
  "Adolescents: irritability, antisocial behavior, substance use, school failure"
]);

// ─── MDD 3: DSM-5-TR Diagnostic Criteria ────────────────────────────────────
addContentSlide(NAV, TEAL, "Diagnostic Criteria — DSM-5-TR", [
  "## Criterion A — ≥5 symptoms during same 2-week period (≥1 must be #1 or #2):",
  "1. Depressed mood most of the day, nearly every day (subjective or observed)",
  "2. Markedly diminished interest or pleasure in activities (anhedonia)",
  "3. Significant weight loss/gain (>5% in 1 month) or appetite change",
  "4. Insomnia or hypersomnia nearly every day",
  "5. Psychomotor agitation or retardation (observable by others)",
  "6. Fatigue or loss of energy",
  "7. Feelings of worthlessness or excessive guilt (not merely about being sick)",
  "8. Diminished ability to think, concentrate, or indecisiveness",
  "9. Recurrent thoughts of death, suicidal ideation, attempt, or specific plan",
  "## Criteria B–E:",
  "B. Symptoms cause clinically significant distress or functional impairment",
  "C. Not attributable to substances or another medical condition",
  "D. Not better explained by schizophrenia spectrum or other psychotic disorder",
  "E. No prior manic or hypomanic episode (would indicate Bipolar I or II)"
]);

// ─── MDD 4: Management — Pharmacological ────────────────────────────────────
addTwoColSlide(NAV, TEAL, "Management — Pharmacological", "First-Line Agents", [
  "SSRIs (fluoxetine, sertraline, escitalopram): first-line; best tolerability profile",
  "SNRIs (venlafaxine, duloxetine): effective, especially with pain or anxiety comorbidity",
  "Bupropion: useful when sedation/sexual SE are concerns; avoid in seizure risk",
  "Mirtazapine: sedating; useful in insomnia/weight loss; works via NaSSA mechanism",
  "TCAs (amitriptyline, imipramine): highly effective; limited by toxicity and narrow TI",
  "MAOIs (phenelzine, tranylcypromine): reserved for atypical/refractory depression",
  "Efficacy established in >500 RCTs; broadly similar across agents vs. placebo"
], "Special Situations", [
  "Psychotic MDD: antidepressant + atypical antipsychotic (or ECT)",
  "Melancholic MDD: TCAs or ECT often more effective than SSRIs",
  "Atypical MDD: MAOIs show strong evidence",
  "Duration: continue 4–9 months after remission (prevent relapse); prophylaxis for recurrent MDD",
  "Withdrawal of antidepressants before 3 months → high relapse risk",
  "Augmentation strategies: lithium, atypical antipsychotics, thyroid hormone, buspirone",
  "Esketamine (Spravato): FDA-approved for TRD; rapid action via NMDA antagonism"
]);

// ─── MDD 5: Management — Non-Pharmacological ────────────────────────────────
addContentSlide(NAV, TEAL, "Management — Non-Pharmacological", [
  "## Psychotherapy",
  "Cognitive-Behavioral Therapy (CBT): equal efficacy to pharmacotherapy; fewer adverse effects; better follow-up; combination with pharmacotherapy often superior",
  "Interpersonal Therapy (IPT): 12–16 weekly sessions; focuses on current interpersonal problems; most effective psychotherapy for severe MDD without medication",
  "Behavioral Therapy: addresses maladaptive behavioral patterns and social reinforcement",
  "Psychodynamic/Psychoanalytic Therapy: targets personality structure changes; longer-term",
  "## Somatic Non-Drug Treatments",
  "Electroconvulsive Therapy (ECT): most effective for severe/psychotic/melancholic MDD and TRD; first-line for psychotic depression; 3x/week, 6–12 sessions",
  "Transcranial Magnetic Stimulation (TMS/rTMS): non-invasive; FDA-approved for TRD",
  "Light Therapy (Phototherapy): first-line for seasonal affective disorder (SAD)",
  "## Psychoeducation & Lifestyle",
  "Exercise: moderate aerobic exercise shown to reduce depressive symptoms",
  "Sleep hygiene, stress management, social support",
  "Patient and family education about chronic nature of disorder and relapse prevention"
]);

// ─── MDD 6: Prognosis ───────────────────────────────────────────────────────
addTwoColSlide(NAV, TEAL, "Prognosis", "Course of Illness", [
  "Not a benign disorder — tends to be chronic with high relapse rates",
  "Untreated episode: lasts 6–13 months; treated: ~3 months",
  "~50% of first-hospitalized patients recover within 1 year",
  "25% relapse within 6 months of discharge",
  "30–50% relapse within 2 years",
  "50–75% will relapse within 5 years",
  "Mean number of episodes over 20 years: 5–6",
  "Each episode → more frequent and more severe subsequent episodes",
  "~50% had significant depressive symptoms before first identified episode"
], "Prognostic Factors", [
  "GOOD: mild severity, absence of psychosis, good premorbid functioning, short episode duration, strong social support",
  "POOR: psychotic features, melancholic features, multiple prior episodes, comorbid substance use, early onset, family history",
  "About 25% of patients have residual symptoms (not full remission)",
  "Suicide: 15% lifetime risk in severe MDD; assess at every visit",
  "Prophylactic pharmacotherapy reduces relapse incidence significantly",
  "Childhood-onset MDD: most severe form; high risk of comorbidities (conduct disorder, substance use)"
]);

// ════════════════════════════════════════════════════════════════════════════
// ──── PART 2: BIPOLAR DISORDER ───────────────────────────────────────────────
// ════════════════════════════════════════════════════════════════════════════
addSectionDivider("BIPOLAR\nDISORDER", PLUM, AMBER, "Part 2 of 2");

// ─── BD 1: Introduction & Epidemiology ──────────────────────────────────────
addContentSlide(PLUM, AMBER, "Introduction & Epidemiology", [
  "## Definition",
  "Characterized by episodes of mania or hypomania, typically interspersed with depressive episodes",
  "Bipolar I: full manic episodes (may include depression); Bipolar II: hypomania + MDD",
  "Cyclothymia: chronic fluctuating mood with hypomania + subsyndromal depression for ≥2 years",
  "## Prevalence",
  "Bipolar I lifetime prevalence: ~1% of the general population (equal in males and females)",
  "Bipolar II: ~0.5–1%; Bipolar spectrum (including cyclothymia): up to 3–6%",
  "BD II more common in women; Rapid cycling more common in women",
  "## Age of Onset",
  "Mean age of onset for Bipolar I: ~30 years (range childhood to >50 years)",
  "Earlier onset than MDD; earlier onset → worse prognosis (greater severity and recurrence)",
  "Adolescent prevalence ~1% for bipolar I; earlier diagnosis increasingly recognized",
  "## Genetics & Risk Factors",
  "Strong genetic component: first-degree relatives have 8–10x increased risk",
  "Concordance in monozygotic twins: ~40–70%",
  "Kindling model: each episode lowers the threshold for future episodes (neuroprogression)"
]);

// ─── BD 2: Clinical Features ────────────────────────────────────────────────
addTwoColSlide(PLUM, AMBER, "Clinical Features", "Manic Episode", [
  "Distinct period of abnormally elevated, expansive, or irritable mood + increased energy (≥1 week, or any duration if hospitalized)",
  "Grandiosity or inflated self-esteem",
  "Decreased need for sleep (feels rested after 3 hours)",
  "More talkative / pressured speech",
  "Flight of ideas or racing thoughts",
  "Distractibility",
  "Increased goal-directed activity or psychomotor agitation",
  "Excessive involvement in activities with high potential for painful consequences (spending sprees, sexual indiscretions, reckless investments)",
  "Severe: may include psychosis (mood-congruent or incongruent)"
], "Hypomanic & Depressive Episodes", [
  "Hypomanic episode: same symptoms as mania but <7 days, less severe, no psychosis, no hospitalization required",
  "Functional change observable by others; not severe enough to markedly impair functioning",
  "Bipolar depression: indistinguishable from MDD by symptoms alone; history of mania/hypomania differentiates",
  "Mixed features: simultaneous manic + depressive symptoms; high suicide risk",
  "Rapid cycling: ≥4 mood episodes/year; more common in women; associated with antidepressant use",
  "Dysphoric/irritable mania: agitation, dysphoria, suicidality — distinct from euphoric mania",
  "Children: may present as irritability, prolonged tantrums, emotional lability"
]);

// ─── BD 3: DSM-5-TR Diagnostic Criteria ─────────────────────────────────────
addContentSlide(PLUM, AMBER, "Diagnostic Criteria — DSM-5-TR", [
  "## Manic Episode (Criterion A): Abnormally elevated/expansive/irritable mood + increased energy, ≥1 week, most of the day, nearly every day",
  "## Criterion B — ≥3 of (or ≥4 if mood is irritable only):",
  "1. Grandiosity / inflated self-esteem",
  "2. Decreased need for sleep",
  "3. More talkative / pressured speech",
  "4. Flight of ideas or racing thoughts",
  "5. Distractibility (easily drawn to irrelevant stimuli)",
  "6. Increased goal-directed activity or psychomotor agitation",
  "7. Risky pleasurable activities (excessive spending, sexual indiscretions)",
  "## Criterion C–D:",
  "C. Episode severe enough to cause marked impairment or require hospitalization, OR with psychotic features",
  "D. Not attributable to substances or medical condition",
  "## Bipolar II: Hypomanic episode (≥4 days, not meeting full mania criteria) + MDD; no full manic episode ever",
  "## Specifiers: with anxious distress, mixed features, rapid cycling, melancholic features, atypical features, psychotic features, catatonia, peripartum onset, seasonal pattern"
]);

// ─── BD 4: Management — Pharmacological ─────────────────────────────────────
addTwoColSlide(PLUM, AMBER, "Management — Pharmacological", "Mood Stabilizers", [
  "Lithium: gold standard; proven antimanic and antidepressant; antisuicidal effect; therapeutic level 0.8–1.2 mEq/L (acute), 0.6–0.8 (maintenance)",
  "Valproate (Depakote/Depakene): especially for mixed/dysphoric mania, rapid cycling; first-line",
  "Lamotrigine: excellent for bipolar depression and maintenance; titrate slowly (Stevens-Johnson risk)",
  "Carbamazepine: effective for lithium-non-responsive, dysphoric mania, rapid cycling; watch for SJS, aplastic anemia",
  "## Atypical Antipsychotics (FDA-approved for BD)",
  "Acute mania: olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, asenapine",
  "Bipolar depression: quetiapine, olanzapine-fluoxetine combination (OFC), lurasidone",
  "Maintenance: olanzapine, aripiprazole, quetiapine (as adjuncts to mood stabilizers)"
], "Special Considerations", [
  "Acute mania: mood stabilizer ± atypical antipsychotic is first-line combination",
  "Antidepressants: use with caution in BD — risk of triggering mania or rapid cycling; always combine with mood stabilizer",
  "Rapid cycling: optimize mood stabilizer (lithium + valproate combination); avoid antidepressants",
  "Bipolar depression: lamotrigine or quetiapine preferred; avoid antidepressant monotherapy",
  "ECT: highly effective for severe manic or depressive episodes; treatment-resistant BD",
  "Monitoring: lithium (renal, thyroid), valproate (LFTs, CBC), carbamazepine (CBC at 3, 6, 9, 12 months)",
  "NAC + aspirin: emerging evidence for adjunctive use in all phases via anti-oxidative mechanism"
]);

// ─── BD 5: Management — Non-Pharmacological ─────────────────────────────────
addContentSlide(PLUM, AMBER, "Management — Non-Pharmacological", [
  "## Psychotherapy",
  "Psychoeducation: cornerstone of non-pharmacological management; improves medication adherence, relapse recognition, and illness awareness",
  "Cognitive-Behavioral Therapy (CBT): adapted for bipolar disorder; reduces depressive episodes; trains early warning sign recognition",
  "Interpersonal and Social Rhythm Therapy (IPSRT): regulates circadian rhythms; reduces episode triggers",
  "Family-Focused Therapy (FFT): psychoeducation for families; reduces expressed emotion; improves outcomes",
  "## Somatic Treatments",
  "ECT: indicated for severe/refractory manic or depressive episodes; safe and highly effective",
  "Transcranial Magnetic Stimulation (TMS): adjunctive role in bipolar depression; evidence emerging",
  "## Lifestyle & Self-Management",
  "Sleep regulation: irregular sleep is a major episode trigger; maintain consistent sleep schedule",
  "Avoidance of alcohol and illicit substances: strongly exacerbate course of BD",
  "Stress reduction and regular exercise",
  "## Crisis Planning",
  "Advance directives for high-risk periods; safety planning for suicidal ideation (mixed episodes carry highest suicide risk)"
]);

// ─── BD 6: Prognosis ─────────────────────────────────────────────────────────
addTwoColSlide(PLUM, AMBER, "Prognosis", "Course of Illness", [
  "Chronic, lifelong condition with high relapse rates despite treatment",
  "Kindling / neuroprogressive model: each episode lowers threshold for subsequent episodes",
  "Cognitive decline with repeated episodes; executive dysfunction associated with elevated TNF",
  "~15–20% of untreated patients die by suicide",
  "Bipolar II has better overall prognosis than Bipolar I but greater duration of depressive episodes",
  "Youth with MDD: 20–40% risk of subsequently developing bipolar disorder",
  "Prepubertal MDD: high risk of conversion to BD; monitor closely",
  "Cyclothymia: 15–20% risk of developing full BD"
], "Prognostic Factors", [
  "GOOD: older age at onset, absence of rapid cycling, good medication adherence, strong social support, euthymic periods >5 years",
  "POOR: early onset, rapid cycling, mixed features, comorbid substance use, comorbid anxiety, multiple prior episodes, psychotic features",
  "Rapid cycling: defined as ≥4 episodes/year; associated with poorer response to lithium",
  "Lithium maintenance significantly reduces suicide risk (antisuicidal effect independent of mood stabilization)",
  "Antidepressant use without mood stabilizer worsens long-term course",
  "Functional impairment persists in ~30–40% of patients even during euthymia (cognitive and occupational)"
]);

// ─── Final Comparison Slide ───────────────────────────────────────────────────
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  const mddRows = [
    ["Feature", "MDD"],
    ["Manic episodes", "Never"],
    ["Gender ratio", "F > M (2:1)"],
    ["1st-line Rx", "SSRI / SNRI"],
    ["Antidepressant", "Safe monotherapy"],
    ["Suicide risk", "15% lifetime"],
    ["Prognosis", "Good with Rx; chronic"],
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    ["Feature", "BD"],
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    ["Gender ratio", "M = F (BD I)"],
    ["1st-line Rx", "Mood stabilizer"],
    ["Antidepressant", "Caution — can trigger mania"],
    ["Suicide risk", "15–20% lifetime"],
    ["Prognosis", "Chronic; neuroprogressive"],
  ];

  // MDD table
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  bdRows.forEach((row, i) => {
    const bg = i === 0 ? AMBER : (i % 2 === 0 ? "261030" : "1A0D2B");
    s.addShape(pres.ShapeType.rect, { x: 5.2, y: 0.8 + i * 0.64, w: 4.6, h: 0.62, fill: { color: bg } });
    s.addText(`${row[0]}:  ${row[1]}`, {
      x: 5.25, y: 0.82 + i * 0.64, w: 4.5, h: 0.58,
      fontSize: i === 0 ? 13 : 12, bold: i === 0, color: i === 0 ? CHARCOAL : LGRAY,
      fontFace: "Calibri", valign: "middle", margin: [0, 4, 0, 4]
    });
  });
}

// ─── Thank You / References ──────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: CHARCOAL } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 5, h: 5.625, fill: { color: NAV } });
  s.addShape(pres.ShapeType.rect, { x: 5, y: 0, w: 5, h: 5.625, fill: { color: PLUM } });
  s.addShape(pres.ShapeType.rect, { x: 4.85, y: 0, w: 0.3, h: 5.625, fill: { color: CHARCOAL } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 4.8, w: 5, h: 0.08, fill: { color: TEAL } });
  s.addShape(pres.ShapeType.rect, { x: 5.15, y: 4.8, w: 5, h: 0.08, fill: { color: AMBER } });
  s.addText("Thank You", {
    x: 0.5, y: 1.5, w: 9, h: 1.0,
    fontSize: 42, bold: true, color: WHITE, fontFace: "Calibri Light", align: "center"
  });
  s.addText("References", {
    x: 0.5, y: 2.7, w: 9, h: 0.4,
    fontSize: 14, bold: true, color: SILVER, fontFace: "Calibri", align: "center"
  });
  s.addText([
    { text: "1. Sadock BJ, Sadock VA, Ruiz P. ", options: { color: LGRAY } },
    { text: "Kaplan & Sadock's Synopsis of Psychiatry, 12th Ed.", options: { italic: true, color: LGRAY } },
    { text: " Wolters Kluwer; 2021.", options: { color: LGRAY } },
    { text: "\n2. American Psychiatric Association. ", options: { color: LGRAY } },
    { text: "Diagnostic and Statistical Manual of Mental Disorders, 5th Ed., Text Revision (DSM-5-TR).", options: { italic: true, color: LGRAY } },
    { text: " APA; 2022.", options: { color: LGRAY } },
  ], {
    x: 1, y: 3.2, w: 8, h: 1.8,
    fontSize: 12, fontFace: "Calibri", align: "center"
  });
}

// ─── Save ────────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/mood-disorders-pptx/MoodDisorders_MDD_BipolarDisorder.pptx" })
  .then(() => console.log("DONE: /home/daytona/workspace/mood-disorders-pptx/MoodDisorders_MDD_BipolarDisorder.pptx"))
  .catch(e => { console.error(e); process.exit(1); });

cat > /home/daytona/workspace/mood-disorders-pptx/build.js << 'JSEOF' const pptx…

cd /home/daytona/workspace/mood-disorders-pptx && node build.js 2>&1

ls -lh /home/daytona/workspace/mood-disorders-pptx/MoodDisorders_MDD_BipolarDiso…

cat > /home/daytona/workspace/mood-disorders-pptx/build2.js << 'JSEOF' const ppt…

cd /home/daytona/workspace/mood-disorders-pptx && node build2.js 2>&1

ls -lh /home/daytona/workspace/mood-disorders-pptx/MoodDisorders_v2.pptx