mental health nursing syllabus topics 1st year 2nd year BSc nursing

ls /home/daytona/workspace/ 2>/dev/null && echo "---" && python3 -c "import repo…

mkdir -p /home/daytona/workspace/mental-health-nursing

~/mental-health-nursing/generate_pdf.py

"""
Mental Health Nursing - Quick Reference PDF Generator
Uses ReportLab to create a comprehensive, color-coded exam study guide.
"""

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm, cm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, PageBreak, KeepTogether
)
from reportlab.platypus.flowables import BalancedColumns
from reportlab.lib.colors import HexColor, white, black
import os

OUTPUT = "/home/daytona/workspace/mental-health-nursing/MentalHealthNursing_QuickRef.pdf"

# ── Colour palette ──────────────────────────────────────────────
C_NAVY   = HexColor("#1A3A5C")   # deep navy – section headers
C_TEAL   = HexColor("#007B8A")   # teal – subsection headers
C_AMBER  = HexColor("#E8A020")   # amber – highlights / warnings
C_RED    = HexColor("#C0392B")   # red – alerts / emergencies
C_GREEN  = HexColor("#1E7E4A")   # green – nursing actions / positives
C_LBLUE  = HexColor("#D6EAF8")   # light blue – table header fill
C_LYELL  = HexColor("#FEF9E7")   # light yellow – tip boxes
C_LGRAY  = HexColor("#F2F3F4")   # light grey – alt table rows
C_PINK   = HexColor("#FADBD8")   # light pink – emergency rows
C_LGREEN = HexColor("#D5F5E3")   # light green – safe/normal rows

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=14*mm, leftMargin=14*mm,
    topMargin=16*mm, bottomMargin=16*mm,
    title="Mental Health Nursing – Quick Reference",
    author="Orris AI"
)

W = A4[0] - 28*mm   # usable width

styles = getSampleStyleSheet()

# ── Custom paragraph styles ──────────────────────────────────────
def S(name, **kw):
    base = kw.pop("parent", "Normal")
    ps = ParagraphStyle(name, parent=styles[base], **kw)
    return ps

TITLE_S  = S("TitleS",  fontSize=22, textColor=white,       leading=28, alignment=TA_CENTER, spaceAfter=4)
SUBT_S   = S("SubtS",   fontSize=11, textColor=HexColor("#BDC3C7"), leading=14, alignment=TA_CENTER, spaceAfter=2)
H1       = S("H1",      fontSize=13, textColor=white,       leading=17, spaceBefore=6, spaceAfter=3, fontName="Helvetica-Bold")
H2       = S("H2",      fontSize=11, textColor=white,       leading=15, spaceBefore=4, spaceAfter=2, fontName="Helvetica-Bold")
H3       = S("H3",      fontSize=10, textColor=C_NAVY,      leading=13, spaceBefore=3, spaceAfter=1, fontName="Helvetica-Bold")
BODY     = S("Body",    fontSize=8.5, textColor=black,      leading=12, spaceAfter=2)
BODYB    = S("BodyB",   fontSize=8.5, textColor=black,      leading=12, spaceAfter=2, fontName="Helvetica-Bold")
SMALL    = S("Small",   fontSize=7.5, textColor=HexColor("#555555"), leading=10)
BULLET   = S("Bullet",  fontSize=8.5, textColor=black,      leading=12, leftIndent=10, spaceAfter=1, bulletIndent=3)
WARN     = S("Warn",    fontSize=8.5, textColor=C_RED,      leading=12, fontName="Helvetica-Bold", spaceAfter=2)
TH       = S("TH",      fontSize=8,   textColor=white,      leading=11, fontName="Helvetica-Bold", alignment=TA_CENTER)
TD       = S("TD",      fontSize=7.5, textColor=black,      leading=10, alignment=TA_LEFT)
TDC      = S("TDC",     fontSize=7.5, textColor=black,      leading=10, alignment=TA_CENTER)
MNEM     = S("Mnem",    fontSize=8.5, textColor=C_GREEN,    leading=12, fontName="Helvetica-Bold")
ALERT    = S("Alert",   fontSize=8.5, textColor=C_RED,      leading=12, fontName="Helvetica-Bold")

story = []

# ════════════════════════════════════════════════════════════════
# HELPER FUNCTIONS
# ════════════════════════════════════════════════════════════════

def cover_block(title, subtitle):
    """Coloured cover banner."""
    data = [[Paragraph(title, TITLE_S)], [Paragraph(subtitle, SUBT_S)]]
    t = Table(data, colWidths=[W])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), C_NAVY),
        ("ROWBACKGROUNDS", (0,0), (-1,-1), [C_NAVY, C_NAVY]),
        ("TOPPADDING",    (0,0), (-1,-1), 10),
        ("BOTTOMPADDING", (0,0), (-1,-1), 10),
        ("LEFTPADDING",   (0,0), (-1,-1), 12),
        ("RIGHTPADDING",  (0,0), (-1,-1), 12),
        ("ROUNDEDCORNERS", [6]),
    ]))
    return t

def section_header(text, color=C_NAVY):
    data = [[Paragraph(text, H1)]]
    t = Table(data, colWidths=[W])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), color),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ]))
    return t

def sub_header(text, color=C_TEAL):
    data = [[Paragraph(text, H2)]]
    t = Table(data, colWidths=[W])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), color),
        ("TOPPADDING",    (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ]))
    return t

def simple_table(headers, rows, col_widths=None, row_colors=None):
    """Generic styled table."""
    if col_widths is None:
        col_widths = [W / len(headers)] * len(headers)
    head_row = [Paragraph(h, TH) for h in headers]
    data = [head_row]
    for r in rows:
        data.append([Paragraph(str(c), TD) for c in r])
    ts = TableStyle([
        ("BACKGROUND",    (0,0), (-1,0), C_NAVY),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [white, C_LGRAY]),
        ("GRID",          (0,0), (-1,-1), 0.3, HexColor("#CCCCCC")),
        ("TOPPADDING",    (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING",   (0,0), (-1,-1), 4),
        ("RIGHTPADDING",  (0,0), (-1,-1), 4),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ])
    if row_colors:
        for (r_idx, bg) in row_colors:
            ts.add("BACKGROUND", (0, r_idx+1), (-1, r_idx+1), bg)
    t = Table(data, colWidths=col_widths, repeatRows=1)
    t.setStyle(ts)
    return t

def alert_box(text, bg=C_PINK, tc=C_RED):
    ps = ParagraphStyle("ab", fontSize=8.5, textColor=tc, leading=12,
                        fontName="Helvetica-Bold", leftIndent=6)
    data = [[Paragraph("⚠  " + text, ps)]]
    t = Table(data, colWidths=[W])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("BOX",           (0,0), (-1,-1), 1, tc),
    ]))
    return t

def tip_box(text, bg=C_LYELL, tc=HexColor("#7D6608")):
    ps = ParagraphStyle("tb", fontSize=8.5, textColor=tc, leading=12, leftIndent=6)
    data = [[Paragraph("💡  " + text, ps)]]
    t = Table(data, colWidths=[W])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("BOX",           (0,0), (-1,-1), 0.5, tc),
    ]))
    return t

def mnemonic_box(letter_meanings, title, bg=C_LGREEN):
    """Render a mnemonic as a compact 2-col table."""
    lines = []
    for lm in letter_meanings:
        letter, meaning = lm[0], lm[1]
        lines.append([
            Paragraph(f"<b>{letter}</b>", ParagraphStyle("ml", fontSize=9, textColor=C_NAVY,
                       fontName="Helvetica-Bold", leading=12)),
            Paragraph(meaning, TD)
        ])
    t = Table(lines, colWidths=[12*mm, W - 12*mm])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 2),
        ("BOTTOMPADDING", (0,0), (-1,-1), 2),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
        ("RIGHTPADDING",  (0,0), (-1,-1), 5),
        ("BOX",           (0,0), (-1,-1), 0.5, C_GREEN),
    ]))
    return t

def sp(h=4): return Spacer(1, h*mm)
def hr(): return HRFlowable(width=W, thickness=0.5, color=HexColor("#CCCCCC"), spaceAfter=2*mm, spaceBefore=2*mm)

# ════════════════════════════════════════════════════════════════
# PAGE 1 – COVER
# ════════════════════════════════════════════════════════════════
story.append(sp(8))
story.append(cover_block(
    "MENTAL HEALTH NURSING",
    "Quick Reference — Exam Preparation Guide  |  MHN 1 &amp; 2"
))
story.append(sp(4))

# TOC-style index
toc_items = [
    ("1", "Foundations, Theories & MSE"),
    ("2", "Defense Mechanisms"),
    ("3", "Therapeutic Communication"),
    ("4", "Erikson's Psychosocial Stages"),
    ("5", "Psychiatric Disorders — Overview"),
    ("6", "Schizophrenia"),
    ("7", "Mood Disorders (MDD & Bipolar)"),
    ("8", "Anxiety & OCD"),
    ("9", "PTSD & Trauma"),
    ("10","Personality Disorders"),
    ("11","Psychopharmacology — Antipsychotics"),
    ("12","Antidepressants & Mood Stabilizers"),
    ("13","Anxiolytics, ECT & Somatic Therapy"),
    ("14","Suicide Risk & Safety"),
    ("15","Substance Use & Alcohol Withdrawal"),
    ("16","Community MH, Crisis & Legal/Ethics"),
    ("17","Priority Safety Alerts"),
    ("18","Master Mnemonics"),
]
toc_data = [[Paragraph(f"<b>{n}.</b> {t}", BODY)] for n, t in toc_items]
toc_table = Table(toc_data, colWidths=[W/2]*2,
                  # split into 2 visual columns manually
                  )
# Redo as 2-col layout
half = len(toc_items) // 2
col1 = toc_items[:half]
col2 = toc_items[half:]
toc_rows = []
for i in range(max(len(col1), len(col2))):
    c1 = f"<b>{col1[i][0]}.</b> {col1[i][1]}" if i < len(col1) else ""
    c2 = f"<b>{col2[i][0]}.</b> {col2[i][1]}" if i < len(col2) else ""
    toc_rows.append([Paragraph(c1, BODY), Paragraph(c2, BODY)])

toc_t = Table(toc_rows, colWidths=[W/2 - 2*mm, W/2 - 2*mm])
toc_t.setStyle(TableStyle([
    ("ROWBACKGROUNDS", (0,0), (-1,-1), [C_LGRAY, white]),
    ("TOPPADDING",    (0,0), (-1,-1), 3),
    ("BOTTOMPADDING", (0,0), (-1,-1), 3),
    ("LEFTPADDING",   (0,0), (-1,-1), 5),
    ("BOX",           (0,0), (-1,-1), 0.5, HexColor("#AAAAAA")),
    ("LINEAFTER",     (0,0), (0,-1), 0.3, HexColor("#CCCCCC")),
]))
story.append(toc_t)
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 1 – FOUNDATIONS
# ════════════════════════════════════════════════════════════════
story.append(section_header("1. FOUNDATIONS, THEORIES & MENTAL STATUS EXAM"))
story.append(sp(2))

story.append(sub_header("Key Definitions"))
defs = [
    ("Mental Health", "WHO: state of well-being where one realises abilities, copes with stress, works productively"),
    ("Mental Illness", "Clinically significant behavioural/psychological syndrome causing distress or disability"),
    ("Psychiatric Nursing", "Specialised nursing using theories of human behaviour + purposeful use of self as art"),
    ("MSE", "Mental Status Exam – systematic assessment of psychological functioning at a point in time"),
]
story.append(simple_table(["Term","Definition"], defs, [40*mm, W-40*mm]))
story.append(sp(3))

story.append(sub_header("Major Theoretical Models"))
models = [
    ("Psychoanalytic (Freud)","Id (pleasure), Ego (reality), Superego (morality); unconscious conflicts → mental illness"),
    ("Psychosocial (Erikson)","8 stages of development; failure at each stage → specific psychopathology"),
    ("Humanistic (Maslow/Rogers)","Hierarchy of needs; unmet needs → illness; unconditional positive regard"),
    ("Behavioral (Skinner)","Mental illness = learned maladaptive behavior; Rx = behavior modification"),
    ("Biological/Medical","Brain disease (genetic, neurochemical); Rx = pharmacotherapy, ECT"),
    ("Sociocultural (Sullivan)","Interpersonal relationships key; social factors shape mental health"),
]
story.append(simple_table(["Model","Key Concept"], models, [45*mm, W-45*mm]))
story.append(sp(3))

story.append(sub_header("Mental Status Exam (MSE) Domains"))
mse = [
    ("Appearance","Dress, hygiene, grooming, posture, eye contact"),
    ("Behavior / Motor","Agitation, retardation, mannerisms, stereotypy"),
    ("Speech","Rate, rhythm, volume, quantity, spontaneity"),
    ("Mood","Patient's subjective state (what they say)"),
    ("Affect","Observed emotional expression – range (full/constricted/blunted/flat), stability, appropriateness"),
    ("Thought Process","Logical / loose associations / flight of ideas / tangential / circumstantial / word salad"),
    ("Thought Content","Delusions, obsessions, phobias, SI/HI"),
    ("Perceptions","Hallucinations (type), illusions, depersonalisation"),
    ("Cognition","Orientation ×3, memory (immediate/recent/remote), attention, concentration"),
    ("Insight","Awareness of illness"),
    ("Judgment","Ability to make sound decisions"),
]
story.append(simple_table(["Domain","What to Assess"], mse, [38*mm, W-38*mm]))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 2 – DEFENSE MECHANISMS
# ════════════════════════════════════════════════════════════════
story.append(section_header("2. DEFENSE MECHANISMS"))
story.append(sp(2))

dm = [
    ("Repression","Unconscious exclusion of anxiety-provoking material","Forgetting childhood abuse","Neurotic"),
    ("Suppression","Conscious pushing away of painful thought","'I'll deal with it later'","Mature"),
    ("Denial","Refusing to acknowledge reality","Alcoholic denying addiction","Primitive"),
    ("Projection","Attributing own feelings to others","'She hates me' (when I hate her)","Primitive"),
    ("Displacement","Redirecting emotion to safer target","Kicking door after boss argument","Neurotic"),
    ("Rationalization","Logical-sounding false excuse","'I drink to relax'","Neurotic"),
    ("Reaction Formation","Adopting opposite feeling","Overly kind to disliked person","Neurotic"),
    ("Sublimation","Channeling impulses into acceptable activity","Aggression → boxing","Mature"),
    ("Regression","Reverting to earlier behavior under stress","Adult throwing tantrum","Primitive"),
    ("Intellectualization","Abstract thinking to avoid emotion","Cold clinical tone about own illness","Neurotic"),
    ("Undoing","Act to neutralize unacceptable thought","Obsessive hand-washing","Neurotic"),
    ("Splitting","All-good or all-bad view of people","Borderline PD","Primitive"),
    ("Identification","Adopting characteristics of admired person","Stockholm syndrome","Varies"),
    ("Isolation of Affect","Separating idea from feeling","Describing trauma without emotion","Neurotic"),
]
story.append(simple_table(
    ["Mechanism","Definition","Example","Level"],
    dm,
    [36*mm, 52*mm, 48*mm, 22*mm]
))
story.append(sp(2))
story.append(tip_box("Mature defenses: Sublimation, Altruism, Humor, Suppression | Neurotic: Rationalization, Displacement | Primitive: Denial, Projection, Splitting, Regression"))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 3 – THERAPEUTIC COMMUNICATION
# ════════════════════════════════════════════════════════════════
story.append(section_header("3. THERAPEUTIC COMMUNICATION"))
story.append(sp(2))

story.append(sub_header("Therapeutic Techniques (USE THESE)"))
tc_rows = [
    ("Active Listening","Full attention + non-verbal cues (nodding, eye contact)"),
    ("Open-ended Questions","'Tell me more about that...'"),
    ("Reflection","Return feelings: 'You sound angry about...'"),
    ("Restatement","Repeat key words: 'You can't sleep?'"),
    ("Clarification","'I'm not sure I understand – can you explain?'"),
    ("Focusing","Direct to important topic: 'Let's talk more about that feeling'"),
    ("Sharing Observations","'I notice you're wringing your hands'"),
    ("Giving Information","Provide factual content, e.g., about medications"),
    ("Summarizing","Condense session: 'So today we talked about...'"),
    ("Silence","Allow time to think; comfortable pause after difficult statements"),
]
story.append(simple_table(["Technique","Example / Purpose"], tc_rows, [45*mm, W-45*mm]))
story.append(sp(3))

story.append(sub_header("Non-Therapeutic Techniques (AVOID)"))
ntc_rows = [
    ("False Reassurance","'Everything will be fine' – dismisses feelings"),
    ("Giving Advice","Undermines patient autonomy"),
    ("Closed Questions","Limits response, blocks exploration"),
    ("Changing Subject","Signals disinterest in patient's concern"),
    ("Clichés","'Cheer up!' – minimises distress"),
    ("Probing / Prying","Invades privacy; pushes before patient is ready"),
    ("Agreeing / Disagreeing","Validates or invalidates without exploration"),
    ("Defending Staff/Institution","Protects staff rather than addressing concern"),
    ("Belittling","'Everyone gets nervous sometimes' – minimises experience"),
]
story.append(simple_table(["Technique","Why Harmful"], ntc_rows, [45*mm, W-45*mm]))
story.append(sp(3))

story.append(sub_header("Peplau's 4 Phases of Nurse-Patient Relationship"))
peplau = [
    ("Pre-interaction","Before meeting patient","Nurse examines own biases, reviews records"),
    ("Orientation","Building trust","Establish rapport, set parameters, identify needs; testing behavior expected"),
    ("Working","Active problem-solving","Most therapeutic work; transference/countertransference occur"),
    ("Termination","Closure","Review progress; patient may regress or become anxious"),
]
story.append(simple_table(["Phase","Focus","Nurse Actions"], peplau, [30*mm, 35*mm, W-65*mm]))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 4 – ERIKSON
# ════════════════════════════════════════════════════════════════
story.append(section_header("4. ERIKSON'S 8 PSYCHOSOCIAL STAGES"))
story.append(sp(2))
erikson = [
    ("1","Trust vs Mistrust","0–18 mo","Hope","Schizoid/paranoid traits, substance use, depression"),
    ("2","Autonomy vs Shame","18 mo–3 yr","Will","OCD traits, impulsivity, compulsive doubting"),
    ("3","Initiative vs Guilt","3–6 yr","Purpose","Phobias, anxiety, conversion disorder, sexual inhibitions"),
    ("4","Industry vs Inferiority","6–12 yr","Competence","Depression, low self-esteem"),
    ("5","Identity vs Role Confusion","12–20 yr","Fidelity","Identity disorders, delinquency"),
    ("6","Intimacy vs Isolation","20–40 yr","Love","Personality disorders"),
    ("7","Generativity vs Stagnation","40–65 yr","Care","Mid-life crisis, depression"),
    ("8","Integrity vs Despair","65+ yr","Wisdom","Depression, hopelessness, bitterness"),
]
story.append(simple_table(
    ["#","Stage","Age","Virtue","Failure Outcomes"],
    erikson,
    [8*mm, 46*mm, 22*mm, 20*mm, W-96*mm]
))
story.append(sp(2))
story.append(tip_box("Exam tip: Stage 1 failure (Basic Mistrust) → paranoid/schizoid traits and predisposes to schizophrenia (Kaplan & Sadock)"))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 5 – DISORDERS OVERVIEW
# ════════════════════════════════════════════════════════════════
story.append(section_header("5. PSYCHIATRIC DISORDERS — OVERVIEW & CLASSIFICATION"))
story.append(sp(2))
story.append(Paragraph("DSM-5-TR (APA) — categorical; ICD-11 (WHO) — international standard", BODY))
story.append(sp(2))

categories = [
    ("Schizophrenia Spectrum","Schizophrenia, Schizoaffective D/O, Delusional D/O, Brief Psychotic D/O"),
    ("Depressive Disorders","MDD, Persistent Depressive D/O (Dysthymia), PMDD"),
    ("Bipolar & Related","Bipolar I, Bipolar II, Cyclothymia"),
    ("Anxiety Disorders","GAD, Panic D/O, Social Anxiety, Specific Phobia, Agoraphobia"),
    ("OCD & Related","OCD, Body Dysmorphic D/O, Hoarding D/O"),
    ("Trauma & Stressor","PTSD, Acute Stress D/O, Adjustment D/O"),
    ("Dissociative Disorders","Dissociative Identity D/O, Amnesia, Depersonalisation"),
    ("Somatic Symptom","Somatic Symptom D/O, Illness Anxiety D/O, Conversion D/O"),
    ("Feeding/Eating","Anorexia Nervosa, Bulimia Nervosa, Binge Eating D/O"),
    ("Substance Use","Alcohol, Opioid, Stimulant, Cannabis, Sedative use disorders"),
    ("Neurodevelopmental","ADHD, ASD, Intellectual Disability, Learning Disorders"),
    ("Personality Disorders","Cluster A (odd), B (dramatic), C (anxious)"),
    ("Neurocognitive","Delirium, Major & Mild NCD (Dementia types)"),
]
story.append(simple_table(["Category","Includes"], categories, [55*mm, W-55*mm]))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 6 – SCHIZOPHRENIA
# ════════════════════════════════════════════════════════════════
story.append(section_header("6. SCHIZOPHRENIA"))
story.append(sp(2))
story.append(alert_box("DSM-5: ≥2 symptoms for ≥1 month (must include ≥1 of: delusions, hallucinations, disorganised speech) + impairment ≥6 months"))
story.append(sp(2))

story.append(sub_header("Positive vs Negative Symptoms"))
pn = [
    ("POSITIVE (excess/distortion)","NEGATIVE (diminution of normal function — harder to treat)"),
    ("Delusions (persecutory most common)","Alogia — poverty of speech"),
    ("Hallucinations (auditory most common)","Avolition — lack of motivation"),
    ("Disorganised thinking (loose associations, word salad)","Anhedonia — inability to experience pleasure"),
    ("Disorganised / catatonic behaviour","Affective Flattening — reduced emotional expression"),
    ("","Asociality — social withdrawal"),
]
pt = Table([[Paragraph(r[0], BODY), Paragraph(r[1], BODY)] for r in pn],
           colWidths=[W/2 - 2*mm, W/2 - 2*mm])
pt.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (0,-1), HexColor("#D6EAF8")),
    ("BACKGROUND",    (1,0), (1,-1), C_LGREEN),
    ("BACKGROUND",    (0,0), (-1,0), C_NAVY),
    ("TEXTCOLOR",     (0,0), (-1,0), white),
    ("FONTNAME",      (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0), (-1,-1), 8.5),
    ("TOPPADDING",    (0,0), (-1,-1), 3),
    ("BOTTOMPADDING", (0,0), (-1,-1), 3),
    ("LEFTPADDING",   (0,0), (-1,-1), 5),
    ("GRID",          (0,0), (-1,-1), 0.3, HexColor("#AAAAAA")),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(pt)
story.append(sp(2))

story.append(sub_header("Dopamine Hypothesis"))
dopa = [
    ("Mesolimbic pathway (↑ dopamine)","→ Positive symptoms","Antipsychotics block D2 here"),
    ("Mesocortical pathway (↓ dopamine)","→ Negative/cognitive symptoms","Harder to treat"),
    ("Nigrostriatal pathway (D2 block by drugs)","→ EPS side effects","Tardive dyskinesia, pseudo-parkinsonism"),
    ("Tuberoinfundibular pathway (D2 block)","→ ↑ Prolactin","Galactorrhoea, amenorrhoea"),
]
story.append(simple_table(["Pathway","Effect","Clinical Note"], dopa, [55*mm, 50*mm, W-105*mm]))
story.append(sp(2))

story.append(sub_header("Nursing Care — Schizophrenia"))
sz_care = [
    "Establish trust; be consistent and predictable",
    "Use simple, clear, concrete language",
    "DO NOT argue about delusions — acknowledge without reinforcing ('I don't share that belief, but I hear that it feels real')",
    "Assess for command hallucinations — HIGH safety risk",
    "Safe, structured milieu with predictable routine",
    "Monitor medication adherence; educate about long-acting injectables (LAI)",
    "Social skills training; supported employment",
    "Family psychoeducation — reduce Expressed Emotion (EE)",
]
for item in sz_care:
    story.append(Paragraph("• " + item, BULLET))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 7 – MOOD DISORDERS
# ════════════════════════════════════════════════════════════════
story.append(section_header("7. MOOD DISORDERS — MDD & BIPOLAR"))
story.append(sp(2))

story.append(sub_header("Major Depressive Disorder (MDD) — SIG E CAPS"))
story.append(mnemonic_box([
    ("S","Sleep disturbance (insomnia or hypersomnia)"),
    ("I","Interest loss / Anhedonia"),
    ("G","Guilt (worthlessness, excessive guilt)"),
    ("E","Energy loss / Fatigue"),
    ("C","Concentration problems"),
    ("A","Appetite change (loss or increase) / weight change"),
    ("P","Psychomotor agitation or retardation"),
    ("S","Suicidal ideation or thoughts of death"),
    ("+","Depressed mood (sadness, hopelessness) — required"),
], "SIG E CAPS"))
story.append(Paragraph("<b>DSM-5:</b> ≥5 symptoms for ≥2 weeks; must include depressed mood OR anhedonia; significant impairment", BODY))
story.append(sp(2))

story.append(sub_header("MDD Specifiers (Key for Exams)"))
spec = [
    ("Melancholic","Worse in morning, early waking, severe anhedonia, excessive guilt, psychomotor changes"),
    ("Atypical","Mood reactivity + hypersomnia, increased appetite, leaden paralysis, rejection sensitivity"),
    ("Psychotic","Mood-congruent or mood-incongruent delusions/hallucinations"),
    ("Peripartum","Onset during pregnancy or within 4 weeks of delivery"),
    ("Seasonal","Recurs at specific time of year (usually winter)"),
]
story.append(simple_table(["Specifier","Features"], spec, [38*mm, W-38*mm]))
story.append(sp(3))

story.append(sub_header("Bipolar Disorder — Types"))
bp_types = [
    ("Bipolar I","≥1 full manic episode (may have depressive episodes); most severe"),
    ("Bipolar II","Hypomanic + major depressive episodes; NO full manic episode"),
    ("Cyclothymia","Subsyndromal highs & lows for ≥2 years; never full criteria for mania or MDD"),
]
story.append(simple_table(["Type","Definition"], bp_types, [30*mm, W-30*mm]))
story.append(sp(2))

story.append(sub_header("Manic Episode — DIG FAST"))
story.append(mnemonic_box([
    ("D","Distractibility"),
    ("I","Impulsivity / Irresponsibility (risky behaviours)"),
    ("G","Grandiosity"),
    ("F","Flight of ideas"),
    ("A","Activity increased / Agitation / Psychomotor ↑"),
    ("S","Sleep decreased (no fatigue despite minimal sleep)"),
    ("T","Talkativeness / Pressured speech"),
], "DIG FAST"))
story.append(Paragraph("<b>DSM-5:</b> ≥1 week elevated/expansive/irritable mood + ↑ activity, with ≥3 (or 4 if irritable) above symptoms", BODY))
story.append(sp(2))

story.append(sub_header("Nursing Care — Mood Disorders"))
mood_care = Table([
    [Paragraph("<b>DEPRESSION</b>", H3), Paragraph("<b>MANIA</b>", H3)],
    [
        Paragraph("• Assess suicide risk FIRST (highest when improving)\n• Assist with ADLs, nutrition, hygiene\n• Therapeutic presence; avoid challenging cognitions early\n• Activity scheduling; positive reinforcement\n• SSRIs take 2–4 weeks to work — educate\n• Remove means if suicidal", BODY),
        Paragraph("• Safety first — impulsive, risk-taking behaviour\n• Quiet, low-stimulation environment\n• Short, clear interactions (patient distractible)\n• Monitor nutrition/hydration (too busy to eat)\n• Monitor sleep\n• Firm, consistent limits on behaviour\n• Lithium monitoring (see Section 12)", BODY)
    ]
], colWidths=[W/2 - 2*mm, W/2 - 2*mm])
mood_care.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (0,0), HexColor("#D6EAF8")),
    ("BACKGROUND", (1,0), (1,0), C_LYELL),
    ("GRID",       (0,0), (-1,-1), 0.3, HexColor("#AAAAAA")),
    ("TOPPADDING", (0,0), (-1,-1), 4),
    ("BOTTOMPADDING",(0,0),(-1,-1), 4),
    ("LEFTPADDING",(0,0), (-1,-1), 5),
    ("VALIGN",     (0,0), (-1,-1), "TOP"),
]))
story.append(mood_care)
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 8 – ANXIETY & OCD
# ════════════════════════════════════════════════════════════════
story.append(section_header("8. ANXIETY DISORDERS & OCD"))
story.append(sp(2))

story.append(sub_header("Anxiety Disorders at a Glance"))
anx = [
    ("GAD","Excessive uncontrollable worry ≥6 months, multiple domains"),
    ("Panic Disorder","Recurrent unexpected panic attacks + concern about more attacks"),
    ("Social Anxiety D/O","Fear of scrutiny in social situations"),
    ("Specific Phobia","Marked fear of specific object/situation"),
    ("Agoraphobia","Fear of open/public spaces, crowds, public transport"),
]
story.append(simple_table(["Disorder","Key Feature"], anx, [42*mm, W-42*mm]))
story.append(sp(2))

story.append(sub_header("Panic Attack Symptoms (peak <10 min)"))
story.append(Paragraph(
    "Palpitations • Sweating • Trembling • Shortness of breath • Chest pain • Nausea • Dizziness • "
    "Derealization/depersonalisation • Fear of dying or losing control • Paresthesias • Chills/hot flushes",
    BODY))
story.append(sp(2))

story.append(sub_header("Peplau's Anxiety Levels — Nursing Response"))
peplau_anx = [
    ("Mild","Increased alertness, learning enhanced","Encourage problem-solving"),
    ("Moderate","Narrowed perceptual field, physical symptoms (HA, tachycardia)","Redirect; teach relaxation; calm presence"),
    ("Severe","Distorted perception; cannot focus or problem-solve","Stay with patient; short simple sentences; reduce stimulation"),
    ("Panic","Terror; disorganised thinking; possible violence/flight","DO NOT leave; calm quiet presence; PRN medication as ordered"),
]
story.append(simple_table(
    ["Level","Clinical Picture","Nursing Intervention"],
    peplau_anx,
    [22*mm, 60*mm, W-82*mm],
    row_colors=[(3, C_PINK)]
))
story.append(sp(2))

story.append(sub_header("OCD"))
story.append(Paragraph("<b>Obsessions</b>: Recurrent, intrusive, unwanted thoughts (contamination, harm, symmetry, forbidden thoughts) — ego-dystonic", BODY))
story.append(Paragraph("<b>Compulsions</b>: Repetitive behaviours/mental acts to neutralise obsession anxiety (washing, checking, counting, repeating)", BODY))
story.append(Paragraph("<b>Criteria</b>: Time-consuming (>1 hr/day); causes distress or impairment", BODY))
story.append(sp(2))
ocd_care = [
    ("Nursing","Do NOT interrupt rituals abruptly (anxiety spikes); non-judgmental; allow time then gradually delay"),
    ("Psychotherapy","CBT with Exposure & Response Prevention (ERP) — gold standard"),
    ("Pharmacotherapy","SSRIs at HIGH doses (e.g., fluoxetine 60–80 mg); Clomipramine (TCA — 2nd line)"),
]
story.append(simple_table(["Approach","Detail"], ocd_care, [35*mm, W-35*mm]))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 9 – PTSD
# ════════════════════════════════════════════════════════════════
story.append(section_header("9. PTSD & TRAUMA-RELATED DISORDERS"))
story.append(sp(2))

story.append(sub_header("PTSD — DSM-5 Four Symptom Clusters"))
ptsd = [
    ("B — Intrusion","Flashbacks, nightmares, intrusive memories, psychological distress at trauma cues"),
    ("C — Avoidance","Avoiding trauma-related thoughts, feelings, people, places, conversations"),
    ("D — Negative Cognitions/Mood","Negative beliefs about self/world, guilt, emotional numbing, persistent negative emotions, detachment"),
    ("E — Hyperarousal/Reactivity","Hypervigilance, exaggerated startle, irritability/aggression, sleep disturbance, reckless behaviour"),
]
story.append(simple_table(["Cluster","Key Symptoms"], ptsd, [42*mm, W-42*mm]))
story.append(Paragraph("<b>Duration</b>: >1 month; <b>Acute Stress Disorder</b>: 3 days – 1 month post-trauma", BODY))
story.append(sp(2))

story.append(sub_header("Nursing Care — Trauma-Informed Approach"))
ptsd_care = [
    "Ensure physical and psychological SAFETY as first priority",
    "Trauma-informed care — never re-traumatise (avoid forced disclosure)",
    "Validate feelings without judgment",
    "Grounding techniques: 5-4-3-2-1 (name 5 things you see, 4 you feel, 3 you hear, 2 you smell, 1 you taste)",
    "Avoid touch without explicit permission",
    "Psychoeducation: normalise trauma responses",
    "Evidence-based therapies: Trauma-focused CBT, EMDR (Eye Movement Desensitisation and Reprocessing)",
    "SSRIs (Sertraline, Paroxetine) — FDA approved for PTSD",
]
for item in ptsd_care:
    story.append(Paragraph("• " + item, BULLET))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 10 – PERSONALITY DISORDERS
# ════════════════════════════════════════════════════════════════
story.append(section_header("10. PERSONALITY DISORDERS"))
story.append(sp(2))

pd_rows = [
    ("A — ODD/ECCENTRIC","Paranoid","Pervasive distrust, suspiciousness, misinterprets motives","Non-confrontational; build slow trust"),
    ("A","Schizoid","Detachment, restricted emotions, prefers solitude","Respect need for distance; don't force socialisation"),
    ("A","Schizotypal","Magical thinking, ideas of reference, odd speech/appearance","Gentle reality testing; structured environment"),
    ("B — DRAMATIC","Antisocial (ASPD)","Violation of others' rights, deceitfulness, no remorse","Firm limits; document behaviour; safety awareness"),
    ("B","Borderline (BPD)","Identity instability, impulsivity, self-harm, splitting","Consistent team; DBT; no-harm planning; don't take splitting personally"),
    ("B","Histrionic","Excessive emotionality, attention-seeking","Therapeutic limits; don't reinforce dramatic behaviour"),
    ("B","Narcissistic","Grandiosity, lack of empathy, entitlement","Maintain professional boundaries; don't reinforce grandiosity"),
    ("C — ANXIOUS","Avoidant","Social inhibition, fears rejection, inadequacy","Gradual exposure; validate worth"),
    ("C","Dependent","Excessive need for care, submissiveness","Encourage autonomy; set limits on reassurance-seeking"),
    ("C","OCPD","Perfectionism, orderliness, control (ego-syntonic!)","Teach flexibility; stress management"),
]
story.append(simple_table(
    ["Cluster","Disorder","Key Features","Nursing Focus"],
    pd_rows,
    [25*mm, 28*mm, 65*mm, W-118*mm]
))
story.append(sp(2))
story.append(alert_box("BPD PRIORITY: Splitting (staff seen as all-good/all-bad) → consistent team communication essential. Self-harm is COMMON — always assess safety."))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 11 – ANTIPSYCHOTICS
# ════════════════════════════════════════════════════════════════
story.append(section_header("11. PSYCHOPHARMACOLOGY — ANTIPSYCHOTICS"))
story.append(sp(2))

story.append(sub_header("First Generation (Typical) — D2 Blockade Only"))
fga = [
    ("Chlorpromazine","100–800 mg/d","High sedation, anticholinergic, orthostatic hypotension, photosensitivity"),
    ("Haloperidol (Haldol)","2–20 mg/d","High EPS; available IM/IV; low sedation"),
    ("Fluphenazine","1–20 mg/d","High EPS; available as long-acting injectable (LAI)"),
    ("Thioridazine","50–800 mg/d","QTc prolongation; retinal pigmentation — limited use"),
]
story.append(simple_table(["Drug","Dose Range","Key Notes"], fga, [42*mm, 28*mm, W-70*mm]))
story.append(sp(2))

story.append(sub_header("Second Generation (Atypical) — D2 + 5HT2A Blockade"))
sga = [
    ("Clozapine","150–600 mg/d","Treatment-resistant; WEEKLY WBC — agranulocytosis risk (1–2%); seizures; hypersalivation"),
    ("Olanzapine","5–20 mg/d","High metabolic effects (wt gain, diabetes, hyperlipidaemia); sedating"),
    ("Risperidone","2–8 mg/d","EPS at high doses; ↑ prolactin; available as LAI"),
    ("Quetiapine","150–800 mg/d","Sedating; used for bipolar depression; minimal EPS; no prolactin rise"),
    ("Aripiprazole","10–30 mg/d","Partial D2 agonist; minimal weight gain; activating; lowest metabolic risk"),
    ("Ziprasidone","40–160 mg/d","QTc prolongation — ECG monitoring; must take with food"),
    ("Paliperidone","3–12 mg/d","Active metabolite of risperidone; LAI available"),
]
story.append(simple_table(["Drug","Dose Range","Key Notes"], sga, [38*mm, 28*mm, W-66*mm]))
story.append(sp(2))

story.append(sub_header("Extrapyramidal Side Effects (EPS)"))
eps = [
    ("Acute Dystonia","Hours–days","Sudden muscle spasm: neck (torticollis), eyes (oculogyric), jaw, tongue","Benztropine IM/IV or Diphenhydramine IM"),
    ("Akathisia","Days–weeks","Restlessness, can't sit still — most DISTRESSING","Reduce dose; Propranolol; Benzodiazepine"),
    ("Pseudo-parkinsonism","Weeks","Tremor, rigidity, bradykinesia, shuffling gait, mask face","Reduce dose; Benztropine; switch drug"),
    ("Tardive Dyskinesia","Months–years","Involuntary mouth/lip/tongue movements — may be IRREVERSIBLE","Prevention; lowest effective dose; Valbenazine"),
]
story.append(simple_table(
    ["EPS Type","Onset","Features","Treatment"],
    eps,
    [35*mm, 22*mm, 65*mm, W-122*mm],
    row_colors=[(3, C_PINK)]
))
story.append(sp(2))

story.append(alert_box("NEUROLEPTIC MALIGNANT SYNDROME (NMS) — MEDICAL EMERGENCY: High Fever + Lead-pipe Rigidity + Autonomic instability + Elevated CK + Altered consciousness. STOP antipsychotic IMMEDIATELY. ICU care. Dantrolene + Bromocriptine."))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 12 – ANTIDEPRESSANTS & MOOD STABILIZERS
# ════════════════════════════════════════════════════════════════
story.append(section_header("12. ANTIDEPRESSANTS & MOOD STABILIZERS"))
story.append(sp(2))

story.append(sub_header("Antidepressants — Classes"))
ads = [
    ("SSRIs (1st line)","Fluoxetine, Sertraline, Escitalopram, Paroxetine, Citalopram","Block serotonin reuptake","Nausea, sexual dysfunction, insomnia, SIADH (hyponatraemia); ONSET 2–4 weeks"),
    ("SNRIs","Venlafaxine, Duloxetine","Block 5-HT + NE reuptake","Similar to SSRI + hypertension"),
    ("TCAs","Amitriptyline, Imipramine, Nortriptyline","Block 5-HT + NE reuptake + anticholinergic + antihistamine","Dangerous in OD (QRS widening); sedating; not 1st line"),
    ("MAOIs","Phenelzine, Tranylcypromine","Block MAO → ↑ monoamines","Tyramine (cheese) reaction → hypertensive crisis; serotonin syndrome with SSRIs; reserved for refractory"),
    ("Others","Bupropion (NE/DA), Mirtazapine (NaSSA), Trazodone","Various","Bupropion: seizure risk, no sexual SE; Mirtazapine: weight gain, sedating"),
]
story.append(simple_table(
    ["Class","Examples","Mechanism","Key Side Effects / Notes"],
    ads,
    [22*mm, 48*mm, 38*mm, W-108*mm]
))
story.append(sp(2))

story.append(sub_header("Serotonin Syndrome vs NMS"))
ssv = [
    ("Cause","Excess serotonin (SSRI + MAOI, tramadol, linezolid)","Antipsychotic dopamine blockade"),
    ("Onset","RAPID — hours","Slow — days to weeks"),
    ("Muscle","Myoclonus, hyperreflexia, tremor, clonus","Lead-pipe RIGIDITY"),
    ("Fever","Present","High (>40°C)"),
    ("GI","Diarrhoea, nausea","Absent"),
    ("Treatment","STOP drug; Cyproheptadine; supportive","STOP antipsychotic; Dantrolene; Bromocriptine"),
]
ss_t = Table(
    [[Paragraph("<b>Feature</b>", TH), Paragraph("<b>Serotonin Syndrome</b>", TH), Paragraph("<b>NMS</b>", TH)]] +
    [[Paragraph(r[0], BODYB), Paragraph(r[1], BODY), Paragraph(r[2], BODY)] for r in ssv],
    colWidths=[30*mm, (W-30*mm)/2, (W-30*mm)/2]
)
ss_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), C_NAVY),
    ("BACKGROUND",    (1,1), (1,-1), HexColor("#D6EAF8")),
    ("BACKGROUND",    (2,1), (2,-1), C_PINK),
    ("ROWBACKGROUNDS",(0,1), (0,-1), [white]),
    ("GRID",          (0,0), (-1,-1), 0.3, HexColor("#AAAAAA")),
    ("TOPPADDING",    (0,0), (-1,-1), 3),
    ("BOTTOMPADDING", (0,0), (-1,-1), 3),
    ("LEFTPADDING",   (0,0), (-1,-1), 4),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(ss_t)
story.append(sp(3))

story.append(sub_header("Mood Stabilizers"))
ms = [
    ("Lithium","Bipolar I/II (1st line)","0.6–1.2 mEq/L (maintenance)\n0.8–1.2 (acute mania)","Toxicity >1.5: nausea, tremor, ataxia, confusion\nToxicity >2.0: seizures, arrhythmia, death\nNSAIDs + ACE inhibitors INCREASE levels"),
    ("Valproate","Bipolar (esp. rapid cycling), seizures","50–125 µg/mL","Hepatotoxicity, thrombocytopenia, hair loss, weight gain; TERATOGENIC (neural tube defects)"),
    ("Carbamazepine","Bipolar, seizures, trigeminal neuralgia","4–12 µg/mL","Aplastic anaemia, agranulocytosis, hyponatraemia; induces own metabolism"),
    ("Lamotrigine","Bipolar depression","—","Stevens-Johnson Syndrome (life-threatening rash) — SLOW titration required; highly effective for depressive phase"),
]
story.append(simple_table(
    ["Drug","Indication","Therapeutic Level","Key Monitoring / Risks"],
    ms,
    [28*mm, 38*mm, 30*mm, W-96*mm]
))
story.append(sp(2))
story.append(alert_box("Lithium Monitoring: Serum level (12h after last dose), Renal function (BUN/Creatinine), Thyroid function, CBC. Adequate fluid/salt intake essential — dehydration → toxicity!"))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 13 – ANXIOLYTICS, ECT, SOMATIC
# ════════════════════════════════════════════════════════════════
story.append(section_header("13. ANXIOLYTICS, ECT & SOMATIC THERAPIES"))
story.append(sp(2))

story.append(sub_header("Benzodiazepines"))
benzo = [
    ("Diazepam (Valium)","Anxiety, alcohol withdrawal, seizures","Long-acting"),
    ("Lorazepam (Ativan)","Acute agitation (IM), alcohol withdrawal, acute anxiety","Medium-acting; IM/IV available"),
    ("Alprazolam (Xanax)","Panic disorder, short-term anxiety","Short-acting; high dependence risk"),
    ("Clonazepam (Klonopin)","Panic disorder, seizures","Long-acting"),
    ("Midazolam","Procedural sedation","Short-acting IV"),
]
story.append(simple_table(["Drug","Uses","Notes"], benzo, [40*mm, 55*mm, W-95*mm]))
story.append(Paragraph("Mechanism: Enhance GABA at GABA-A receptors → CNS depression", BODY))
story.append(Paragraph("Reversal agent: <b>Flumazenil</b> | Withdrawal: tremors, sweating, SEIZURES (can be fatal with abrupt stop)", BODY))
story.append(Paragraph("Buspirone: Non-benzo anxiolytic; 5-HT1A partial agonist; NO dependence/sedation; onset 1–2 weeks; for GAD", BODY))
story.append(sp(3))

story.append(sub_header("Electroconvulsive Therapy (ECT)"))
ect_ind = [
    ("Indications","Severe depression unresponsive to meds; imminent suicide risk; severe mania; catatonia; depression in pregnancy"),
    ("Contraindications","No absolute contraindications; Relative: raised ICP, recent MI, cerebral aneurysm"),
    ("Procedure","NPO 6–8h; atropine (secretions); methohexital (anesthesia); succinylcholine (muscle relaxant); electrical seizure induction; 6–12 treatments (3×/week)"),
    ("Main Side Effects","Short-term memory loss (most significant); postictal confusion; headache; nausea; muscle aches"),
]
story.append(simple_table(["Aspect","Detail"], ect_ind, [35*mm, W-35*mm]))
story.append(sp(2))

story.append(sub_header("ECT Nursing Care"))
ect_care = [
    ("Pre-ECT","Obtain informed consent; NPO; remove metal objects/dentures/hairpins; baseline vitals & neuro check; IV access; empty bladder"),
    ("During","Airway management; seizure monitoring; vital signs; oxygen"),
    ("Post-ECT","Monitor vitals until stable; reorient patient (confusion is EXPECTED); assess memory; manage headache/nausea; do NOT allow driving; reassure memory loss usually temporary"),
]
story.append(simple_table(["Phase","Nursing Actions"], ect_care, [20*mm, W-20*mm]))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 14 – SUICIDE RISK & SAFETY
# ════════════════════════════════════════════════════════════════
story.append(section_header("14. SUICIDE RISK ASSESSMENT & SAFETY"))
story.append(sp(2))
story.append(alert_box("Previous suicide attempt is the SINGLE STRONGEST predictor of future attempt/completion"))
story.append(sp(2))

story.append(sub_header("Risk Factors vs Protective Factors"))
risk_prot = [
    ("Previous attempt (strongest)","Strong social support network"),
    ("Male sex (higher completion; females attempt more)","Religious/spiritual beliefs"),
    ("Mental illness (depression, schizophrenia, BPD, substance use)","Reasons for living / children at home"),
    ("Hopelessness (Beck's Hopelessness Scale)","Access to mental health care"),
    ("Social isolation / recent loss","Responsibility for others"),
    ("Access to lethal means (especially firearms)","Problem-solving ability"),
    ("Chronic pain / terminal illness","Fear of death / cultural prohibitions"),
    ("Family history of suicide",""),
    ("History of trauma / abuse",""),
]
rf_data = [[Paragraph("<b>RISK FACTORS</b>", ParagraphStyle("rfh", fontSize=9, textColor=C_RED, fontName="Helvetica-Bold", leading=12)),
            Paragraph("<b>PROTECTIVE FACTORS</b>", ParagraphStyle("pfh", fontSize=9, textColor=C_GREEN, fontName="Helvetica-Bold", leading=12))]]
for r in risk_prot:
    rf_data.append([Paragraph("▸ " + r[0], BODY), Paragraph(("✓ " + r[1]) if r[1] else "", BODY)])
rf_t = Table(rf_data, colWidths=[W/2 - 2*mm, W/2 - 2*mm])
rf_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (0,0), C_PINK),
    ("BACKGROUND",    (1,0), (1,0), C_LGREEN),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [white, C_LGRAY]),
    ("GRID",          (0,0), (-1,-1), 0.3, HexColor("#AAAAAA")),
    ("TOPPADDING",    (0,0), (-1,-1), 3),
    ("BOTTOMPADDING", (0,0), (-1,-1), 3),
    ("LEFTPADDING",   (0,0), (-1,-1), 5),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(rf_t)
story.append(sp(2))

story.append(sub_header("Nursing Interventions — Suicidal Patient (Priority Order)"))
si_int = [
    "1.", "Ask DIRECTLY about suicidal ideation — this does NOT increase risk",
    "2.", "Assess: Plan / Method / Means / Intent / Timeline",
    "3.", "REMOVE all access to lethal means (firearms, medications, sharps)",
    "4.", "1:1 (one-to-one) observation — do NOT leave patient alone",
    "5.", "Document thoroughly — clinical and legal requirement",
    "6.", "Safety planning (Stanley-Brown model): warning signs, coping, contacts, means restriction",
    "7.", "Therapeutic milieu — safe environment",
    "8.", "Medications as ordered (antidepressant, lithium — anti-suicidal effect)",
    "9.", "Involve family/support with patient consent",
    "10.","Follow up on discharge — schedule first appointment before leaving hospital",
]
for i in range(0, len(si_int), 2):
    story.append(Paragraph(f"<b>{si_int[i]}</b> {si_int[i+1]}", BULLET))
story.append(sp(2))
story.append(tip_box("Paradox: Suicide risk is HIGHEST when patient is beginning to IMPROVE (more energy to act on ideation). Maintain vigilance during recovery phase."))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 15 – SUBSTANCE USE
# ════════════════════════════════════════════════════════════════
story.append(section_header("15. SUBSTANCE USE DISORDERS"))
story.append(sp(2))

story.append(sub_header("Stages of Change — Prochaska & DiClemente"))
soc = [
    ("1. Precontemplation","Not thinking about change; denies problem","Build rapport; provide information; avoid confrontation"),
    ("2. Contemplation","Considering change; ambivalent","Explore pros/cons; motivational interviewing"),
    ("3. Preparation","Planning to change; ready soon","Help set goals; connect with resources"),
    ("4. Action","Actively making change","Support; reinforce efforts; teach coping"),
    ("5. Maintenance","Sustaining change","Relapse prevention; ongoing support"),
    ("6. Relapse","Returns to old behaviour","NORMALISE: not failure; re-engage in cycle"),
]
story.append(simple_table(
    ["Stage","Characteristics","Nursing Approach"],
    soc,
    [35*mm, 55*mm, W-90*mm]
))
story.append(sp(2))

story.append(sub_header("CAGE Screening Tool (Score ≥2 = Probable Alcoholism)"))
story.append(mnemonic_box([
    ("C","Have you ever felt you should CUT DOWN on your drinking?"),
    ("A","Have people ANNOYED you by criticising your drinking?"),
    ("G","Have you ever felt GUILTY about drinking?"),
    ("E","Have you ever had a drink first thing in the morning as an EYE-OPENER?"),
], "CAGE"))
story.append(sp(2))

story.append(sub_header("Alcohol Withdrawal — Timeline & Management"))
aw = [
    ("6–24 hours","Minor withdrawal","Tremors, diaphoresis, anxiety, tachycardia, nausea"),
    ("24–48 hours","Seizures","Grand mal seizures; greatest risk at 24h"),
    ("48–72 hours","Delirium Tremens (DTs)","Confusion, agitation, visual hallucinations ('seeing bugs'), severe autonomic instability; mortality 5–15% untreated"),
]
story.append(simple_table(
    ["Timeframe","Stage","Clinical Features"],
    aw,
    [28*mm, 35*mm, W-63*mm],
    row_colors=[(2, C_PINK)]
))
story.append(sp(2))
story.append(alert_box("DTs MANAGEMENT: IV Benzodiazepines (Lorazepam or Chlordiazepoxide) via CIWA-Ar protocol + IV THIAMINE BEFORE glucose (prevents Wernicke's encephalopathy)"))
story.append(sp(2))

story.append(sub_header("Motivational Interviewing — OARS"))
story.append(mnemonic_box([
    ("O","Open-ended questions"),
    ("A","Affirmations — acknowledge strengths"),
    ("R","Reflective listening"),
    ("S","Summarizing"),
], "OARS"))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 16 – COMMUNITY, CRISIS, LEGAL
# ════════════════════════════════════════════════════════════════
story.append(section_header("16. COMMUNITY MH, CRISIS INTERVENTION & LEGAL/ETHICS"))
story.append(sp(2))

story.append(sub_header("Caplan's Levels of Prevention"))
caplan = [
    ("Primary","Reduce INCIDENCE; promote mental health","Stress management workshops; anti-stigma campaigns; school programmes"),
    ("Secondary","Early identification; reduce PREVALENCE","Screening programmes; crisis hotlines; early intervention teams"),
    ("Tertiary","Reduce DISABILITY; rehabilitation","Relapse prevention; supported employment; day programmes"),
]
story.append(simple_table(["Level","Goal","Examples"], caplan, [25*mm, 40*mm, W-65*mm]))
story.append(sp(2))

story.append(sub_header("Crisis Intervention — Roberts' 7-Stage Model"))
roberts = [
    ("1","Plan & assess lethality and safety"),
    ("2","Establish rapport and therapeutic relationship"),
    ("3","Identify major problems (precipitants)"),
    ("4","Deal with feelings and provide support"),
    ("5","Generate and explore alternatives"),
    ("6","Develop an action plan"),
    ("7","Follow-up plan"),
]
story.append(simple_table(["Stage","Action"], roberts, [15*mm, W-15*mm]))
story.append(Paragraph("Crisis is SELF-LIMITING (usually resolves in 4–6 weeks) and an opportunity for growth. Person is more receptive to help during crisis.", BODY))
story.append(sp(2))

story.append(sub_header("Hospitalisation Types"))
hosp = [
    ("Voluntary","Patient signs own admission; can leave AMA with notice"),
    ("Informal","Does not contest admission; may not know they can leave"),
    ("Involuntary (Formal)","Legal certification; criteria: danger to self, danger to others, or gravely disabled"),
]
story.append(simple_table(["Type","Definition"], hosp, [30*mm, W-30*mm]))
story.append(sp(2))

story.append(sub_header("Key Legal & Ethical Concepts"))
legal = [
    ("Informed Consent","Disclosure + Comprehension + Voluntariness + Competence — all four required"),
    ("Confidentiality","Protected; broken ONLY for: danger to self/others, child/elder abuse, court order, Tarasoff"),
    ("Tarasoff Decision (1976)","Duty to warn identifiable potential victims of patient's stated violent intent — overrides confidentiality"),
    ("Least Restrictive Environment","Patient's right to receive care in the setting with fewest restrictions on freedom"),
    ("Habeas Corpus","Right to challenge lawfulness of involuntary hospitalisation"),
    ("Duty of Care","Nurse must provide reasonable standard of care; failure = negligence"),
    ("Restraint","LAST RESORT; requires physician order; monitor every 15 min (vitals, circulation, skin, behaviour)"),
]
story.append(simple_table(["Concept","Key Points"], legal, [40*mm, W-40*mm]))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 17 – PRIORITY SAFETY ALERTS
# ════════════════════════════════════════════════════════════════
story.append(section_header("17. PRIORITY SAFETY ALERTS FOR NURSES", color=C_RED))
story.append(sp(2))

alerts = [
    ("NMS","STOP antipsychotic IMMEDIATELY; ICU care; Dantrolene + Bromocriptine; do NOT restart same drug"),
    ("Lithium Toxicity (>1.5 mEq/L)","HOLD lithium; check level; IV fluids; seizure precautions; dialysis for severe toxicity"),
    ("Alcohol Withdrawal DTs","IV benzodiazepines (CIWA-Ar); IV Thiamine BEFORE glucose; seizure precautions; cardiac monitoring"),
    ("Clozapine + Fever/Sore Throat","Check WBC STAT — agranulocytosis risk; HOLD clozapine if ANC <1000; do not restart without haematology"),
    ("Acute Dystonia (EPS)","IM Benztropine (anticholinergic) or IM Diphenhydramine — relief within minutes"),
    ("MAOI + Tyramine foods","Hypertensive crisis — monitor BP; treat with phentolamine; avoid aged cheese, wine, cured meats"),
    ("Serotonin Syndrome","STOP all serotonergic agents; Cyproheptadine; supportive care; cooling if hyperthermia"),
    ("Suicidal Patient","1:1 observation; REMOVE all means; safety plan; do NOT leave alone; document thoroughly"),
    ("Command Hallucinations","Full safety assessment; immediate risk; medication review; secure environment"),
    ("Panic Attack","Do NOT leave patient; calm quiet presence; slow breathing; PRN anxiolytic as ordered"),
    ("Severe Mania","Low-stimulation environment; prevent exhaustion/dehydration; short interactions; PRN sedation"),
    ("Alcohol Withdrawal Seizures","IV lorazepam; seizure precautions (padded rails); airway management; Thiamine IV"),
]

al_data = [[Paragraph("<b>SITUATION</b>", TH), Paragraph("<b>PRIORITY NURSING RESPONSE</b>", TH)]]
for i, (sit, act) in enumerate(alerts):
    bg = C_PINK if i % 2 == 0 else C_LYELL
    al_data.append([Paragraph(f"<b>{sit}</b>", WARN), Paragraph(act, BODY)])

al_t = Table(al_data, colWidths=[50*mm, W-50*mm])
al_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), C_RED),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [C_PINK, C_LYELL]),
    ("GRID",          (0,0), (-1,-1), 0.3, HexColor("#CCCCCC")),
    ("TOPPADDING",    (0,0), (-1,-1), 4),
    ("BOTTOMPADDING", (0,0), (-1,-1), 4),
    ("LEFTPADDING",   (0,0), (-1,-1), 5),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(al_t)
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════
# SECTION 18 – MASTER MNEMONICS
# ════════════════════════════════════════════════════════════════
story.append(section_header("18. MASTER MNEMONICS & QUICK-RECALL TABLES"))
story.append(sp(2))

story.append(sub_header("All Key Mnemonics at a Glance"))
mnems = [
    ("SIG E CAPS","Depression symptoms (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide)"),
    ("DIG FAST","Mania symptoms (Distractibility, Impulsivity, Grandiosity, Flight of ideas, Activity, Sleep ↓, Talkativeness)"),
    ("5 A's","Negative symptoms of Schizophrenia (Alogia, Avolition, Anhedonia, Affect flat, Asociality)"),
    ("FALTER","NMS (Fever, Autonomic instability, Lead-pipe Rigidity, Tachycardia, Elevated CK, Reduced consciousness)"),
    ("CAGE","Alcohol screening (Cut down, Annoyed, Guilty, Eye-opener) — score ≥2 positive"),
    ("OARS","Motivational Interviewing (Open questions, Affirmations, Reflective listening, Summarizing)"),
    ("ADPIE","Nursing Process (Assessment, Diagnosis, Planning, Implementation, Evaluation)"),
    ("DIG FAST + mood","Manic episode key symptoms"),
    ("RSVP","Suicide Risk factors (Recent attempt, Substance use, Verbal cues, Plan present)"),
    ("SAD PERSONS","Suicide risk scale (Sex, Age, Depression, Previous attempt, EtOH, Rational thinking loss, Social support, Organized plan, No spouse, Sickness)"),
]
story.append(simple_table(["Mnemonic","Stands For / Meaning"], mnems, [35*mm, W-35*mm]))
story.append(sp(3))

story.append(sub_header("Delirium vs Dementia vs Depression — The 3 D's"))
three_d = [
    ("Onset","ACUTE (hours–days)","GRADUAL (years)","Weeks–months"),
    ("Course","FLUCTUATING","Progressive (stable decline)","Episodic"),
    ("Consciousness","IMPAIRED (fluctuates)","Normal until late stage","Normal"),
    ("Attention","Severely impaired","Intact until late","Mildly impaired"),
    ("Reversibility","YES — treat cause","NO (irreversible)","YES — treat depression"),
    ("Hallucinations","Common (visual)","Possible (Lewy Body)","Rare (psychotic subtype)"),
    ("Memory","Short-term impaired","All types impaired (progressive)","Patchy; subjective complaints"),
    ("Key cause","Medical (infection, drugs, metabolic, post-op)","Neurodegeneration","Mood disorder"),
]
ddd_t = Table(
    [[Paragraph("<b>Feature</b>", TH), Paragraph("<b>DELIRIUM</b>", TH),
      Paragraph("<b>DEMENTIA</b>", TH), Paragraph("<b>DEPRESSION</b>", TH)]] +
    [[Paragraph(r[0], BODYB), Paragraph(r[1], BODY), Paragraph(r[2], BODY), Paragraph(r[3], BODY)]
     for r in three_d],
    colWidths=[30*mm, (W-30*mm)/3, (W-30*mm)/3, (W-30*mm)/3]
)
ddd_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), C_NAVY),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [C_PINK, C_LYELL]),
    ("BACKGROUND",    (3,1), (3,-1), C_LGREEN),
    ("GRID",          (0,0), (-1,-1), 0.3, HexColor("#AAAAAA")),
    ("TOPPADDING",    (0,0), (-1,-1), 3),
    ("BOTTOMPADDING", (0,0), (-1,-1), 3),
    ("LEFTPADDING",   (0,0), (-1,-1), 4),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(ddd_t)
story.append(sp(3))

story.append(sub_header("Yalom's 11 Therapeutic Factors in Group Therapy"))
yalom = [
    ("1","Instillation of Hope","Seeing others improve gives hope"),
    ("2","Universality","'I'm not alone in this'"),
    ("3","Imparting Information","Psychoeducation from leader/members"),
    ("4","Altruism","Helping others improves self-worth"),
    ("5","Corrective Recapitulation","Re-experience family dynamics safely"),
    ("6","Socialising Techniques","Learning/practicing social skills"),
    ("7","Imitative Behaviour","Modelling healthy behaviours"),
    ("8","Interpersonal Learning","Learning through group interactions"),
    ("9","Group Cohesiveness","Belonging, acceptance, trust"),
    ("10","Catharsis","Emotional release/expression"),
    ("11","Existential Factors","Meaning, responsibility, isolation"),
]
story.append(simple_table(["#","Factor","Description"], yalom, [8*mm, 50*mm, W-58*mm]))
story.append(sp(3))

# Final footer
story.append(hr())
story.append(Paragraph(
    "<i>Sources: Kaplan &amp; Sadock's Synopsis of Psychiatry | Kaplan &amp; Sadock's Comprehensive Textbook of Psychiatry | "
    "Stahl's Essential Psychopharmacology | The Maudsley Prescribing Guidelines in Psychiatry (15th Ed.) | "
    "Kaplan &amp; Sadock's Comprehensive Textbook of Psychiatry</i>",
    SMALL
))
story.append(Paragraph(
    "<i>Generated by Orris AI — for exam preparation only. Always verify with current clinical guidelines.</i>",
    SMALL
))

# ════════════════════════════════════════════════════════════════
# BUILD PDF
# ════════════════════════════════════════════════════════════════
doc.build(story)
print(f"PDF saved to: {OUTPUT}")

cd /home/daytona/workspace/mental-health-nursing && python3 generate_pdf.py 2>&1

ls -lh /home/daytona/workspace/mental-health-nursing/MentalHealthNursing_QuickRe…

python3 -c "import genanki; print('genanki ok')" 2>&1 || pip install --user gena…

pip install --user genanki -q 2>&1 | tail -3 && python3 -c "import genanki; prin…

~/mental-health-nursing/generate_anki.py

"""
Mental Health Nursing — Anki Flashcard Deck Generator
Creates a .apkg file importable directly into Anki desktop or AnkiDroid/AnkiMobile.

Cards are tagged by topic and use a styled front/back template with color coding.
"""

import genanki
import random
import os

OUTPUT = "/home/daytona/workspace/mental-health-nursing/MentalHealthNursing_Anki.apkg"

# ── Stable IDs (must not change between re-runs or Anki will duplicate) ──
MODEL_ID = 1987654321
DECK_ID  = 1234567890

# ── Card model with styled HTML template ────────────────────────────────
model = genanki.Model(
    MODEL_ID,
    "MHN Quick Reference",
    fields=[
        {"name": "Front"},
        {"name": "Back"},
        {"name": "Tag"},
    ],
    templates=[{
        "name": "Card 1",
        "qfmt": """
<div class="card-wrap">
  <div class="tag-pill">{{Tag}}</div>
  <div class="question">{{Front}}</div>
</div>
""",
        "afmt": """
<div class="card-wrap">
  <div class="tag-pill">{{Tag}}</div>
  <div class="question">{{Front}}</div>
  <hr class="divider">
  <div class="answer">{{Back}}</div>
</div>
""",
    }],
    css="""
.card {
  font-family: 'Segoe UI', Arial, sans-serif;
  background: #f8f9fa;
  min-height: 100%;
  padding: 0;
  margin: 0;
}
.card-wrap {
  max-width: 680px;
  margin: 16px auto;
  background: #ffffff;
  border-radius: 12px;
  box-shadow: 0 2px 12px rgba(0,0,0,0.10);
  padding: 20px 24px 24px 24px;
}
.tag-pill {
  display: inline-block;
  background: #1A3A5C;
  color: #ffffff;
  font-size: 11px;
  font-weight: 700;
  letter-spacing: 0.8px;
  text-transform: uppercase;
  border-radius: 20px;
  padding: 3px 12px;
  margin-bottom: 14px;
}
.question {
  font-size: 18px;
  font-weight: 600;
  color: #1A3A5C;
  line-height: 1.5;
  margin-bottom: 4px;
}
.divider {
  border: none;
  border-top: 2px solid #007B8A;
  margin: 16px 0;
}
.answer {
  font-size: 15px;
  color: #2c3e50;
  line-height: 1.7;
}
.answer b {
  color: #007B8A;
}
.answer .red   { color: #C0392B; font-weight: bold; }
.answer .green { color: #1E7E4A; font-weight: bold; }
.answer .amber { color: #E8A020; font-weight: bold; }
table.fl { border-collapse: collapse; width: 100%; font-size: 13px; margin-top: 6px; }
table.fl th { background: #1A3A5C; color: white; padding: 4px 8px; text-align: left; }
table.fl td { border: 1px solid #ddd; padding: 4px 8px; vertical-align: top; }
table.fl tr:nth-child(even) td { background: #f2f3f4; }
ul.ans { margin: 6px 0 0 0; padding-left: 18px; }
ul.ans li { margin-bottom: 4px; }
"""
)

# ── Deck ────────────────────────────────────────────────────────────────
deck = genanki.Deck(DECK_ID, "Mental Health Nursing :: Quick Reference")

def card(front, back, tag):
    return genanki.Note(
        model=model,
        fields=[front, back, tag],
        tags=[tag.replace(" ", "_").replace("/", "_")]
    )

# ════════════════════════════════════════════════════════════════════════
# CARDS DATA
# Each tuple: (front, back, tag)
# ════════════════════════════════════════════════════════════════════════

cards = []

# ── SECTION 1: FOUNDATIONS ───────────────────────────────────────────────
T = "1. Foundations"
cards += [
card("What is the WHO definition of <b>Mental Health</b>?",
     "A state of <b>well-being</b> in which an individual realises their abilities, can cope with normal life stresses, works productively, and contributes to the community.",
     T),

card("What is <b>Psychiatric Nursing</b>?",
     "A specialised area of nursing that uses <b>theories of human behaviour</b> as its science and the <b>purposeful use of self</b> as its art.",
     T),

card("Who was <b>Philippe Pinel</b> and what did he do?",
     "French psychiatrist (1793) who <b>removed chains</b> from mentally ill patients in Paris — founding 'moral treatment' and humane psychiatric care.",
     T),

card("Who is considered the <b>first psychiatric nurse</b> in the USA?",
     "<b>Linda Richards</b> (1882) — established the first psychiatric nursing training programme.",
     T),

card("List the <b>3 levels of consciousness</b> according to Freud.",
     "<b>Conscious</b> — currently aware<br><b>Preconscious</b> — accessible with effort<br><b>Unconscious</b> — hidden; contains repressed material",
     T),

card("What are Freud's <b>3 structural components</b> of the mind?",
     "<b>Id</b> — pleasure principle; primitive drives; unconscious<br><b>Ego</b> — reality principle; mediates id/superego<br><b>Superego</b> — moral conscience; internalized parental rules",
     T),

card("What is <b>Maslow's Hierarchy of Needs</b> in order (base to top)?",
     "1. Physiological → 2. Safety → 3. Love/Belonging → 4. Esteem → 5. <b>Self-Actualisation</b>",
     T),

card("What are the <b>3 stages of GAS</b> (Selye's General Adaptation Syndrome)?",
     "1. <b>Alarm</b> — fight-or-flight; cortisol/adrenaline surge<br>2. <b>Resistance</b> — body adapts; sustained cortisol<br>3. <b>Exhaustion</b> — adaptive capacity depleted; disease risk",
     T),

card("What is the difference between <b>mood</b> and <b>affect</b> in the MSE?",
     "<b>Mood</b> = patient's <i>subjective</i> emotional state (what they <b>say</b> they feel)<br><b>Affect</b> = <i>observed</i> emotional expression (what you <b>see</b>)",
     T),

card("What does <b>ADPIE</b> stand for in the nursing process?",
     "<b>A</b>ssessment → <b>D</b>iagnosis → <b>P</b>lanning → <b>I</b>mplementation → <b>E</b>valuation",
     T),

card("Name the <b>4 phases of Peplau's therapeutic relationship</b>.",
     "1. <b>Pre-interaction</b> — nurse self-reflection before meeting<br>2. <b>Orientation</b> — trust building; identify needs<br>3. <b>Working</b> — active problem-solving (most therapeutic)<br>4. <b>Termination</b> — closure; review progress",
     T),

card("What is <b>transference</b> vs <b>countertransference</b>?",
     "<b>Transference</b>: Client projects feelings from <i>past relationships</i> onto the nurse<br><b>Countertransference</b>: Nurse projects <i>personal feelings</i> onto the client — must be recognised and managed",
     T),

card("What is <b>empathy</b> (vs sympathy) in therapeutic nursing?",
     "<b>Empathy</b>: Understanding the client's experience <i>without taking it on</i><br><b>Sympathy</b>: Sharing/feeling the client's emotions — less therapeutic; can blur professional boundaries",
     T),
]

# ── SECTION 2: DEFENSE MECHANISMS ───────────────────────────────────────
T = "2. Defense Mechanisms"
cards += [
card("What is <b>Repression</b>? What level of defense is it?",
     "<b>Repression</b>: Unconscious exclusion of anxiety-provoking thoughts from awareness<br>Example: Forgetting childhood abuse<br>Level: <b>Neurotic</b>",
     T),

card("What is the difference between <b>Repression</b> and <b>Suppression</b>?",
     "<b>Repression</b>: <i>Unconscious</i> — the person has no awareness of pushing the thought away<br><b>Suppression</b>: <i>Conscious</i> — deliberate deferral ('I'll deal with it later') — this is a <b>MATURE</b> defense",
     T),

card("What is <b>Projection</b>? Give an example.",
     "Attributing one's own <b>unacceptable feelings</b> to another person<br>Example: 'She hates me' (when in fact <i>I</i> hate her)<br>Level: <b>Primitive</b>",
     T),

card("What is <b>Reaction Formation</b>?",
     "Adopting the <b>opposite</b> feeling/behaviour to an unacceptable impulse<br>Example: Being overly kind to someone you intensely dislike<br>Level: <b>Neurotic</b>",
     T),

card("What is <b>Sublimation</b> and why is it considered mature?",
     "Channeling unacceptable impulses into <b>socially acceptable activity</b><br>Example: Aggression → boxing or surgery<br>It is <b>mature</b> because energy is redirected productively without distortion of reality",
     T),

card("What is <b>Splitting</b>? Which personality disorder is it most associated with?",
     "Viewing people as either <b>all-good or all-bad</b> — inability to integrate ambivalence<br>Most associated with <b>Borderline Personality Disorder (BPD)</b><br>Level: <b>Primitive</b>",
     T),

card("What is <b>Displacement</b>?",
     "Redirecting an emotion from the original threatening target to a <b>safer substitute</b><br>Example: Angry at boss → kicks door at home<br>Level: <b>Neurotic</b>",
     T),

card("What is <b>Rationalization</b>?",
     "Providing a <b>logical-sounding but false</b> excuse for unacceptable behaviour<br>Example: 'I drink to relax and cope with stress'<br>Level: <b>Neurotic</b>",
     T),

card("Name the <b>4 mature defense mechanisms</b>.",
     "1. <b>Sublimation</b><br>2. <b>Altruism</b><br>3. <b>Humor</b><br>4. <b>Suppression</b>",
     T),

card("What is <b>Undoing</b>?",
     "An act performed to <b>symbolically neutralise</b> a previous unacceptable thought or action<br>Example: Obsessive hand-washing after 'impure' thoughts<br>Level: <b>Neurotic</b>",
     T),
]

# ── SECTION 3: THERAPEUTIC COMMUNICATION ────────────────────────────────
T = "3. Therapeutic Communication"
cards += [
card("What is the therapeutic technique of <b>Reflection</b>?",
     "Returning the client's <b>feelings</b> back to them so they can examine their own emotional experience<br>Example: <i>'You sound really angry about what happened.'</i>",
     T),

card("Why is <b>giving false reassurance</b> non-therapeutic?",
     "Statements like <i>'Everything will be fine'</i> <b>dismiss</b> the client's feelings and are not based in reality — they close down communication and undermine trust",
     T),

card("What is the difference between <b>clarification</b> and <b>restatement</b>?",
     "<b>Restatement</b>: Repeating key words to show you're listening — <i>'You can't sleep?'</i><br><b>Clarification</b>: Seeking understanding of an ambiguous message — <i>'I'm not sure I understand, can you explain?'</i>",
     T),

card("Why should nurses avoid <b>giving advice</b> to psychiatric patients?",
     "Giving advice <b>undermines patient autonomy</b>, implies the nurse knows better, and fosters dependence rather than empowering the client to problem-solve",
     T),

card("How should a nurse use <b>therapeutic silence</b>?",
     "Allow a comfortable pause after a difficult statement — gives the client <b>time to think and feel</b> without pressure. Maintain attentive body language. Do NOT fill silence with reassurances or topic changes.",
     T),

card("What is the purpose of <b>open-ended questions</b> in therapeutic communication?",
     "They <b>encourage elaboration</b> and allow the client to direct the conversation in any direction<br>Example: <i>'Tell me more about that...'</i> vs closed: <i>'Are you feeling sad?'</i>",
     T),

card("What is the <b>working phase</b> of the therapeutic relationship characterised by?",
     "The <b>most active therapeutic phase</b> — client uses nurse as resource; active problem-solving occurs; transference and countertransference may emerge; nurse implements planned interventions",
     T),
]

# ── SECTION 4: ERIKSON ───────────────────────────────────────────────────
T = "4. Erikson's Stages"
cards += [
card("What is Erikson's Stage 1, and what disorders result from failure?",
     "<b>Trust vs Mistrust</b> (0–18 months)<br>Virtue: Hope<br>Failure → <b>Schizoid/paranoid traits</b>, substance use, dysthymia, hopelessness — 'basic mistrust is a significant contributor to schizophrenia' (Kaplan & Sadock)",
     T),

card("What is Erikson's Stage 2, and what disorders result from failure?",
     "<b>Autonomy vs Shame & Doubt</b> (18 mo–3 yr)<br>Virtue: Will<br>Failure → <b>OCD traits</b>, compulsive doubting, impulsivity, anal personality (3 P's: parsimonious, punctual, perfectionistic)",
     T),

card("What is Erikson's Stage 3, and what disorders result from failure?",
     "<b>Initiative vs Guilt</b> (3–6 yr)<br>Virtue: Purpose<br>Failure → <b>Anxiety disorders</b>, phobias, conversion disorder, psychosomatic illness, sexual inhibitions",
     T),

card("What is Erikson's Stage 5, and what is the failure outcome?",
     "<b>Identity vs Role Confusion</b> (12–20 yr)<br>Virtue: Fidelity<br>Failure → <b>Identity disorders</b>, delinquency, role diffusion",
     T),

card("What virtue is associated with Erikson's Stage 8 (Integrity vs Despair)?",
     "<b>Wisdom</b><br>Failure at this stage → Depression, hopelessness, bitterness, sense that life was wasted",
     T),
]

# ── SECTION 5-6: SCHIZOPHRENIA ───────────────────────────────────────────
T = "5. Schizophrenia"
cards += [
card("What are the <b>DSM-5 diagnostic criteria</b> for Schizophrenia?",
     "≥<b>2</b> of the following for ≥<b>1 month</b> (must include ≥1 of #1–3):<br>1. Delusions<br>2. Hallucinations<br>3. Disorganised speech<br>4. Disorganised/catatonic behaviour<br>5. Negative symptoms<br>Plus: impairment ≥<b>6 months</b>",
     T),

card("Name the <b>5 A's</b> — negative symptoms of schizophrenia.",
     "<b>A</b>logia — poverty of speech<br><b>A</b>volition — lack of motivation<br><b>A</b>nhedonia — inability to experience pleasure<br><b>A</b>ffective flattening — reduced emotional expression<br><b>A</b>sociality — social withdrawal",
     T),

card("Which type of <b>hallucination</b> is most common in schizophrenia?",
     "<b>Auditory hallucinations</b> — most commonly voices commenting on behaviour or giving commands.<br>Visual hallucinations are more common in <i>delirium/organic</i> conditions.",
     T),

card("Which type of <b>delusion</b> is most common in schizophrenia?",
     "<b>Persecutory delusions</b> — fixed false belief that others are plotting against, spying on, or trying to harm the patient",
     T),

card("Explain the <b>Dopamine Hypothesis</b> of schizophrenia.",
     "<b>Mesolimbic</b> pathway (↑ dopamine) → <b>positive symptoms</b><br><b>Mesocortical</b> pathway (↓ dopamine) → <b>negative/cognitive symptoms</b><br>Antipsychotics block D2 receptors in the mesolimbic pathway",
     T),

card("What are the <b>4 phases</b> of schizophrenia?",
     "1. <b>Premorbid</b> — subtle deficits before illness<br>2. <b>Prodromal</b> — deterioration, withdrawal (weeks to years before psychosis)<br>3. <b>Active/Psychotic</b> — florid positive symptoms<br>4. <b>Residual</b> — negative symptoms predominate",
     T),

card("How should a nurse respond to a patient's <b>delusions</b>?",
     "<b>Do NOT argue or reinforce</b> the delusion<br>Acknowledge without confirming: <i>'I don't share that belief, but I hear that it feels very real to you.'</i><br>Remain calm, consistent, non-confrontational",
     T),

card("Why is assessing for <b>command hallucinations</b> a priority safety concern?",
     "Command hallucinations instruct the patient to harm <b>themselves or others</b> — they carry high risk of violence/suicide. Always assess: <i>'Do the voices tell you to do anything?'</i>",
     T),

card("What is <b>Expressed Emotion (EE)</b> and why is it important in schizophrenia?",
     "High EE in families = high <b>criticism, hostility, and over-involvement</b><br>High EE significantly <b>increases relapse rates</b> in schizophrenia<br>Family psychoeducation aims to reduce EE",
     T),
]

# ── SECTION 7: MOOD DISORDERS ────────────────────────────────────────────
T = "6. Mood Disorders"
cards += [
card("What does <b>SIG E CAPS</b> stand for? (Depression mnemonic)",
     "<b>S</b>leep disturbance<br><b>I</b>nterest loss (anhedonia)<br><b>G</b>uilt / worthlessness<br><b>E</b>nergy loss<br><b>C</b>oncentration problems<br><b>A</b>ppetite change<br><b>P</b>sychomotor agitation or retardation<br><b>S</b>uicidal ideation<br><i>Plus: depressed mood — required for diagnosis</i>",
     T),

card("What are the <b>DSM-5 criteria</b> for Major Depressive Disorder?",
     "≥<b>5</b> SIG E CAPS symptoms for ≥<b>2 weeks</b>, causing significant impairment<br>Must include <b>depressed mood</b> OR <b>anhedonia</b> (at least one)",
     T),

card("What does <b>DIG FAST</b> stand for? (Mania mnemonic)",
     "<b>D</b>istractibility<br><b>I</b>mpulsivity/Irresponsibility<br><b>G</b>randiosity<br><b>F</b>light of ideas<br><b>A</b>ctivity ↑ / Agitation<br><b>S</b>leep decreased (no fatigue)<br><b>T</b>alkativeness / pressured speech",
     T),

card("What is the difference between <b>Bipolar I</b> and <b>Bipolar II</b>?",
     "<b>Bipolar I</b>: ≥1 full <b>manic</b> episode (depressive episodes may occur)<br><b>Bipolar II</b>: <b>Hypomanic</b> + major depressive episodes — <i>NO</i> full manic episode<br><b>Cyclothymia</b>: Subsyndromal highs and lows ≥2 years",
     T),

card("What are the features of <b>melancholic</b> specifier in depression?",
     "Worse in <b>morning</b>, early morning awakening, severe anhedonia (no mood reactivity), excessive guilt, psychomotor changes, significant weight/appetite loss",
     T),

card("What are the features of <b>atypical</b> specifier in depression?",
     "<b>Mood reactivity</b> (mood brightens to positive events) PLUS ≥2 of:<br>Hypersomnia, increased appetite/weight gain, <b>leaden paralysis</b>, rejection sensitivity",
     T),

card("When is suicide risk <b>highest</b> in a depressed patient? Why?",
     "When the patient begins to <b>IMPROVE</b> from severe depression — they now have enough <b>energy</b> to act on their suicidal ideation, whereas previously they were too psychomotorically retarded",
     T),

card("What is the <b>therapeutic lithium level</b> for maintenance and acute mania?",
     "Maintenance: <b>0.6–1.2 mEq/L</b><br>Acute mania: <b>0.8–1.2 mEq/L</b><br>Toxic: >1.5 mEq/L",
     T),

card("What are the signs of <b>lithium toxicity</b> at different levels?",
     "1.5–2.0: Nausea, vomiting, diarrhoea, <b>coarse tremor</b>, drowsiness<br>2.0–2.5: Confusion, <b>ataxia</b>, dysarthria, muscle twitching<br>>2.5: <b>Seizures, coma, cardiac arrhythmias, death</b>",
     T),

card("What drugs can <b>increase lithium levels</b> dangerously?",
     "<b>NSAIDs</b> (ibuprofen, diclofenac) — reduce renal prostaglandins → ↓ lithium excretion<br><b>ACE inhibitors / ARBs</b> — reduce renal blood flow<br><b>Thiazide diuretics</b> — increase reabsorption<br><b>Dehydration / low-sodium diet</b>",
     T),

card("What 3 parameters must be monitored for lithium therapy?",
     "1. <b>Serum lithium level</b> (draw 12h after last dose)<br>2. <b>Renal function</b> (BUN, creatinine — lithium is renally excreted)<br>3. <b>Thyroid function</b> (lithium can cause hypothyroidism)",
     T),

card("What is the nursing priority for a <b>manic patient</b> who won't eat?",
     "Provide <b>high-calorie finger foods and drinks</b> the patient can consume while moving around — they are too distracted/hyperactive to sit for meals. Monitor nutrition and hydration carefully.",
     T),
]

# ── SECTION 8: ANXIETY & OCD ─────────────────────────────────────────────
T = "7. Anxiety & OCD"
cards += [
card("What are Peplau's <b>4 levels of anxiety</b> and their effects?",
     "<b>Mild</b>: Increased alertness; learning enhanced<br><b>Moderate</b>: Narrowed perception; physical symptoms (HA, tachycardia)<br><b>Severe</b>: Distorted perception; cannot problem-solve<br><b>Panic</b>: Terror; disorganised thinking; possible violence/flight",
     T),

card("What is the nursing response to a patient in <b>panic-level anxiety</b>?",
     "<span class='red'>DO NOT leave the patient</span><br>Calm, quiet presence; reduce stimulation<br>Slow, simple, short sentences<br>Guide slow breathing<br>Administer PRN anxiolytic as ordered<br>Stay until anxiety decreases",
     T),

card("What is the difference between <b>obsessions</b> and <b>compulsions</b> in OCD?",
     "<b>Obsessions</b>: Recurrent, intrusive, unwanted <i>thoughts</i> (contamination, harm, symmetry) — ego-dystonic<br><b>Compulsions</b>: Repetitive <i>behaviours/mental acts</i> to neutralise obsession anxiety (washing, checking, counting)",
     T),

card("What is the <b>first-line psychotherapy</b> for OCD?",
     "<b>Cognitive Behavioural Therapy with Exposure and Response Prevention (CBT-ERP)</b><br>Patient is gradually exposed to feared stimuli and <i>prevented</i> from performing the compulsion — anxiety extinguishes over time",
     T),

card("Should a nurse <b>interrupt OCD rituals</b> abruptly? Why?",
     "<b>No</b> — abruptly interrupting a ritual causes <b>severe anxiety spikes</b><br>Allow ritual, then <b>gradually delay</b> and reduce ritual time using a collaborative plan with the patient",
     T),

card("What are the <b>DSM-5 criteria for GAD</b>?",
     "Excessive, <b>uncontrollable</b> worry about multiple domains for ≥<b>6 months</b>, plus ≥3 of: restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disturbance",
     T),
]

# ── SECTION 9: PTSD ──────────────────────────────────────────────────────
T = "8. PTSD & Trauma"
cards += [
card("What are the <b>4 DSM-5 symptom clusters</b> of PTSD?",
     "<b>B — Intrusion</b>: Flashbacks, nightmares, intrusive memories<br><b>C — Avoidance</b>: Avoiding reminders (thoughts, places, people)<br><b>D — Negative Cognitions/Mood</b>: Guilt, numbing, detachment<br><b>E — Hyperarousal</b>: Hypervigilance, startle, irritability, sleep disturbance",
     T),

card("What is the difference between <b>PTSD</b> and <b>Acute Stress Disorder</b>?",
     "<b>Acute Stress Disorder</b>: Same symptom clusters but duration <b>3 days – 1 month</b> after trauma<br><b>PTSD</b>: Symptoms persist <b>>1 month</b>",
     T),

card("What is the <b>5-4-3-2-1 grounding technique</b>?",
     "Sensory grounding to reduce dissociation/flashbacks:<br>Name <b>5</b> things you see<br>Name <b>4</b> things you feel (touch)<br>Name <b>3</b> things you hear<br>Name <b>2</b> things you smell<br>Name <b>1</b> thing you taste",
     T),

card("What is <b>EMDR</b> and what is it used for?",
     "<b>Eye Movement Desensitisation and Reprocessing</b><br>Evidence-based therapy for PTSD — patient recalls traumatic memory while following therapist's finger movements<br>Reduces emotional distress linked to the memory",
     T),

card("What does <b>trauma-informed care</b> mean in nursing practice?",
     "Approach that recognises widespread impact of trauma and integrates trauma knowledge into care:<br>• Ensure <b>safety</b> first<br>• Never re-traumatise (avoid forced disclosure)<br>• Ask permission before touching<br>• Validate responses as normal reactions to abnormal events",
     T),
]

# ── SECTION 10: PERSONALITY DISORDERS ───────────────────────────────────
T = "9. Personality Disorders"
cards += [
card("What are the <b>3 Clusters</b> of personality disorders?",
     "<b>Cluster A</b> — Odd/Eccentric: Paranoid, Schizoid, Schizotypal<br><b>Cluster B</b> — Dramatic/Emotional: Antisocial, Borderline, Histrionic, Narcissistic<br><b>Cluster C</b> — Anxious/Fearful: Avoidant, Dependent, OCPD",
     T),

card("What are the key features of <b>Borderline Personality Disorder (BPD)</b>?",
     "• Instability in <b>relationships, self-image, affect</b><br>• Impulsivity<br>• <b>Splitting</b> (all-good/all-bad)<br>• Chronic feelings of emptiness<br>• <b>Self-harm</b> / suicidal behaviour<br>• Frantic efforts to avoid abandonment<br>• Identity disturbance",
     T),

card("What is the nursing priority when caring for a patient with <b>BPD and splitting</b>?",
     "<b>Consistent team communication</b> — all staff present the same approach/limits to prevent staff being split into 'good' and 'bad'<br>Regularly scheduled staff meetings and care-plan consistency are essential",
     T),

card("What is <b>DBT</b> and for which disorder is it first-line?",
     "<b>Dialectical Behaviour Therapy</b> (Marsha Linehan)<br>First-line for <b>BPD</b><br>4 modules: <b>Mindfulness</b> | <b>Distress Tolerance</b> | <b>Emotional Regulation</b> | <b>Interpersonal Effectiveness</b>",
     T),

card("What distinguishes <b>Antisocial PD</b> from other personality disorders in nursing approach?",
     "Patients may attempt to <b>manipulate</b> staff and other patients<br>Nursing response: <b>Firm, consistent limits</b>; document behaviour objectively; be alert to safety of others; avoid power struggles; do not take manipulation personally",
     T),

card("What is the key difference between <b>OCD</b> and <b>OCPD</b>?",
     "<b>OCD</b>: <i>Ego-dystonic</i> — patient finds obsessions/compulsions distressing and unwanted<br><b>OCPD</b>: <i>Ego-syntonic</i> — patient sees their perfectionism/orderliness as <i>correct</i> and desirable",
     T),
]

# ── SECTION 11: ANTIPSYCHOTICS ───────────────────────────────────────────
T = "10. Antipsychotics"
cards += [
card("What is the mechanism of <b>first-generation (typical)</b> antipsychotics?",
     "Dopamine <b>D2 receptor blockade</b> in mesolimbic pathway<br>Effective against <b>positive symptoms only</b><br>Examples: Haloperidol, Chlorpromazine, Fluphenazine",
     T),

card("What is the mechanism of <b>second-generation (atypical)</b> antipsychotics?",
     "<b>D2 + 5-HT2A</b> (serotonin-dopamine) receptor blockade<br>Effective against <b>positive AND negative symptoms</b><br>Examples: Clozapine, Olanzapine, Risperidone, Quetiapine, Aripiprazole",
     T),

card("Why does <b>Clozapine</b> require weekly WBC monitoring?",
     "Risk of <b>agranulocytosis</b> (1–2%) — life-threatening drop in neutrophils<br>Protocol: Weekly WBC for 6 months → fortnightly for 6 months → monthly thereafter<br><span class='red'>HOLD if ANC <1000 — do not restart without haematology review</span>",
     T),

card("What are the <b>metabolic side effects</b> of atypical antipsychotics, especially Olanzapine?",
     "• <b>Weight gain</b> (most with Olanzapine, Clozapine)<br>• <b>Hyperglycaemia / Type 2 diabetes</b><br>• <b>Hyperlipidaemia</b><br>Monitor: BMI, fasting glucose, lipid panel at baseline and regularly",
     T),

card("What is <b>Tardive Dyskinesia</b>? How is it managed?",
     "Involuntary, repetitive movements of <b>mouth, lips, tongue</b> (also limbs/trunk) after long-term antipsychotic use<br>May be <b>irreversible</b><br>Prevention: Lowest effective dose; regular AIMS assessment<br>Treatment: <b>Valbenazine</b> or Deutetrabenazine; switch to lower-EPS drug",
     T),

card("What is <b>Akathisia</b> and why is it particularly distressing?",
     "Intense subjective <b>restlessness</b> — patient cannot sit still; pacing, shifting<br>Most <b>distressing</b> EPS — linked to <b>non-adherence</b> and even suicide<br>Treatment: Reduce dose; <b>Propranolol</b>; Benzodiazepine; switch drug",
     T),

card("What is <b>Acute Dystonia</b> and how is it treated?",
     "Sudden, sustained <b>muscle spasm</b>: torticollis (neck), oculogyric crisis (eyes), tongue, jaw<br>Onset: Hours to days after starting antipsychotic<br><span class='green'>Treatment: IM/IV <b>Benztropine</b> or IM <b>Diphenhydramine</b> — relief within minutes</span>",
     T),

card("What is <b>NMS</b> and how do you remember it?",
     "<b>Neuroleptic Malignant Syndrome</b> — medical emergency caused by antipsychotics<br>Mnemonic <b>FALTER</b>: <b>F</b>ever (high) | <b>A</b>utonomic instability | <b>L</b>ead-pipe Rigidity | <b>T</b>achycardia | <b>E</b>levated CK | <b>R</b>educed consciousness<br><span class='red'>STOP antipsychotic IMMEDIATELY → ICU → Dantrolene + Bromocriptine</span>",
     T),

card("What are <b>anticholinergic side effects</b> of antipsychotics? (mnemonic)",
     "<i>'Dry as a bone, blind as a bat, red as a beet, hot as a hare, mad as a hatter'</i><br>= <b>Dry mouth</b>, blurred vision, flushing, hyperthermia, delirium/confusion<br>Also: urinary retention, constipation, tachycardia",
     T),

card("What is unique about <b>Aripiprazole</b> among atypical antipsychotics?",
     "<b>Partial D2 agonist</b> (not pure antagonist)<br>Lowest metabolic side effects / minimal weight gain<br>Activating (not sedating)<br>No QTc prolongation",
     T),
]

# ── SECTION 12: ANTIDEPRESSANTS ──────────────────────────────────────────
T = "11. Antidepressants"
cards += [
card("What is the <b>first-line pharmacotherapy</b> for depression and how long until effect?",
     "<b>SSRIs</b> (Selective Serotonin Reuptake Inhibitors)<br>Examples: Fluoxetine, Sertraline, Escitalopram<br>Therapeutic onset: <b>2–4 weeks</b><br>Nurse must educate patient not to stop early due to perceived lack of effect",
     T),

card("What is the <b>Tyramine (Cheese) Reaction</b> with MAOIs?",
     "MAOIs block breakdown of tyramine in gut → excess tyramine → <b>hypertensive crisis</b><br>Avoid: Aged cheeses, red wine, cured meats, fermented foods, beer<br>Emergency: Monitor BP; treat with <b>phentolamine</b> (alpha-blocker)",
     T),

card("Why are <b>TCAs dangerous in overdose</b>?",
     "TCAs cause <b>QRS widening</b> → ventricular arrhythmias → cardiac arrest<br>Also: Anticholinergic toxidrome, seizures, hypotension<br>Minimum lethal dose can be close to therapeutic dose — <span class='red'>never prescribe large quantities to suicidal patients</span>",
     T),

card("What is <b>Serotonin Syndrome</b>? How does it differ from NMS?",
     "<table class='fl'><tr><th>Feature</th><th>Serotonin Syn.</th><th>NMS</th></tr><tr><td>Cause</td><td>Serotonergic excess</td><td>Antipsychotic</td></tr><tr><td>Onset</td><td>Rapid (hours)</td><td>Slow (days)</td></tr><tr><td>Muscles</td><td>Myoclonus, clonus</td><td>Lead-pipe rigidity</td></tr><tr><td>GI</td><td>Diarrhoea</td><td>Absent</td></tr><tr><td>Rx</td><td>Cyproheptadine</td><td>Dantrolene</td></tr></table>",
     T),

card("What is <b>SIADH</b> as an SSRI side effect?",
     "Syndrome of Inappropriate Antidiuretic Hormone secretion → <b>hyponatraemia</b><br>Risk: Elderly patients especially<br>Symptoms: Confusion, nausea, headache, seizures in severe cases<br>Monitor: Serum sodium, especially in first weeks of therapy",
     T),

card("What is <b>Lamotrigine</b> used for and what is its dangerous side effect?",
     "Most effective mood stabiliser for <b>bipolar depression</b><br>Dangerous: <b>Stevens-Johnson Syndrome</b> (life-threatening mucocutaneous rash)<br>Prevention: Very <b>slow titration</b> — any rash must be evaluated immediately",
     T),

card("What is the risk of <b>Valproate</b> in women of childbearing age?",
     "Highly <b>teratogenic</b> — causes <b>neural tube defects</b> (spina bifida)<br>Also: Polycystic ovary syndrome, weight gain, hair loss, hepatotoxicity, thrombocytopenia<br>Requires counselling and contraception in women of childbearing age",
     T),
]

# ── SECTION 13: ANXIOLYTICS & ECT ───────────────────────────────────────
T = "12. Anxiolytics & ECT"
cards += [
card("What is the mechanism of <b>benzodiazepines</b>?",
     "Enhance the effect of <b>GABA</b> (inhibitory neurotransmitter) at <b>GABA-A receptors</b> → CNS depression<br>Reversal agent: <b>Flumazenil</b>",
     T),

card("What are the dangers of <b>abrupt benzodiazepine withdrawal</b>?",
     "Physical dependence develops with regular use<br>Abrupt withdrawal → tremors, sweating, tachycardia, psychosis, and <span class='red'><b>SEIZURES</b> (potentially fatal)</span><br>Always taper doses gradually",
     T),

card("How does <b>Buspirone</b> differ from benzodiazepines?",
     "Mechanism: 5-HT1A <b>partial agonist</b><br><b>No</b> abuse potential | <b>No</b> sedation | <b>No</b> withdrawal | <b>No</b> immediate effect<br>Onset: <b>1–2 weeks</b> — not suitable for acute anxiety<br>Best for: GAD long-term management",
     T),

card("What are the <b>indications for ECT</b>?",
     "• Severe depression unresponsive to medications<br>• Imminent <b>suicide risk</b> requiring rapid response<br>• Severe mania<br>• <b>Catatonia</b><br>• Depression in <b>pregnancy</b> (when medications contraindicated)<br>• Treatment-resistant schizophrenia",
     T),

card("What is the most significant <b>side effect of ECT</b>?",
     "<b>Short-term memory loss</b> — both anterograde and retrograde<br>Usually temporary and resolves over weeks<br>Nurse must: Reassure patient, reorient post-procedure, document baseline memory",
     T),

card("What are the <b>pre-ECT nursing responsibilities</b>?",
     "• Obtain <b>informed consent</b><br>• NPO for <b>6–8 hours</b><br>• Remove metal objects, dentures, hairpins, nail polish<br>• Baseline vitals + neuro assessment<br>• IV access<br>• Empty bladder<br>• Administer prescribed pre-medications (atropine)",
     T),

card("What are <b>post-ECT nursing priorities</b>?",
     "• Monitor vitals until stable<br>• <b>Reorient patient</b> — confusion is EXPECTED and normal post-ictally<br>• Assess memory<br>• Manage headache/nausea<br>• <span class='red'>Do NOT allow driving or important decisions</span><br>• Reassure patient about memory loss",
     T),
]

# ── SECTION 14: SUICIDE ──────────────────────────────────────────────────
T = "13. Suicide & Safety"
cards += [
card("What is the <b>single strongest predictor</b> of future suicide attempt?",
     "<b>Previous suicide attempt</b><br>Other strong predictors: Hopelessness (Beck's scale), specific plan with lethal means, male sex, mental illness (depression, schizophrenia, BPD, substance use)",
     T),

card("Is it safe to ask a patient directly about <b>suicidal ideation</b>?",
     "<b>YES</b> — asking directly about suicide does <b>NOT</b> increase risk<br>It opens communication, shows you take them seriously, and allows accurate assessment<br>Always use direct language: <i>'Are you thinking about killing yourself?'</i>",
     T),

card("What does <b>CAGE</b> stand for? What score is clinically significant?",
     "<b>C</b>ut down — ever felt you should?<br><b>A</b>nnoyed — by criticism of drinking?<br><b>G</b>uilty — about drinking?<br><b>E</b>ye-opener — drink first thing in morning?<br>Score ≥<b>2</b> = probable alcoholism",
     T),

card("What are the <b>10 priority nursing interventions</b> for a suicidal patient?",
     "1. Ask directly<br>2. Assess plan/means/intent<br>3. <b>Remove lethal means</b><br>4. <b>1:1 observation</b><br>5. Document<br>6. Safety planning<br>7. Therapeutic milieu<br>8. Medications as ordered<br>9. Family involvement (with consent)<br>10. Discharge follow-up before leaving",
     T),

card("What is the <b>Stanley-Brown Safety Planning</b> model?",
     "Collaborative 6-step plan:<br>1. Warning signs<br>2. Internal coping strategies<br>3. Social contacts for distraction<br>4. People to ask for help<br>5. Professionals/crisis lines<br>6. <b>Means restriction</b>",
     T),

card("Which gender has higher <b>suicide completion rate</b> vs attempt rate?",
     "<b>Males</b>: Higher <b>completion rate</b> (use more lethal means)<br><b>Females</b>: Higher <b>attempt rate</b> (tend to use less immediately lethal methods)<br>Elderly males have the highest completion rate of any demographic",
     T),
]

# ── SECTION 15: SUBSTANCE USE ────────────────────────────────────────────
T = "14. Substance Use"
cards += [
card("What are the <b>6 Stages of Change</b> (Prochaska & DiClemente)?",
     "1. <b>Precontemplation</b> — not considering change<br>2. <b>Contemplation</b> — considering; ambivalent<br>3. <b>Preparation</b> — planning to change soon<br>4. <b>Action</b> — actively changing<br>5. <b>Maintenance</b> — sustaining change<br>6. <b>Relapse</b> — normal part of recovery, not failure",
     T),

card("What is <b>Motivational Interviewing (MI)</b>? What are the OARS skills?",
     "Client-centred technique to enhance motivation for change<br><b>O</b>pen-ended questions<br><b>A</b>ffirmations<br><b>R</b>eflective listening<br><b>S</b>ummarizing",
     T),

card("What is the timeline of <b>alcohol withdrawal</b> complications?",
     "6–24h: Tremors, diaphoresis, anxiety, tachycardia<br>24–48h: <b>Grand mal seizures</b> (peak risk)<br>48–72h: <b>Delirium Tremens (DTs)</b> — confusion, agitation, visual hallucinations, autonomic instability<br>Untreated DT mortality: <b>5–15%</b>",
     T),

card("Why must <b>Thiamine</b> be given BEFORE glucose in alcohol withdrawal?",
     "Thiamine (Vitamin B1) deficiency + glucose load → precipitates <b>Wernicke's Encephalopathy</b> (confusion, ataxia, ophthalmoplegia)<br>If untreated → <b>Korsakoff's psychosis</b> (irreversible memory disorder)<br><span class='red'>Always give IV Thiamine FIRST</span>",
     T),

card("What is <b>Delirium Tremens (DTs)</b>? How is it treated?",
     "Medical emergency of severe alcohol withdrawal (48–72h):<br>Severe autonomic instability, hyperthermia, confusion, agitation, <b>visual hallucinations</b> (classically 'seeing bugs/animals')<br>Treatment: IV <b>Benzodiazepines</b> (CIWA-Ar protocol) + IV Thiamine + electrolyte replacement",
     T),

card("What is the <b>CIWA-Ar</b> protocol?",
     "<b>Clinical Institute Withdrawal Assessment for Alcohol revised</b><br>10-item scale rating severity of withdrawal symptoms (tremor, sweating, anxiety, agitation, etc.)<br>Score guides benzodiazepine dosing<br>Score >15 = severe withdrawal requiring IV treatment",
     T),
]

# ── SECTION 16: COMMUNITY / LEGAL ───────────────────────────────────────
T = "15. Community MH & Legal"
cards += [
card("What are <b>Caplan's 3 levels of prevention</b> in mental health?",
     "<b>Primary</b>: Reduce <i>incidence</i> — stress management, anti-stigma programmes<br><b>Secondary</b>: Early identification — screening, crisis hotlines<br><b>Tertiary</b>: Reduce <i>disability</i> — rehabilitation, relapse prevention, supported employment",
     T),

card("What are the <b>3 criteria</b> for involuntary psychiatric admission?",
     "1. <b>Danger to self</b> (suicidal)<br>2. <b>Danger to others</b> (homicidal)<br>3. <b>Gravely disabled</b> — unable to provide basic needs (food, clothing, shelter) due to mental illness",
     T),

card("What is the <b>Tarasoff Decision</b>?",
     "<b>Tarasoff v. Regents of UC (1976)</b><br>Mental health providers have a <b>legal duty to warn</b> identifiable potential victims of a patient's stated violent intent<br>This overrides confidentiality — nurse must report to supervisor/physician immediately",
     T),

card("What are the <b>4 elements of informed consent</b>?",
     "1. <b>Disclosure</b> — diagnosis, treatment, risks, benefits, alternatives<br>2. <b>Comprehension</b> — patient understands the information<br>3. <b>Voluntariness</b> — no coercion<br>4. <b>Competence</b> — legal capacity to consent",
     T),

card("When can <b>confidentiality</b> be broken without patient consent?",
     "1. Danger to self or others (Tarasoff)<br>2. Suspected <b>child or elder abuse</b><br>3. <b>Court order</b><br>4. Communicable disease reporting requirements",
     T),

card("What are <b>Roberts' 7 Stages</b> of crisis intervention?",
     "1. Plan & assess lethality/safety<br>2. Establish rapport<br>3. Identify major problems<br>4. Deal with feelings<br>5. Generate alternatives<br>6. Develop action plan<br>7. <b>Follow-up</b>",
     T),

card("How long does a <b>crisis</b> typically last, and what is the key nursing opportunity?",
     "Crises are <b>self-limiting</b> — usually resolve within <b>4–6 weeks</b><br>Key opportunity: People in crisis are <b>highly receptive to help</b> and intervention — best time for lasting change",
     T),
]

# ── SECTION 17: DELIRIUM vs DEMENTIA vs DEPRESSION ──────────────────────
T = "16. Delirium vs Dementia vs Depression"
cards += [
card("What is the key distinguishing feature of <b>delirium</b> vs dementia?",
     "<b>Delirium</b>: <i>Acute</i> onset (hours–days), <i>fluctuating</i> course, <b>impaired consciousness</b>, reversible with treatment of cause<br><b>Dementia</b>: <i>Gradual</i> onset (years), progressive, consciousness intact until late stage, <b>irreversible</b>",
     T),

card("What are the <b>4 main types of dementia</b>?",
     "<b>Alzheimer's</b> (most common): Amyloid plaques + neurofibrillary tangles; memory loss first<br><b>Vascular</b>: Step-wise progression post-strokes<br><b>Lewy Body</b>: Fluctuating cognition + visual hallucinations + parkinsonism<br><b>Frontotemporal</b>: Personality/behaviour changes, disinhibition first",
     T),

card("What is <b>Lewy Body Dementia</b> characterised by?",
     "Classic triad:<br>1. <b>Fluctuating cognition</b><br>2. <b>Vivid visual hallucinations</b><br>3. <b>Parkinsonism</b> (tremor, rigidity, bradykinesia)<br>Important: Antipsychotics can cause severe neuroleptic sensitivity reactions in LBD — use with extreme caution",
     T),

card("Why is <b>depression in the elderly</b> often confused with dementia?",
     "Depression can cause <b>pseudodementia</b> — apparent cognitive impairment that improves with depression treatment<br>Key clue: Onset is <b>subacute</b> (weeks), patient <b>complains</b> of memory problems (dementia patients often don't), improves with antidepressants",
     T),
]

# ── SECTION 18: GROUP THERAPY ────────────────────────────────────────────
T = "17. Group Therapy"
cards += [
card("Name <b>5 of Yalom's 11 therapeutic factors</b> in group therapy.",
     "1. Instillation of <b>Hope</b><br>2. <b>Universality</b> ('I'm not alone')<br>3. <b>Altruism</b> (helping others)<br>4. <b>Catharsis</b> (emotional release)<br>5. <b>Group Cohesiveness</b> (belonging/acceptance)<br>(Also: Imparting info, Socialising techniques, Imitative behaviour, Interpersonal learning, Corrective recapitulation, Existential factors)",
     T),

card("What is <b>Universality</b> as a therapeutic group factor?",
     "The realisation that <b>'I am not alone'</b> — other group members share similar problems, thoughts, or experiences<br>Often the most immediately impactful factor for new group members who feel ashamed or isolated",
     T),

card("What is the nurse's role as a <b>group facilitator</b> (not leader)?",
     "• Establish and <b>maintain norms</b><br>• Facilitate, not dominate<br>• <b>Protect</b> vulnerable members<br>• Manage disruptive behaviours (monopolisers, scapegoating)<br>• Summarise and close sessions<br>• Maintain confidentiality",
     T),
]

# ── SECTION: PHARMACOLOGY EXTRA ─────────────────────────────────────────
T = "18. Pharmacology — Quick Facts"
cards += [
card("What is the reversal agent for <b>benzodiazepine</b> overdose?",
     "<b>Flumazenil</b> (competitive benzodiazepine antagonist at GABA-A receptor)<br>Short half-life — may need repeat dosing; can precipitate withdrawal seizures",
     T),

card("Which antipsychotic has the <b>highest risk of QTc prolongation</b>?",
     "<b>Ziprasidone</b> and <b>Thioridazine</b> have the highest QTc prolongation risk<br>Requires <b>baseline and monitoring ECGs</b><br>Ziprasidone must be taken <b>with food</b> (doubles bioavailability)",
     T),

card("What is the dosing consideration for <b>SSRIs in OCD</b> vs depression?",
     "OCD requires <b>HIGHER doses</b> than depression<br>Example: Fluoxetine up to 60–80 mg/day for OCD vs 20–40 mg for depression<br>Also takes longer to respond (10–12 weeks vs 4–6 weeks)",
     T),

card("What is the <b>mechanism of Lithium</b> as a mood stabiliser?",
     "Multiple mechanisms (not fully understood):<br>• Alters Na+/K+ transport across cell membranes<br>• Modulates second messenger systems (IP3, PKC)<br>• Neuroprotective effects<br>• Reduces glutamate neurotransmission",
     T),

card("What is a <b>Long-Acting Injectable (LAI)</b> antipsychotic and when is it used?",
     "Depot formulation given IM every 2–4 weeks<br>Used for: <b>Non-adherent patients</b>, frequent relapse due to stopping medication<br>Examples: Fluphenazine decanoate, Paliperidone palmitate, Risperidone microspheres",
     T),

card("What are the <b>SSRIs approved by FDA</b> specifically for PTSD?",
     "<b>Sertraline (Zoloft)</b> and <b>Paroxetine (Paxil)</b> — the only FDA-approved pharmacotherapies for PTSD<br>Others (Fluoxetine, Venlafaxine) are used off-label",
     T),
]

# ────────────────────────────────────────────────────────────────────────
# BUILD DECK
# ────────────────────────────────────────────────────────────────────────
for c in cards:
    deck.add_note(c)

pkg = genanki.Package(deck)
pkg.write_to_file(OUTPUT)

print(f"✅ Anki deck written to: {OUTPUT}")
print(f"   Total cards: {len(cards)}")
print(f"   Model: {model.name}")
print(f"   Deck: {deck.name}")

cd /home/daytona/workspace/mental-health-nursing && python3 generate_anki.py 2>&…

~/mental-health-nursing/generate_anki.py

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/mental-health-nursing/generate_anki.py'

~/mental-health-nursing/generate_anki.py

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/mental-health-nursing/generate_anki.py'

cd /home/daytona/workspace/mental-health-nursing && python3 generate_anki.py 2>&…

# Check if it actually wrote the file to /tmp and try copy2 instead ls -lh /tmp/…

ls -lh /home/daytona/workspace/mental-health-nursing/MentalHealthNursing_Anki.ap…

python3 -c " import sqlite3, zipfile, os, tempfile apkg = '/home/daytona/worksp…