const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = 'LAYOUT_16x9';
pres.title = 'Major Depressive Disorder & Bipolar Disorder';
pres.author = 'Orris Medical';

// ── PALETTE ────────────────────────────────────────────────────────────────
const C = {
  ink:       "0B1120",   // near-black navy — dominant bg
  navy:      "112240",   // section bg
  deepTeal:  "0E4D5C",   // MDD accent bg
  deepPlum:  "2D1654",   // Bipolar accent bg
  teal:      "1A8FA0",   // MDD highlight
  plum:      "7B2FBE",   // Bipolar highlight
  gold:      "C8973A",   // accent stripe
  cream:     "F5F0E8",   // light slide bg
  offWhite:  "FAFAFA",
  white:     "FFFFFF",
  textDark:  "1A1A2E",
  textMid:   "3D405B",
  textLight: "6B7280",
  cardBg:    "EEF2F7",
  tealFaint: "E0F4F7",
  plumFaint: "EFE5F9",
  greenAcc:  "1E8449",
  redAcc:    "C0392B",
  amber:     "D4870A",
};

// ── HELPERS ────────────────────────────────────────────────────────────────
function bullets(items) {
  return items.map((b, i) => {
    const isLast = i === items.length - 1;
    if (typeof b === 'string') {
      return { text: b, options: { bullet: { indent: 14 }, fontSize: 13.5, color: C.textDark, breakLine: !isLast, fontFace: "Calibri", paraSpaceAfter: 5 } };
    }
    const sub = b.sub || false;
    const head = b.head || false;
    return {
      text: b.text,
      options: {
        bullet: sub ? { indent: 32 } : (head ? false : { indent: 14 }),
        fontSize: sub ? 12 : (head ? 14 : 13.5),
        color: sub ? C.textMid : (head ? C.teal : C.textDark),
        bold: head,
        italic: sub && b.italic,
        breakLine: !isLast,
        fontFace: "Calibri",
        paraSpaceAfter: sub ? 3 : 5,
      }
    };
  });
}

function bulletsPlum(items) {
  return items.map((b, i) => {
    const isLast = i === items.length - 1;
    if (typeof b === 'string') {
      return { text: b, options: { bullet: { indent: 14 }, fontSize: 13.5, color: C.textDark, breakLine: !isLast, fontFace: "Calibri", paraSpaceAfter: 5 } };
    }
    const sub = b.sub || false;
    const head = b.head || false;
    return {
      text: b.text,
      options: {
        bullet: sub ? { indent: 32 } : (head ? false : { indent: 14 }),
        fontSize: sub ? 12 : (head ? 14 : 13.5),
        color: sub ? C.textMid : (head ? C.plum : C.textDark),
        bold: head,
        breakLine: !isLast,
        fontFace: "Calibri",
        paraSpaceAfter: sub ? 3 : 5,
      }
    };
  });
}

// Standard content slide (light bg)
function contentSlide(title, items, accent, isTeal) {
  const s = pres.addSlide();
  // background
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: C.offWhite } });
  // left accent bar
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.18, h:5.625, fill:{ color: accent } });
  // top header band
  s.addShape(pres.ShapeType.rect, { x:0.18, y:0, w:9.82, h:1.0, fill:{ color: accent } });
  // gold rule under header
  s.addShape(pres.ShapeType.rect, { x:0.18, y:1.0, w:9.82, h:0.055, fill:{ color: C.gold } });
  // title text
  s.addText(title, {
    x:0.42, y:0.08, w:9.4, h:0.84,
    fontSize: 20, bold: true, color: C.white, fontFace: "Calibri Light",
    align: "left", valign: "middle", margin: 0
  });
  // body
  s.addText(isTeal ? bullets(items) : bulletsPlum(items), {
    x:0.42, y:1.13, w:9.36, h:4.3,
    valign: "top", fontFace: "Calibri"
  });
  return s;
}

// Dark background content slide
function darkContentSlide(title, items, accent) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: C.ink } });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.07, fill:{ color: C.gold } });
  s.addShape(pres.ShapeType.rect, { x:0, y:0.07, w:10, h:1.0, fill:{ color: accent } });
  s.addShape(pres.ShapeType.rect, { x:0, y:1.07, w:10, h:0.055, fill:{ color: C.gold } });
  s.addText(title, {
    x:0.4, y:0.12, w:9.2, h:0.88,
    fontSize: 20, bold: true, color: C.white, fontFace: "Calibri Light",
    align: "left", valign: "middle", margin: 0
  });
  const its = items.map((b, i) => {
    const isLast = i === items.length - 1;
    if (typeof b === 'string') {
      return { text: b, options: { bullet: { indent: 14 }, fontSize: 13.5, color: "D0D8E8", breakLine: !isLast, fontFace: "Calibri", paraSpaceAfter: 5 } };
    }
    return {
      text: b.text,
      options: {
        bullet: b.sub ? { indent: 32 } : (b.head ? false : { indent: 14 }),
        fontSize: b.sub ? 12 : (b.head ? 14 : 13.5),
        color: b.sub ? "8899BB" : (b.head ? C.gold : "D0D8E8"),
        bold: b.head,
        breakLine: !isLast,
        fontFace: "Calibri",
        paraSpaceAfter: b.sub ? 3 : 5,
      }
    };
  });
  s.addText(its, { x:0.4, y:1.18, w:9.2, h:4.28, valign: "top" });
  return s;
}

// Section divider
function sectionDiv(label, title, sub, accent) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: accent } });
  // decorative diagonal stripe
  s.addShape(pres.ShapeType.rect, { x:7.5, y:0, w:2.5, h:5.625, fill:{ color: "FFFFFF", transparency: 92 } });
  s.addShape(pres.ShapeType.rect, { x:0, y:5.2, w:10, h:0.425, fill:{ color: C.gold } });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.07, fill:{ color: C.gold } });
  s.addText(label, {
    x:0.55, y:0.7, w:7, h:0.55,
    fontSize: 13, bold: true, color: "FFFFFF", fontFace: "Calibri",
    charSpacing: 4, align: "left"
  });
  s.addText(title, {
    x:0.55, y:1.3, w:7.8, h:2.0,
    fontSize: 42, bold: true, color: C.white, fontFace: "Calibri Light",
    align: "left", valign: "top"
  });
  if (sub) {
    s.addText(sub, {
      x:0.55, y:3.4, w:7.8, h:0.7,
      fontSize: 16, color: "DDEEFF", fontFace: "Calibri Light", align: "left"
    });
  }
  return s;
}

// Two-column card slide
function twoCol(title, lHead, lItems, rHead, rItems, accent, isTeal) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: C.offWhite } });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.18, h:5.625, fill:{ color: accent } });
  s.addShape(pres.ShapeType.rect, { x:0.18, y:0, w:9.82, h:0.9, fill:{ color: accent } });
  s.addShape(pres.ShapeType.rect, { x:0.18, y:0.9, w:9.82, h:0.055, fill:{ color: C.gold } });
  s.addText(title, {
    x:0.42, y:0.06, w:9.3, h:0.78,
    fontSize: 19, bold: true, color: C.white, fontFace: "Calibri Light",
    align: "left", valign: "middle", margin: 0
  });
  // left card
  s.addShape(pres.ShapeType.rect, { x:0.28, y:1.02, w:4.55, h:4.45, fill:{ color: C.white }, line:{ color:"D5DDE6", pt:1 } });
  s.addShape(pres.ShapeType.rect, { x:0.28, y:1.02, w:4.55, h:0.38, fill:{ color: isTeal ? C.teal : C.plum } });
  s.addText(lHead, { x:0.38, y:1.04, w:4.35, h:0.33, fontSize: 12.5, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
  const li = lItems.map((b, i) => ({
    text: typeof b === 'string' ? b : b.text,
    options: { bullet: { indent: 12 }, fontSize: 12, color: C.textDark, breakLine: i < lItems.length - 1, fontFace: "Calibri", paraSpaceAfter: 4 }
  }));
  s.addText(li, { x:0.36, y:1.44, w:4.38, h:3.96, valign: "top" });
  // right card
  s.addShape(pres.ShapeType.rect, { x:5.15, y:1.02, w:4.55, h:4.45, fill:{ color: C.white }, line:{ color:"D5DDE6", pt:1 } });
  s.addShape(pres.ShapeType.rect, { x:5.15, y:1.02, w:4.55, h:0.38, fill:{ color: isTeal ? C.teal : C.plum } });
  s.addText(rHead, { x:5.25, y:1.04, w:4.35, h:0.33, fontSize: 12.5, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
  const ri = rItems.map((b, i) => ({
    text: typeof b === 'string' ? b : b.text,
    options: { bullet: { indent: 12 }, fontSize: 12, color: C.textDark, breakLine: i < rItems.length - 1, fontFace: "Calibri", paraSpaceAfter: 4 }
  }));
  s.addText(ri, { x:5.23, y:1.44, w:4.38, h:3.96, valign: "top" });
  return s;
}

// Quote/highlight slide
function quoteSlide(quote, attribution, accent) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: C.ink } });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.07, fill:{ color: C.gold } });
  s.addShape(pres.ShapeType.rect, { x:0, y:5.555, w:10, h:0.07, fill:{ color: C.gold } });
  s.addShape(pres.ShapeType.rect, { x:4.5, y:0.07, w:0.07, h:5.485, fill:{ color: accent, transparency: 60 } });
  // big quote mark
  s.addText("\u201C", { x:0.4, y:0.5, w:4, h:2.2, fontSize: 120, color: accent, fontFace: "Georgia", transparency: 60 });
  s.addText(quote, {
    x:0.5, y:1.5, w:3.8, h:3.5,
    fontSize: 16, color: C.white, fontFace: "Calibri Light",
    italic: true, valign: "top", align: "left"
  });
  s.addText(attribution, {
    x:5.0, y:2.0, w:4.7, h:2.0,
    fontSize: 13, color: "AABBCC", fontFace: "Calibri Light",
    valign: "middle", align: "left"
  });
  return s;
}

// Stat/number highlight slide (3 stats)
function statSlide(title, stats, accent) {
  // stats = [{num, label, sub}]
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: C.ink } });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.07, fill:{ color: C.gold } });
  s.addText(title, {
    x:0.5, y:0.18, w:9, h:0.65,
    fontSize: 21, bold: true, color: C.white, fontFace: "Calibri Light", align: "center"
  });
  const positions = [
    { x:0.25, y:1.1 },
    { x:3.58, y:1.1 },
    { x:6.91, y:1.1 },
  ];
  stats.forEach((st, i) => {
    const p = positions[i];
    s.addShape(pres.ShapeType.rect, { x:p.x, y:p.y, w:3.0, h:3.8, fill:{ color: accent, transparency: 80 }, line:{ color: accent, pt:1 } });
    s.addShape(pres.ShapeType.rect, { x:p.x, y:p.y, w:3.0, h:0.07, fill:{ color: accent } });
    s.addText(st.num, {
      x:p.x, y:p.y + 0.25, w:3.0, h:1.4,
      fontSize: 48, bold: true, color: accent, fontFace: "Calibri", align: "center", valign: "middle"
    });
    s.addText(st.label, {
      x:p.x + 0.1, y:p.y + 1.7, w:2.8, h:0.6,
      fontSize: 13.5, bold: true, color: C.white, fontFace: "Calibri", align: "center"
    });
    if (st.sub) {
      s.addText(st.sub, {
        x:p.x + 0.1, y:p.y + 2.35, w:2.8, h:1.2,
        fontSize: 11, color: "AABBCC", fontFace: "Calibri", align: "center", valign: "top"
      });
    }
  });
  return s;
}

// DSM criteria slide
function dsmSlide(title, intro, items, accent) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: C.offWhite } });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.18, h:5.625, fill:{ color: accent } });
  s.addShape(pres.ShapeType.rect, { x:0.18, y:0, w:9.82, h:0.9, fill:{ color: accent } });
  s.addShape(pres.ShapeType.rect, { x:0.18, y:0.9, w:9.82, h:0.055, fill:{ color: C.gold } });
  s.addText(title, {
    x:0.42, y:0.05, w:9.4, h:0.82,
    fontSize: 19, bold: true, color: C.white, fontFace: "Calibri Light",
    align: "left", valign: "middle", margin: 0
  });
  if (intro) {
    s.addShape(pres.ShapeType.rect, { x:0.3, y:0.98, w:9.4, h:0.44, fill:{ color: C.cardBg }, line:{ color: accent, pt:1 } });
    s.addText(intro, {
      x:0.45, y:1.0, w:9.2, h:0.4,
      fontSize: 12, bold: true, color: accent, fontFace: "Calibri", valign: "middle"
    });
  }
  const its = items.map((b, i) => {
    const isLast = i === items.length - 1;
    return { text: b, options: { bullet: { indent: 14 }, fontSize: 12.5, color: C.textDark, breakLine: !isLast, fontFace: "Calibri", paraSpaceAfter: 4 } };
  });
  s.addText(its, {
    x:0.3, y:intro ? 1.47 : 0.98, w:9.4, h:intro ? 3.98 : 4.48,
    valign: "top"
  });
  return s;
}

// Table-style comparison slide
function compareSlide(title, headers, rows, accent) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: C.offWhite } });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.18, h:5.625, fill:{ color: accent } });
  s.addShape(pres.ShapeType.rect, { x:0.18, y:0, w:9.82, h:0.85, fill:{ color: accent } });
  s.addShape(pres.ShapeType.rect, { x:0.18, y:0.85, w:9.82, h:0.055, fill:{ color: C.gold } });
  s.addText(title, {
    x:0.42, y:0.05, w:9.3, h:0.76,
    fontSize: 19, bold: true, color: C.white, fontFace: "Calibri Light",
    align: "left", valign: "middle", margin: 0
  });
  // table via shapes + text
  const cols = headers.length;
  const colW = 9.5 / cols;
  const startX = 0.25;
  const startY = 0.95;
  const rowH = 0.62;
  // header row
  headers.forEach((h, ci) => {
    const col_accent = ci === 1 ? C.teal : (ci === 2 ? C.plum : C.navy);
    s.addShape(pres.ShapeType.rect, { x: startX + ci*colW, y: startY, w: colW, h: 0.52, fill:{ color: col_accent } });
    s.addText(h, { x: startX + ci*colW + 0.05, y: startY, w: colW - 0.1, h: 0.52, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
  });
  // data rows
  rows.forEach((row, ri) => {
    const rowY = startY + 0.52 + ri * rowH;
    const rowBg = ri % 2 === 0 ? C.white : C.cardBg;
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x: startX + ci*colW, y: rowY, w: colW, h: rowH, fill:{ color: rowBg }, line:{ color:"D5DDE6", pt:0.5 } });
      s.addText(cell, { x: startX + ci*colW + 0.08, y: rowY, w: colW - 0.16, h: rowH, fontSize: 11.5, color: C.textDark, fontFace: "Calibri", align: ci===0 ? "left":"center", valign: "middle" });
    });
  });
  return s;
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 1 — MAIN TITLE
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: C.ink } });
  // decorative top stripe
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.09, fill:{ color: C.gold } });
  // right panel
  s.addShape(pres.ShapeType.rect, { x:6.6, y:0.09, w:3.4, h:5.535, fill:{ color: C.navy } });
  // teal block
  s.addShape(pres.ShapeType.rect, { x:6.6, y:1.8, w:3.4, h:1.8, fill:{ color: C.teal, transparency: 30 } });
  // plum block
  s.addShape(pres.ShapeType.rect, { x:6.6, y:3.6, w:3.4, h:1.935, fill:{ color: C.plum, transparency: 30 } });
  // gold vertical line
  s.addShape(pres.ShapeType.rect, { x:6.5, y:0.09, w:0.1, h:5.535, fill:{ color: C.gold } });
  // main title
  s.addText("Mood Disorders", {
    x:0.55, y:0.6, w:5.8, h:0.85,
    fontSize: 14, color: C.gold, fontFace: "Calibri Light",
    bold: false, charSpacing: 3, align: "left"
  });
  s.addText("Major Depressive\nDisorder", {
    x:0.55, y:1.4, w:5.8, h:1.7,
    fontSize: 38, bold: true, color: C.white, fontFace: "Calibri Light",
    align: "left", valign: "top"
  });
  s.addShape(pres.ShapeType.rect, { x:0.55, y:3.15, w:2.2, h:0.06, fill:{ color: C.teal } });
  s.addText("&", { x:0.55, y:3.28, w:0.6, h:0.5, fontSize: 24, color: C.gold, fontFace: "Calibri", bold: true });
  s.addText("Bipolar Disorder", {
    x:0.55, y:3.78, w:5.8, h:0.9,
    fontSize: 36, bold: true, color: C.white, fontFace: "Calibri Light", align: "left"
  });
  // right labels
  s.addText("Part A", { x:6.72, y:1.85, w:3.1, h:0.4, fontSize:11, color:C.white, fontFace:"Calibri", charSpacing:3 });
  s.addText("MDD", { x:6.72, y:2.25, w:3.1, h:0.8, fontSize:26, bold:true, color:C.white, fontFace:"Calibri Light" });
  s.addText("Part B", { x:6.72, y:3.65, w:3.1, h:0.4, fontSize:11, color:C.white, fontFace:"Calibri", charSpacing:3 });
  s.addText("Bipolar\nDisorder", { x:6.72, y:4.05, w:3.1, h:1.1, fontSize:22, bold:true, color:C.white, fontFace:"Calibri Light" });
  // footer
  s.addShape(pres.ShapeType.rect, { x:0, y:5.3, w:6.5, h:0.325, fill:{ color: C.navy } });
  s.addText("Kaplan & Sadock's Synopsis of Psychiatry, 12th Ed.  |  DSM-5-TR (APA, 2022)", {
    x:0.3, y:5.32, w:6.1, h:0.28, fontSize:9.5, color:"8899BB", fontFace:"Calibri", italic:true
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 2 — TABLE OF CONTENTS
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{ color: C.offWhite } });
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.09, fill:{ color: C.gold } });
  s.addShape(pres.ShapeType.rect, { x:0, y:0.09, w:10, h:0.85, fill:{ color: C.ink } });
  s.addText("CONTENTS", {
    x:0.4, y:0.12, w:9.2, h:0.75,
    fontSize:22, bold:true, color:C.white, fontFace:"Calibri Light",
    charSpacing:4, align:"left", valign:"middle"
  });
  // two columns
  const partA = [
    "1.  Introduction & Overview",
    "2.  Epidemiology",
    "3.  Neurobiology & Etiology",
    "4.  Clinical Features",
    "5.  Specifiers & Subtypes",
    "6.  DSM-5-TR Diagnostic Criteria",
    "7.  Pharmacological Management",
    "8.  Non-Pharmacological Management",
    "9.  Special Populations",
    "10. Prognosis & Suicide Risk",
  ];
  const partB = [
    "11. Introduction & Epidemiology",
    "12. Neurobiology & Genetics",
    "13. Clinical Features: Mania",
    "14. Clinical Features: Depression & Hypomania",
    "15. Mixed Features & Rapid Cycling",
    "16. DSM-5-TR Criteria: Bipolar I",
    "17. DSM-5-TR Criteria: Bipolar II & Cyclothymia",
    "18. Pharmacological Management",
    "19. Non-Pharmacological Management",
    "20. Prognosis, Suicide & Comparison",
  ];
  // left panel
  s.addShape(pres.ShapeType.rect, { x:0.25, y:1.05, w:4.55, h:4.35, fill:{ color: C.white }, line:{ color:"D5DDE6", pt:1 } });
  s.addShape(pres.ShapeType.rect, { x:0.25, y:1.05, w:4.55, h:0.42, fill:{ color: C.teal } });
  s.addText("PART A — Major Depressive Disorder", { x:0.35, y:1.07, w:4.35, h:0.38, fontSize:12, bold:true, color:C.white, fontFace:"Calibri", valign:"middle" });
  const la = partA.map((t, i) => ({ text:t, options:{ bullet:false, fontSize:12.5, color:C.textDark, breakLine:i<partA.length-1, fontFace:"Calibri", paraSpaceAfter:5 } }));
  s.addText(la, { x:0.38, y:1.5, w:4.3, h:3.82, valign:"top" });
  // right panel
  s.addShape(pres.ShapeType.rect, { x:5.2, y:1.05, w:4.55, h:4.35, fill:{ color: C.white }, line:{ color:"D5DDE6", pt:1 } });
  s.addShape(pres.ShapeType.rect, { x:5.2, y:1.05, w:4.55, h:0.42, fill:{ color: C.plum } });
  s.addText("PART B — Bipolar Disorder", { x:5.3, y:1.07, w:4.35, h:0.38, fontSize:12, bold:true, color:C.white, fontFace:"Calibri", valign:"middle" });
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// ══════════════════════════════════════════════════════════════════════════
// PART A — MAJOR DEPRESSIVE DISORDER
// ══════════════════════════════════════════════════════════════════════════
sectionDiv("PART A", "Major Depressive\nDisorder", "DSM-5-TR Criteria  |  Kaplan & Sadock, 12th Ed.", C.deepTeal);

// A1 — Introduction
contentSlide("MDD — Introduction & Overview", [
  { text:"Definition", head:true },
  "Major Depressive Disorder (MDD) is characterized by one or more major depressive episodes — periods of depressed mood and/or anhedonia lasting ≥2 weeks, accompanied by significant functional impairment.",
  "",
  { text:"Historical Context", head:true },
  "The term 'melancholia' dates to Hippocrates (4th century BC) — described as a dark mood state driven by 'black bile' (melas chole).",
  "Modern classification: DSM-III (1980) introduced the current diagnostic framework; DSM-5-TR (2022) includes updated specifiers.",
  "",
  { text:"Key Concepts", head:true },
  "MDD is NOT a single disease — it is a heterogeneous collection of disorders with overlapping phenomenology but different underlying etiologies.",
  "A single episode is sufficient for diagnosis; however, MDD is typically recurrent.",
  "MDD is a leading cause of disability worldwide (WHO Global Burden of Disease study).",
  "The disorder lies within the spectrum of 'unipolar' mood disorders — no manic or hypomanic episodes by definition.",
], C.deepTeal, true);

// A2 — Epidemiology
contentSlide("MDD — Epidemiology", [
  { text:"Global Prevalence", head:true },
  "Point prevalence: 12.9%  |  1-year prevalence: 7.2%  |  Lifetime prevalence: 10.8%",
  { text:"Based on a meta-analysis of 90 studies from 30 countries (1994–2014), >1 million participants (Lim et al., 2018)", sub:true },
  "US (SAMHSA/NSDUH): 1-year prevalence of a major depressive episode = 7.1%",
  "",
  { text:"Sex Differences", head:true },
  "Women > Men universally: 14.4% vs 11.5% lifetime prevalence internationally",
  "US data: 8.7% (women) vs 5.3% (men) for 1-year prevalence",
  { text:"Biologic, hormonal, and psychosocial factors contribute; sex ratio persists across cultures", sub:true },
  "",
  { text:"Age of Onset", head:true },
  "Mean onset ~40 years; 50% of patients develop MDD between ages 20–50",
  "Adolescent females: 1-year prevalence of 20% — nearly double the adult rate",
  "Highest 1-year prevalence in young adults aged 18–25",
  "",
  { text:"Marital & Socioeconomic Status", head:true },
  "More common in divorced/separated individuals and those without close interpersonal ties",
  "No proven correlation with socioeconomic status; may be slightly more prevalent in rural settings",
], C.deepTeal, true);

// A3 — Epidemiology stats visual
statSlide("MDD — Key Epidemiological Statistics", [
  { num:"10.8%", label:"Lifetime Prevalence", sub:"90-study global meta-analysis\n>1 million participants\n(Lim et al., 2018)" },
  { num:"2:1", label:"Female : Male Ratio", sub:"Universal across cultures\n14.4% vs 11.5% lifetime\nHormonal & social factors" },
  { num:"~40 yrs", label:"Mean Age of Onset", sub:"50% onset between\nages 20–50\nAdolescents increasingly affected" },
], C.teal);

// A4 — Neurobiology & Etiology
contentSlide("MDD — Neurobiology & Etiology", [
  { text:"Monoamine Hypothesis (Classic)", head:true },
  "Deficiency of serotonin (5-HT), norepinephrine (NE), and/or dopamine (DA) in key brain circuits underlies depressive symptoms.",
  { text:"Supported by mechanism of effective antidepressants (SSRIs, SNRIs, TCAs, MAOIs)", sub:true },
  "",
  { text:"HPA Axis Dysregulation", head:true },
  "Depressed patients show elevated 24-hour cortisol (hypercortisolemia) — found in 40–60% of inpatients.",
  "Increased CRH from hypothalamus + decreased feedback inhibition → abnormal Dexamethasone Suppression Test (DST).",
  { text:"Not sensitive/specific enough for diagnosis, but confirms biological basis", sub:true },
  "",
  { text:"Neuroplasticity & Structural Changes", head:true },
  "Reduced hippocampal volume (stress-induced neuronal atrophy); reduced BDNF levels.",
  "Prefrontal cortex hypoactivity; amygdala hyperactivity.",
  "",
  { text:"Genetics", head:true },
  "Heritability ~37% (moderate); polygenic; concordance ~50% in monozygotic twins.",
  "Serotonin transporter polymorphism (5-HTTLPR) influences SSRI response.",
  "",
  { text:"Thyroid Axis", head:true },
  "5–10% of depressed patients have thyroid dysfunction; blunted TSH response to TRH.",
], C.deepTeal, true);

// A5 — Clinical Features
contentSlide("MDD — Core Clinical Features", [
  { text:"Core Mood Symptoms", head:true },
  "Depressed mood most of the day, nearly every day (subjective report or objective observation)",
  "In children/adolescents: irritable mood may substitute for depressed mood",
  "Anhedonia: markedly diminished interest or pleasure in all or almost all activities",
  "",
  { text:"Neurovegetative Symptoms", head:true },
  "Sleep: insomnia (early morning awakening is classic — melancholic) or hypersomnia (atypical)",
  "Appetite/Weight: significant change >5% body weight per month; ↑ or ↓",
  "Energy: fatigue or loss of energy nearly every day",
  "Psychomotor: agitation (visible restlessness) or retardation (slowed speech, movement) — observable by others",
  "",
  { text:"Cognitive Symptoms", head:true },
  "Diminished ability to think, concentrate, or make decisions",
  "Feelings of worthlessness or excessive/inappropriate guilt (may reach delusional intensity)",
  "Negative cognitive triad (Beck): negative view of self, world, and future",
  "",
  { text:"Suicidal Ideation", head:true },
  "Recurrent thoughts of death, suicidal ideation with or without a plan, or suicide attempt",
], C.deepTeal, true);

// A6 — Clinical Features contd (subtypes & special populations)
contentSlide("MDD — Clinical Features: Adolescents & Special Presentations", [
  { text:"Children & Adolescents", head:true },
  "Somatic complaints, psychomotor agitation, mood-congruent hallucinations more prominent than in adults",
  "Adolescents: negativism, irritability, antisocial behavior, substance use, school failure, social withdrawal",
  "Sleep and appetite problems more prominent in adults; hopelessness and delusions more common in adolescents/adults",
  { text:"Up to 17% of adolescents with MDD receive initial evaluation due to substance abuse (Kaplan)", sub:true },
  "",
  { text:"Geriatric Depression", head:true },
  "May present as 'pseudodementia' — cognitive complaints, memory difficulty, resembling dementia",
  "Somatic complaints often predominate; sadness may be underreported",
  "Late-onset subtype (>50 yrs): less familial loading, more vascular risk factors",
  "",
  { text:"Postpartum Depression", head:true },
  "Onset within 4 weeks postpartum (DSM-5-TR peripartum specifier)",
  "Distinct from 'baby blues' (transient, days 3–5) — 'baby blues' does NOT meet MDD criteria",
  "Brexanolone (IV allopregnanolone) FDA-approved specifically for postpartum depression (2019)",
  "",
  { text:"Seasonal Affective Disorder (SAD)", head:true },
  "Recurrent episodes with seasonal pattern (typically fall/winter onset, spring remission)",
  "Light therapy is first-line; bupropion extended-release is FDA-approved for prevention of SAD",
], C.deepTeal, true);

// A7 — Specifiers
contentSlide("MDD — DSM-5-TR Specifiers", [
  { text:"With Melancholic Features", head:true },
  "Loss of pleasure in ALL activities (complete anhedonia) OR lack of reactivity to usually pleasurable stimuli",
  "PLUS ≥3: depression worse in AM, early morning awakening (≥2 hrs before usual), psychomotor changes, significant anorexia/weight loss, excessive guilt",
  { text:"'Endogenous depression' — arises without clear external precipitants; autonomic/endocrine changes", sub:true },
  "",
  { text:"With Atypical Features", head:true },
  "Mood reactivity (brightens in response to actual/potential positive events)",
  "PLUS ≥2: hypersomnia, hyperphagia, leaden paralysis (heavy limbs), long-standing rejection sensitivity",
  "",
  { text:"With Psychotic Features", head:true },
  "Mood-congruent: guilt, punishment, disease, nihilism, poverty — harmonious with depressed mood",
  "Mood-incongruent: not consistent with depressed mood — raises concern for schizoaffective disorder",
  "",
  { text:"With Anxious Distress  |  With Catatonia  |  With Peripartum Onset", head:true },
  "Anxious Distress: feeling keyed up/tense, unusual restlessness, difficulty concentrating due to worry, fear of losing control",
  "Catatonia: motor immobility, extreme negativism, echolalia/echopraxia — requires separate catatonia specifier",
  "",
  { text:"Severity Specifiers", head:true },
  "Mild: Minimal symptoms, minor functional impairment  |  Moderate: Between mild and severe",
  "Severe: # and severity of symptoms well beyond diagnostic minimum; marked functional impairment",
], C.deepTeal, true);

// A8 — DSM-5-TR Criteria
dsmSlide(
  "MDD — DSM-5-TR Diagnostic Criteria (A–E)",
  "Criterion A: ≥5 symptoms during the SAME 2-week period (at least 1 must be depressed mood or anhedonia):",
  [
    "1. Depressed mood most of the day, nearly every day (subjective or observed by others)",
    "2. Markedly diminished interest/pleasure in all or almost all activities (anhedonia)",
    "3. Significant weight loss (not dieting) or gain >5%/month, or ↓/↑ appetite nearly every day",
    "4. Insomnia or hypersomnia nearly every day",
    "5. Psychomotor agitation or retardation observable by others (not merely subjective)",
    "6. Fatigue or loss of energy nearly every day",
    "7. Feelings of worthlessness OR excessive/inappropriate guilt (may be delusional)",
    "8. Diminished ability to think or concentrate, or indecisiveness, nearly every day",
    "9. Recurrent thoughts of death, suicidal ideation, suicide attempt, or specific plan",
    "",
    "Criterion B: Symptoms cause clinically significant distress OR impairment in social, occupational, or other important areas",
    "Criterion C: Not due to substances, medications, or another medical condition",
    "Criterion D: Not better explained by schizoaffective disorder, schizophrenia, or other psychotic disorder",
    "Criterion E: No prior manic or hypomanic episode (would reclassify as bipolar disorder)",
  ],
  C.teal
);

// A9 — Differential Diagnosis
contentSlide("MDD — Differential Diagnosis", [
  { text:"Primary Psychiatric Differentials", head:true },
  "Bipolar I/II Disorder: key distinction is history of manic/hypomanic episodes; antidepressant monotherapy hazardous in bipolar depression",
  { text:"Screen ALL depressed patients for hypomania/mania before initiating antidepressants", sub:true },
  "Persistent Depressive Disorder (Dysthymia): chronic, low-grade depression ≥2 years; does NOT meet full MDD criteria",
  "Adjustment Disorder with Depressed Mood: identifiable stressor + symptoms ≤6 months; does not meet MDD threshold",
  "Grief/Bereavement: can coexist with MDD (DSM-5 removed bereavement exclusion); judge duration, severity, functional impairment",
  "",
  { text:"Medical Conditions", head:true },
  "Hypothyroidism — check TSH in all new-onset depression",
  "Cushing syndrome, Addison disease, hyperparathyroidism",
  "Neurological: Parkinson disease, MS, stroke, dementia (pseudodementia)",
  "Medications: beta-blockers, corticosteroids, interferon, isotretinoin, oral contraceptives",
  "",
  { text:"Substance-Induced", head:true },
  "Alcohol, benzodiazepines, opioids (depressant); stimulant withdrawal (cocaine, amphetamine)",
  "Diagnosis: substance-induced mood disorder if symptoms onset during intoxication/withdrawal",
], C.deepTeal, true);

// A10 — Pharmacological Management
twoCol(
  "MDD — Pharmacological Management",
  "First-Line Agents",
  [
    "SSRIs: fluoxetine, sertraline, escitalopram, paroxetine, citalopram — equal efficacy; best tolerability",
    "SNRIs: venlafaxine, duloxetine, desvenlafaxine — added NE effect useful in pain comorbidity",
    "Bupropion (NDRI): dopamine + NE reuptake inhibition; no sexual side effects; good for fatigue/smoking cessation",
    "Mirtazapine: NaSSA; promotes sleep; weight gain; good for anxiety/insomnia",
    "~1/3 achieve full remission in 6–8 weeks; maintain for ≥6–12 months after remission",
    "Maintenance therapy reduces relapse risk by 52% (FDA meta-analysis)",
  ],
  "Second-Line & Augmentation",
  [
    "TCAs (amitriptyline, nortriptyline, imipramine): effective; cardiotoxic in overdose; narrow therapeutic window",
    "MAOIs (phenelzine, tranylcypromine): effective for atypical MDD; tyramine diet required; many drug interactions",
    "Augmentation: Lithium, T3 (liothyronine) — convert ~50% of antidepressant non-responders",
    "Atypical antipsychotics: aripiprazole, quetiapine, brexpiprazole — FDA-approved augmentation",
    "Esketamine (Spravato) intranasal: FDA-approved 2019; treatment-resistant MDD; rapid onset within 4 hours",
    "Brexanolone IV: FDA-approved 2019 for postpartum depression; GABA-A positive allosteric modulator",
  ],
  C.deepTeal, true
);

// A11 — STAR*D & Treatment Algorithm
darkContentSlide("MDD — Treatment Algorithm & STAR*D Evidence", [
  { text:"Step 1 (STAR*D)", head:true },
  "Initial antidepressant (SSRI, typically citalopram): ~28% remission at 12 weeks",
  "",
  { text:"Step 2: After SSRI failure", head:true },
  "Switch strategy: sertraline, bupropion-SR, or venlafaxine-XR — all equivalent efficacy",
  "Augmentation: buspirone or bupropion added to citalopram",
  "",
  { text:"Step 3: After 2 failures", head:true },
  "Switch to mirtazapine or nortriptyline",
  "Augmentation: lithium or T3 added",
  "",
  { text:"Step 4: Severe/refractory", head:true },
  "MAOI (tranylcypromine) or mirtazapine + venlafaxine combination",
  "ECT — most effective treatment for severe/refractory depression",
  "",
  { text:"General Principles", head:true },
  "Adequate trial: ≥4–6 weeks at therapeutic dose; 8–12 weeks to assess full effect",
  "After 2 failed adequate antidepressant trials = Treatment-Resistant Depression (TRD)",
  "Combination pharmacotherapy + psychotherapy > either alone for moderate-severe MDD",
  "Taper, do NOT abruptly stop — SSRI/SNRI discontinuation syndrome (flu-like, dizziness, paresthesia)",
], C.teal);

// A12 — Non-Pharmacological
contentSlide("MDD — Non-Pharmacological Management", [
  { text:"Psychotherapies (Evidence-Based)", head:true },
  "Cognitive-Behavioral Therapy (CBT): modifies negative automatic thoughts and maladaptive behaviors; most studied; equally effective as antidepressants in mild-moderate MDD",
  "Interpersonal Therapy (IPT): targets grief, role disputes, role transitions, interpersonal deficits; ~12–16 sessions",
  "Psychodynamic Therapy: insight-oriented; addresses unconscious conflicts and attachment patterns",
  "Behavioral Activation (BA): increasing engagement with rewarding activities; dismantles avoidance-depression cycle",
  "Mindfulness-Based Cognitive Therapy (MBCT): prevents relapse; most effective in patients with ≥3 prior episodes",
  "",
  { text:"Somatic / Neuromodulation Therapies", head:true },
  "ECT (Electroconvulsive Therapy): first-line for severe/psychotic depression, imminent suicide risk, pregnancy, catatonia, medication refusal; response rate ~60–80%",
  "rTMS (Repetitive Transcranial Magnetic Stimulation): FDA-approved; outpatient; for treatment-resistant MDD; high-frequency left DLPFC",
  "VNS (Vagus Nerve Stimulation): FDA-approved for chronic/treatment-resistant depression ≥4 failed trials",
  "Light Therapy (phototherapy): 10,000 lux lamp × 30 min/morning; first-line for SAD; used with mood stabilizer in bipolar SAD",
  "",
  { text:"Lifestyle Interventions", head:true },
  "Aerobic exercise: 30–45 minutes, 3–5 times/week — RCTs confirm antidepressant effect (comparable to antidepressants in mild-moderate MDD)",
  "Sleep hygiene, nutritional support, social support networks, regular daily routine",
  "Psychoeducation for patient and family; safety planning for suicidal ideation",
], C.deepTeal, true);

// A13 — Special Populations
contentSlide("MDD — Management in Special Populations", [
  { text:"Pregnancy & Postpartum", head:true },
  "Risk of untreated depression (preterm birth, low birth weight, poor attachment) generally > teratogenic risk of SSRIs",
  "Sertraline and escitalopram: preferred SSRIs in pregnancy (most safety data)",
  "Paroxetine: Category D — avoid in first trimester (cardiac defects)",
  "Brexanolone IV: specifically for postpartum depression (2.5-day IV infusion in certified facility)",
  "ECT: safe and effective in pregnancy (avoid in first trimester if possible)",
  "",
  { text:"Pediatric (< 18 years)", head:true },
  "FDA black-box warning: antidepressants increase suicidal ideation in children/adolescents (<18 yrs) — monitor closely especially in first 4 weeks",
  "Fluoxetine: only FDA-approved antidepressant for children ≥8 years with MDD",
  "Escitalopram: FDA-approved for adolescents ≥12 years",
  "Psychotherapy (CBT) is first-line for mild-moderate; combined for moderate-severe",
  "",
  { text:"Elderly", head:true },
  "Start low, go slow — reduced hepatic metabolism, more side effects",
  "Avoid TCAs (anticholinergic, falls risk, cardiotoxicity); prefer SSRIs, SNRIs",
  "Screen for vascular risk factors; distinguish from dementia (pseudodementia)",
], C.deepTeal, true);

// A14 — Prognosis
contentSlide("MDD — Prognosis", [
  { text:"Episode Outcomes", head:true },
  "~50% of patients recover from the index episode within 6 months with adequate treatment",
  "Without treatment: episodes typically last 6–13 months; spontaneous recovery possible but delayed",
  "With treatment: median time to remission ~8–12 weeks",
  "",
  { text:"Recurrence Risk", head:true },
  "After 1 episode: ~50% chance of a second episode",
  "After 2 episodes: ~70% chance of a third episode",
  "After 3 episodes: ~90% chance of further recurrence",
  { text:"Maintenance therapy after 3+ episodes strongly recommended (indefinite)", sub:true },
  "~15–20% develop a chronic course without full remission",
  "",
  { text:"Poor Prognostic Indicators", head:true },
  "Psychotic features, melancholic features, severe/prolonged initial episode",
  "Comorbid anxiety, substance use disorder, personality disorder, medical illness",
  "Early childhood onset; inadequate initial treatment; poor social support; ongoing stressors",
  "",
  { text:"Good Prognostic Indicators", head:true },
  "Acute onset, identifiable precipitant, good premorbid functioning, strong social support",
  "Absence of psychotic features, no comorbid psychiatric illness, normal personality",
], C.deepTeal, true);

// A15 — Suicide Risk in MDD
darkContentSlide("MDD — Suicide Risk Assessment & Management", [
  { text:"Epidemiology", head:true },
  "Lifetime suicide risk in severe/untreated MDD: ~15%",
  "MDD is the single greatest risk factor for suicide in high-income countries",
  "~60% of people who complete suicide had a diagnosed mood disorder",
  "",
  { text:"Risk Assessment (SAD PERSONS mnemonic)", head:true },
  "S — Sex (male)  |  A — Age (<19 or >45)  |  D — Depression",
  "P — Prior attempt (strongest predictor)  |  E — Ethanol/substance use  |  R — Rational thinking loss",
  "S — Social support lacking  |  O — Organized/specific plan  |  N — No spouse  |  S — Sickness",
  "",
  { text:"Protective Factors", head:true },
  "Social support, religious beliefs, responsibility for children, fear of death/pain, positive coping skills",
  "Access to mental health care, therapeutic alliance, reason for living",
  "",
  { text:"Management", head:true },
  "Safety planning: means restriction, emergency contacts, crisis resources",
  "Hospitalization: when imminent risk, unable to contract for safety, inadequate social support",
  "ECT: fastest effective treatment when suicidal risk is imminent",
  "Lithium: proven anti-suicidal effect (reduces all-cause mortality in mood disorders by ~60%)",
  "Clozapine: reduces suicidal behavior in treatment-resistant patients",
], C.teal);

// ══════════════════════════════════════════════════════════════════════════
// PART B — BIPOLAR DISORDER
// ══════════════════════════════════════════════════════════════════════════
sectionDiv("PART B", "Bipolar\nDisorder", "DSM-5-TR Criteria  |  Kaplan & Sadock, 12th Ed.", C.deepPlum);

// B1 — Introduction
contentSlide("Bipolar Disorder — Introduction & Overview", [
  { text:"Definition", head:true },
  "Bipolar disorder is a recurrent, episodic mood disorder defined by the presence of manic, hypomanic, and/or major depressive episodes, causing significant functional impairment.",
  "",
  { text:"Historical Note", head:true },
  "Kraepelin (1921) unified 'manic-depressive insanity' as a single entity distinct from dementia praecox (schizophrenia).",
  "Leonhard (1959) first proposed unipolar vs bipolar distinction.",
  "DSM-III (1980) formalized bipolar as a separate diagnostic category.",
  "",
  { text:"Classification (DSM-5-TR)", head:true },
  "Bipolar I Disorder: at least one manic episode (±depressive episodes)",
  "Bipolar II Disorder: at least one hypomanic episode + at least one major depressive episode; NO lifetime manic episode",
  "Cyclothymic Disorder: chronic cycling ≥2 years, never meeting full criteria for mania or MDD",
  "Other Specified / Unspecified Bipolar Disorders: short-duration hypomania, substance-induced, medical condition",
  "",
  { text:"Key Concept", head:true },
  "Bipolar II is NOT a milder form of Bipolar I — the depressive burden in Bipolar II is often greater, and suicide risk is comparable to or exceeds Bipolar I.",
], C.deepPlum, false);

// B2 — Epidemiology
contentSlide("Bipolar Disorder — Epidemiology", [
  { text:"Prevalence", head:true },
  "Bipolar I: lifetime prevalence ~0.8–1.6% globally; ~1.0% point prevalence",
  "Bipolar II: lifetime prevalence ~0.5%; significantly underdiagnosed (hypomania often not recognized)",
  "Bipolar spectrum (I + II + subthreshold): ~2.4–4.4% lifetime prevalence",
  "Cyclothymia: ~0.4–1.0% lifetime prevalence",
  "",
  { text:"Sex Differences", head:true },
  "Bipolar I: roughly equal between men and women",
  "Bipolar II: women > men (women more likely to have depressive-predominant course, rapid cycling)",
  { text:"Women overrepresented in depressive phases; men in manic/mixed phases", sub:true },
  "Rapid cycling: 70–90% women",
  "",
  { text:"Age of Onset", head:true },
  "Mean onset: 17–22 years (teenage to early adulthood)",
  "Average delay to diagnosis: 5–10 years (often initially misdiagnosed as MDD, ADHD, or personality disorder)",
  { text:"Earlier onset = more severe course, stronger genetic loading, higher recurrence risk", sub:true },
  "",
  { text:"Genetics", head:true },
  "Heritability ~80% — among the most heritable psychiatric disorders",
  "First-degree relatives: 7–10× increased lifetime risk",
  "Monozygotic twin concordance: ~60–70% (Bipolar I)",
], C.deepPlum, false);

// B3 — Epidemiology stats
statSlide("Bipolar Disorder — Key Epidemiological Data", [
  { num:"~80%", label:"Heritability", sub:"Among the most heritable\npsychiatric conditions\nMZ twin concordance ~60–70%" },
  { num:"5–10 yrs", label:"Diagnostic Delay", sub:"Average time from onset\nto correct diagnosis\nFrequently misdiagnosed as MDD" },
  { num:"25%", label:"Lifetime Suicide Risk", sub:"One of the highest among\npsychiatric disorders\nHighest in depressive/mixed phases" },
], C.plum);

// B4 — Neurobiology
contentSlide("Bipolar Disorder — Neurobiology & Pathophysiology", [
  { text:"Monoamine Dysregulation", head:true },
  "Mania: excess dopamine and norepinephrine activity; relative serotonin deficiency in depression phase",
  "Dopamine D2/D3 receptor hypersensitivity implicated in mania and psychosis",
  "",
  { text:"Kindling Model (Neuroprogression)", head:true },
  "Each mood episode increases neurobiological vulnerability to subsequent episodes (sensitization/kindling effect)",
  "Progressive worsening: shorter interepisode intervals, greater severity, more cognitive impairment with each relapse",
  { text:"Supported by CRF-mediated changes, immune activation, oxidative stress, and allostatic load buildup", sub:true },
  "",
  { text:"Immune & Inflammatory Pathways", head:true },
  "Elevated CRP, TNF, IL-6, IL-1RA found during acute bipolar episodes (mania, depression, and euthymia)",
  "T-cell imbalance (pro-inflammatory Th1 vs anti-inflammatory Th2) — normalizes between episodes in BD (unlike MDD)",
  "N-acetylcysteine (NAC): reduces oxidative stress; shown to improve depressive symptoms in BD",
  "",
  { text:"Structural Brain Changes", head:true },
  "Enlarged amygdala volume; reduced prefrontal cortex volume; white matter hyperintensities",
  "Hippocampal volume loss with repeated episodes (more pronounced than in MDD)",
  "",
  { text:"Circadian Rhythm Dysregulation", head:true },
  "Disrupted sleep-wake cycles are both a symptom and a trigger of mood episodes",
  "Social Rhythm Therapy (IPSRT) targets circadian stabilization as a therapeutic goal",
], C.deepPlum, false);

// B5 — Clinical Features: Manic Episode
contentSlide("Bipolar Disorder — Clinical Features: Manic Episode", [
  { text:"Core Features", head:true },
  "Distinct period of abnormally and persistently elevated, expansive, or irritable mood",
  "PLUS markedly increased goal-directed activity or energy",
  "Duration: ≥7 days (or any duration if hospitalization required or psychotic features present)",
  "",
  { text:"DIG FAST Mnemonic (7 Manic Symptoms)", head:true },
  "D — Distractibility: attention easily pulled by irrelevant stimuli",
  "I — Impulsivity/Indiscretion: reckless spending, sexual behavior, unwise investments",
  "G — Grandiosity: inflated self-esteem, may become delusional ('I am God')",
  "F — Flight of ideas / Racing thoughts (rapid, hard-to-follow thought jumps)",
  "A — Activity ↑ goal-directed (work, social, sexual) or psychomotor agitation",
  "S — Sleep decreased: 3 hours feels sufficient; patient feels rested and energized",
  "T — Talkativeness: pressured speech, difficult to interrupt, loud",
  "",
  { text:"Psychotic Features in Mania", head:true },
  "Mood-congruent delusions: grandiose > paranoid (e.g., special powers, missions, divine identity)",
  "Hallucinations less common than in schizophrenia; typically mood-congruent",
  "Flight of ideas vs. thought disorder: in mania, associative links are PRESERVED (vs. schizophrenia)",
], C.deepPlum, false);

// B6 — Mania severity & mixed
contentSlide("Bipolar Disorder — Mania: Severity, Mixed Features & Psychosis", [
  { text:"Severity Spectrum", head:true },
  "Stage 1 (Hypomania): elevated mood, increased energy, decreased sleep, not impairing — 4 days minimum",
  "Stage 2 (Mania): marked impairment or hospitalization required — 7 days minimum",
  "Stage 3 (Severe Mania with Psychosis): delusions, hallucinations, may resemble schizophrenia",
  "",
  { text:"Mixed Features Specifier (DSM-5-TR)", head:true },
  "Manic episode WITH ≥3 concurrent depressive symptoms: dysphoria, guilt, hopelessness, suicidality",
  "Depressive episode WITH ≥3 concurrent manic symptoms: elevated mood, grandiosity, racing thoughts",
  "Mixed states carry the HIGHEST suicide risk in bipolar disorder",
  { text:"Poorer response to lithium monotherapy; valproate preferred; avoid antidepressants", sub:true },
  "",
  { text:"Differential Diagnosis of Mania", head:true },
  "Schizophrenia: persistent psychosis beyond mood episode; more prominent negative symptoms; no clear mood elevation",
  "Schizoaffective Disorder: psychotic symptoms ≥2 weeks WITHOUT mood symptoms",
  "Substance-induced: cocaine, amphetamine, PCP, corticosteroids — must rule out",
  "Medical: thyroid storm, CNS lesions, SLE, temporal lobe epilepsy",
  "ADHD: hyperactivity/distractibility but no episodic course, grandiosity, or decreased sleep",
], C.deepPlum, false);

// B7 — Clinical Features: Hypomania & Depression
contentSlide("Bipolar Disorder — Hypomanic & Depressive Episodes", [
  { text:"Hypomanic Episode", head:true },
  "Same symptom profile as mania but DISTINCT differences:",
  { text:"Duration ≥4 consecutive days (not ≥7)", sub:true },
  { text:"Does NOT cause marked functional impairment", sub:true },
  { text:"Does NOT require hospitalization", sub:true },
  { text:"No psychotic features (presence = mania by definition)", sub:true },
  "Unequivocal change from usual behavior, observable by others",
  "Patient may describe as 'normal' or 'best self' — frequently unreported → diagnostic delay in Bipolar II",
  "",
  { text:"Bipolar Depression", head:true },
  "Clinically overlaps with MDD but distinguishing features include:",
  "Hypersomnia > insomnia; psychomotor retardation > agitation",
  "Atypical features more common (leaden paralysis, mood reactivity, rejection sensitivity)",
  "Psychotic features and suicidal ideation more common than unipolar depression",
  "Earlier age of onset; seasonal pattern; postpartum onset; strong family history of BD",
  "Responds POORLY to antidepressant monotherapy (risk of switch to mania or rapid cycling)",
  "",
  { text:"Screening Tool", head:true },
  "MDQ (Mood Disorder Questionnaire): 13-item screen for bipolar spectrum; sensitivity ~73%, specificity ~90%",
  "HCL-32 (Hypomania Checklist): more sensitive for Bipolar II/hypomania detection",
], C.deepPlum, false);

// B8 — Rapid Cycling & Cyclothymia
contentSlide("Bipolar Disorder — Rapid Cycling & Cyclothymia", [
  { text:"Rapid Cycling (DSM-5-TR Specifier)", head:true },
  "Definition: ≥4 distinct mood episodes (mania, hypomania, or major depression) within any 12-month period",
  "Prevalence: ~10–15% of bipolar patients; predominant in women (70–90%)",
  "Associated conditions: hypothyroidism (check TFTs), antidepressant use, substance abuse",
  { text:"Antidepressant monotherapy is a key precipitant — AVOID in rapid cyclers", sub:true },
  "",
  { text:"Management of Rapid Cycling", head:true },
  "Preferred: valproate (Depakote) ± lithium combination",
  "Lamotrigine: effective for depressive phase; limited anti-manic effect",
  "Thyroid hormone augmentation (levothyroxine to high-normal or slightly supraphysiologic TSH)",
  "Quetiapine: evidence for both phases; often used as adjunct",
  "Taper/discontinue any antidepressants; avoid stimulants",
  "",
  { text:"Cyclothymic Disorder", head:true },
  "Duration: ≥2 years (≥1 year in children/adolescents) of hypomanic + depressive periods",
  "Symptoms never meet full criteria for manic or major depressive episode",
  "No symptom-free period exceeding 2 months",
  "Not attributable to substances or another medical/psychiatric condition",
  "Lifetime risk of developing Bipolar I or II: ~15–50%",
  "Management: psychotherapy (psychoeducation, CBT) ± mood stabilizers",
], C.deepPlum, false);

// B9 — DSM-5-TR Bipolar I
dsmSlide(
  "Bipolar I Disorder — DSM-5-TR Diagnostic Criteria",
  "Criterion: ≥1 Manic Episode. Criterion A: Distinct period of abnormally elevated/expansive/irritable mood + ↑ energy/activity (≥7 days or any duration if hospitalized).",
  [
    "Criterion B: During mood disturbance, ≥3 of the following present (≥4 if mood is irritable only):",
    "  1. Inflated self-esteem or grandiosity",
    "  2. Decreased need for sleep (feels rested after only 3 hours of sleep)",
    "  3. More talkative than usual OR pressure to keep talking",
    "  4. Flight of ideas OR subjective experience of thoughts racing",
    "  5. Distractibility (attention easily drawn to unimportant/irrelevant stimuli)",
    "  6. ↑ Goal-directed activity (social/work/sexual/school) OR psychomotor agitation",
    "  7. Excessive involvement in activities with high potential for painful consequences",
    "       (unrestrained spending, sexual indiscretions, foolish business investments)",
    "",
    "Criterion C: Mood disturbance causes MARKED impairment OR requires hospitalization to prevent harm OR has psychotic features",
    "Criterion D: NOT attributable to physiological effects of a substance or another medical condition",
    "",
    "Note: A major depressive episode is NOT required for Bipolar I diagnosis.",
    "One manic episode is sufficient. One manic episode in a patient with prior Bipolar II → upgrades to Bipolar I.",
  ],
  C.plum
);

// B10 — DSM-5-TR Bipolar II
dsmSlide(
  "Bipolar II Disorder — DSM-5-TR Diagnostic Criteria",
  "Criteria: ≥1 Hypomanic Episode + ≥1 Major Depressive Episode; NO history of a full manic episode.",
  [
    "Hypomanic Episode Criterion A: Distinct period of abnormally elevated/expansive/irritable mood + ↑ energy (≥4 consecutive days)",
    "",
    "Hypomanic Criterion B: Same 7 symptoms as mania (≥3 required; ≥4 if irritable mood only)",
    "",
    "Hypomanic Criteria C–F:",
    "  C. Episode is an unequivocal change from non-depressed baseline — observable by others",
    "  D. Not severe enough to cause marked functional impairment or require hospitalization",
    "  E. No psychotic features (if present → manic episode → diagnosis = Bipolar I)",
    "  F. Not attributable to substances or another medical condition",
    "",
    "Major Depressive Episode: ≥5 MDD criteria met for ≥2 weeks (see MDD criteria)",
    "",
    "Important Distinctions:",
    "• Bipolar II ≠ milder Bipolar I — patients spend more time in depression; significant functional impairment",
    "• Suicide risk in Bipolar II is at least equal to, possibly greater than, Bipolar I",
    "• One manic episode at any point in life = UPGRADE diagnosis to Bipolar I",
    "• Must be distinguished from MDD, borderline personality disorder, and cyclothymia",
  ],
  C.plum
);

// B11 — DSM Cyclothymia table
dsmSlide(
  "Cyclothymic Disorder — DSM-5-TR Diagnostic Criteria",
  "A chronic, fluctuating mood disturbance that is a subthreshold bipolar spectrum condition.",
  [
    "Criterion A: ≥2 years (≥1 year in children/adolescents) of numerous hypomanic and depressive periods",
    "  — Hypomanic periods: do not meet full criteria for a hypomanic episode",
    "  — Depressive periods: do not meet full criteria for a major depressive episode",
    "",
    "Criterion B: During the 2-year period (1 year in children), the hypomanic and depressive periods have been present ≥50% of the time and the individual has not been without symptoms for >2 consecutive months",
    "",
    "Criterion C: Criteria for a major depressive, manic, or hypomanic episode have NEVER been met",
    "",
    "Criterion D: Symptoms not better explained by schizoaffective disorder, schizophrenia, or other psychotic disorder",
    "Criterion E: Not attributable to substances or another medical condition",
    "Criterion F: Symptoms cause clinically significant distress or functional impairment",
    "",
    "Key Points:",
    "• Lifetime conversion risk to Bipolar I or II: ~15–50%",
    "• Treat as a bipolar spectrum condition: avoid antidepressant monotherapy",
    "• Mood stabilizers + psychotherapy; lithium and valproate have evidence",
  ],
  C.plum
);

// B12 — Pharmacological Management: Acute Mania
contentSlide("Bipolar Disorder — Pharmacological Tx: Acute Mania", [
  { text:"First-Line Mood Stabilizers", head:true },
  "Lithium (Eskalith): first-line; 50–70% response rate; classic euphoric mania responds best",
  { text:"Therapeutic serum level: 0.8–1.2 mEq/L (acute); 0.6–1.0 mEq/L (maintenance)", sub:true },
  { text:"Monitor: renal function, TFTs, serum levels; toxic above 1.5 mEq/L (tremor, confusion, polyuria)", sub:true },
  "Valproate (Depakote/Depakene): faster onset than lithium; especially effective for mixed mania, rapid cycling, dysphoric mania, organic mania",
  { text:"Monitor: LFTs, CBC, serum level (50–125 mcg/mL); weight gain, teratogenic (neural tube defects)", sub:true },
  "Carbamazepine (Tegretol): effective; especially when lithium non-responders, dysphoric mania",
  { text:"Monitor: CBC (aplastic anemia risk ~1:125,000), LFTs; autoinduction reduces own serum levels", sub:true },
  "",
  { text:"Atypical Antipsychotics (FDA-Approved for Acute Mania)", head:true },
  "Olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, asenapine, cariprazine, paliperidone",
  "Faster onset of antimanic effect than mood stabilizers; often used in combination",
  "Adjunctive benzodiazepines (lorazepam, clonazepam): acute agitation and sleep",
  "",
  { text:"Avoid in Mania", head:true },
  "Antidepressant monotherapy: high risk of manic switch or precipitating rapid cycling",
  "Stimulants, caffeine, sleep deprivation — all can precipitate or worsen manic episodes",
], C.deepPlum, false);

// B13 — Pharmacological: Bipolar Depression
contentSlide("Bipolar Disorder — Pharmacological Tx: Bipolar Depression", [
  { text:"FDA-Approved for Bipolar Depression", head:true },
  "Quetiapine (Seroquel) monotherapy: most robust evidence for bipolar depression (Bipolar I and II)",
  "Lurasidone (Latuda): FDA-approved for bipolar I depression; monotherapy or adjunct to lithium/valproate",
  "Olanzapine-fluoxetine combination (Symbyax): FDA-approved; effective but weight gain concern",
  "Cariprazine (Vraylar): FDA-approved for bipolar I depression; also effective for mania",
  "",
  { text:"Mood Stabilizers in Depression", head:true },
  "Lithium: moderate antidepressant effect in bipolar depression; also reduces suicidal ideation",
  "Lamotrigine (Lamictal): most evidence for bipolar II depression maintenance; slow titration (weeks) to reduce Stevens-Johnson Syndrome (SJS) risk",
  { text:"SJS risk: titrate slowly; 25 mg/week for 6 weeks; valproate doubles lamotrigine levels (halve dose)", sub:true },
  "",
  { text:"Antidepressants: Use with CAUTION", head:true },
  "May be used ADJUNCTIVELY with a mood stabilizer (never as monotherapy in bipolar)",
  "Risk: manic switch (~10–15%), rapid cycling induction, mixed state worsening",
  "If used: bupropion and SSRIs preferred over TCAs/SNRIs (lower switch rates)",
  "",
  { text:"Non-Standard/Emerging", head:true },
  "Pramipexole (dopamine agonist): evidence for bipolar II depression",
  "Ketamine/esketamine: rapid antidepressant effect; being studied in bipolar depression",
  "NAC (N-acetylcysteine): adjunctive; reduces depressive symptoms; anti-inflammatory mechanism",
], C.deepPlum, false);

// B14 — Pharmacological: Maintenance
twoCol(
  "Bipolar Disorder — Maintenance Pharmacotherapy",
  "Long-Term Mood Stabilizers",
  [
    "Lithium: gold standard maintenance; reduces all-cause mortality by ~60%; proven anti-suicide effect; prevents both mania and depression",
    "Valproate: especially effective for mania prevention; less evidence for depression prevention",
    "Lamotrigine: superior for depression prevention; limited anti-manic effect",
    "Carbamazepine: alternative to lithium; prophylaxis for dysphoric mania, Bipolar II, schizoaffective",
    "Combination therapy often superior to monotherapy (lithium + valproate; lithium + lamotrigine)",
  ],
  "Atypical Antipsychotics (Maintenance)",
  [
    "Aripiprazole: FDA-approved for mania maintenance (Bipolar I)",
    "Quetiapine: FDA-approved for maintenance (Bipolar I); evidence for both poles",
    "Olanzapine: FDA-approved for maintenance; significant metabolic side effects",
    "Risperidone LAI: long-acting injectable; reduces relapse in Bipolar I",
    "Monitoring for ALL long-term bipolar meds: metabolic syndrome (weight, glucose, lipids), thyroid (lithium), renal (lithium), teratogenicity (valproate — Neural Tube Defects in pregnancy)",
    "Abrupt lithium discontinuation = HIGH risk of rebound mania — taper over ≥2 weeks",
  ],
  C.deepPlum, false
);

// B15 — Non-Pharmacological
contentSlide("Bipolar Disorder — Non-Pharmacological Management", [
  { text:"Electroconvulsive Therapy (ECT)", head:true },
  "Highly effective for acute severe mania, mixed episodes, psychotic mania, catatonic features",
  "Effective for severe bipolar depression (especially with psychosis, suicidality, pregnancy)",
  "Preferred when rapid response is critical; response rates ~60–80%",
  "",
  { text:"Psychoeducation (CORNERSTONE of BD Management)", head:true },
  "Recognition of prodromal symptoms (early warning signs of mania or depression)",
  "Understanding triggers: sleep disruption, stress, substance use, irregular routine",
  "Medication adherence — poor adherence is the leading cause of relapse",
  "Role of family/significant others in monitoring mood changes",
  "",
  { text:"Structured Psychotherapies", head:true },
  "Interpersonal and Social Rhythm Therapy (IPSRT): stabilizes biological rhythms and sleep-wake cycles; directly targets circadian dysregulation",
  "Family-Focused Therapy (FFT): reduces expressed emotion (EE) in family; improves communication",
  "Cognitive-Behavioral Therapy (CBT): relapse prevention, adherence, cognitive restructuring",
  "Group Therapy / Peer Support: reduces isolation, improves insight, shared coping strategies",
  "",
  { text:"Lifestyle Modifications", head:true },
  "Regular sleep schedule (sleep disruption is a MAJOR precipitant of mania)",
  "Abstinence from alcohol and illicit substances (substance use comorbidity in ~60% of BD patients)",
  "Daily routine stabilization; regular exercise; stress management; avoiding night-shift work",
], C.deepPlum, false);

// B16 — Lithium: Deep Dive
darkContentSlide("Bipolar Disorder — Lithium: Pharmacology & Monitoring", [
  { text:"Mechanism of Action", head:true },
  "Inhibits inositol monophosphatase (IP3 pathway) → ↓ PKC signaling; inhibits GSK-3β → neuroprotective effects",
  "Modulates dopamine and serotonin neurotransmission; promotes BDNF expression and neuroplasticity",
  "",
  { text:"Pharmacokinetics", head:true },
  "Oral bioavailability ~95%; renal excretion (competes with sodium — dehydration/low-sodium diet ↑ toxicity)",
  "Narrow therapeutic index: therapeutic 0.8–1.2 mEq/L; toxic >1.5 mEq/L",
  "Half-life: 18–36 hours; steady-state in 4–5 days",
  "",
  { text:"Adverse Effects", head:true },
  "Early (therapeutic): fine tremor, polyuria/polydipsia (nephrogenic DI), nausea, diarrhea, cognitive slowing",
  "Long-term: hypothyroidism (↑TSH ~20–40%), hyperparathyroidism, renal impairment, weight gain, acne",
  "Toxicity: coarse tremor, ataxia, confusion, seizures, cardiac arrhythmias, renal failure",
  "",
  { text:"Monitoring Protocol", head:true },
  "Before starting: serum creatinine, TFTs, urinalysis, ECG (if >50 yrs), pregnancy test",
  "During treatment: serum level (12 hrs post-dose), creatinine, TFTs — every 6 months",
  "Interactions: NSAIDs, thiazide diuretics, ACE inhibitors/ARBs → ↑ lithium levels (toxicity risk)",
  "Caffeine withdrawal → ↑ lithium levels; sodium restriction → ↑ lithium levels",
], C.plum);

// B17 — Prognosis
contentSlide("Bipolar Disorder — Prognosis & Course", [
  { text:"Course & Chronicity", head:true },
  "Bipolar disorder is a lifelong condition — most patients require lifelong treatment",
  "Average of 8–10 mood episodes over a lifetime without treatment",
  "Interepisode intervals tend to SHORTEN with each recurrence (kindling)",
  "~15–20% have a chronic course with incomplete interepisode remission",
  "",
  { text:"Functional Outcomes", head:true },
  "~40–50% of patients have significant functional impairment between episodes (occupational, social, cognitive)",
  "Cognitive impairment (memory, executive function) persists during euthymia in a subset — 'neuroprogression'",
  "50% of patients with BD eventually require disability assistance at some point",
  "",
  { text:"Poor Prognostic Indicators", head:true },
  "Early onset (<21 yrs), rapid cycling, mixed episodes, psychotic features",
  "Comorbid substance use disorder (very common — ~50–60% lifetime)",
  "Medication non-adherence (most common cause of relapse); abrupt lithium discontinuation",
  "High expressed emotion in family; multiple prior episodes; comorbid anxiety disorders",
  "",
  { text:"Favorable Prognostic Indicators", head:true },
  "Later onset, good premorbid functioning, clear episodic pattern, strong social support",
  "Lithium responsiveness (predicts better long-term course)",
  "Absence of rapid cycling, psychosis, or substance use comorbidity",
], C.deepPlum, false);

// B18 — Suicide in Bipolar
darkContentSlide("Bipolar Disorder — Suicide Risk", [
  { text:"Epidemiology", head:true },
  "Lifetime suicide risk: ~15–25% — among the highest of any psychiatric disorder",
  "Suicide attempts: ~25–50% of patients with BD will attempt suicide at least once",
  "Rate of completed suicide: 10–30× higher than general population",
  "Bipolar II may carry HIGHER suicide attempt rate than Bipolar I (more time in depression, less grandiosity)",
  "",
  { text:"Highest Risk Periods", head:true },
  "During depressive and mixed episodes",
  "During rapid cycling phase",
  "Early in illness (first 2 years — often before diagnosis/adequate treatment)",
  "Transition periods: entering or exiting mania (partial treatment → mixed state)",
  "",
  { text:"Risk Factors Specific to BD", head:true },
  "Past suicide attempt (strongest predictor), hopelessness, comorbid substance abuse",
  "Mixed features (dysphoric mania) — high energy + dysphoria = lethal combination",
  "Impulsivity — especially during manic/mixed episodes with access to means",
  "Comorbid anxiety disorders significantly increase suicide risk",
  "",
  { text:"Protective Pharmacotherapy", head:true },
  "Lithium: strongest evidence for reduction of suicidal behavior (all-cause mortality ↓ ~60%)",
  "Clozapine: FDA-approved for reducing suicidal behavior in schizoaffective/schizophrenia (evidence in BD)",
  "Adequate mood stabilization; avoid antidepressant monotherapy; treat substance use comorbidity",
], C.plum);

// ══════════════════════════════════════════════════════════════════════════
// COMPARISON SLIDES
// ══════════════════════════════════════════════════════════════════════════
sectionDiv("COMPARISON", "MDD vs.\nBipolar Disorder", "Clinical distinctions and diagnostic pearls", C.navy);

// Comparison table
compareSlide(
  "MDD vs. Bipolar Disorder — Clinical Comparison",
  ["Feature", "MDD (Unipolar)", "Bipolar Disorder"],
  [
    ["Mood episodes",        "Depressive only",                    "Manic + depressive ± hypomanic"],
    ["Mean age of onset",    "~40 years",                          "~18–22 years"],
    ["Sex predominance",     "Women > Men (2:1)",                  "BD-I: Equal; BD-II: Women > Men"],
    ["Lifetime prevalence",  "~10.8%",                             "~1–4% (spectrum)"],
    ["Sleep pattern",        "Insomnia (early morning awakening)", "↓ Sleep in mania; hypersomnia in depression"],
    ["Psychomotor",          "Agitation OR retardation",           "Agitation (mania); retardation (depression)"],
    ["Antidepressant use",   "Safe as monotherapy",                "RISKY alone — may precipitate mania/rapid cycling"],
    ["First-line Rx",        "SSRIs / SNRIs",                      "Lithium / Valproate / Atypical antipsychotics"],
    ["Suicide risk",         "~15% lifetime",                      "~15–25% lifetime"],
    ["Prognosis",            "Episodic; ~15–20% chronic",          "Lifelong; neuroprogression with recurrence"],
  ],
  C.navy
);

// Key differentiation slide
twoCol(
  "Differentiating Bipolar Depression from MDD",
  "Clues Pointing to Bipolar",
  [
    "Earlier age of onset (<25 yrs)",
    "Family history of bipolar disorder",
    "Multiple prior episodes (≥3) or rapid cycling",
    "Hypersomnia, hyperphagia, leaden paralysis predominant",
    "Prior hypomanic symptoms (even if mild/unreported)",
    "Seasonality of episodes",
    "Psychotic features within a depressive episode",
    "Postpartum mood episode",
    "Antidepressant-induced agitation/mood activation",
    "Poor/partial response to multiple antidepressants",
  ],
  "Management Pitfalls to Avoid",
  [
    "Never start antidepressant monotherapy without ruling out bipolar",
    "Always screen with MDQ / HCL-32 in new-onset depression",
    "Antidepressant monotherapy in bipolar → risk of manic switch or rapid cycling",
    "Lithium discontinuation must be gradual — never abrupt",
    "Lamotrigine must be titrated slowly (SJS risk)",
    "Valproate: teratogenic (neural tube defects) — contraception required in women of childbearing age",
    "Rapid cycling: investigate and treat hypothyroidism; taper antidepressants",
    "Mixed states: avoid antidepressants; valproate or atypical antipsychotics preferred",
  ],
  C.navy, false
);

// Drug summary comparison
compareSlide(
  "Pharmacological Management — Quick Reference Summary",
  ["Drug/Class", "MDD", "Bipolar Disorder"],
  [
    ["SSRIs",             "First-line",                              "Adjunct ONLY with mood stabilizer (risk of switch)"],
    ["SNRIs",             "First-line",                              "Caution — higher switch risk than SSRIs"],
    ["Bupropion",         "First-line (esp. fatigue, weight)",       "Lower switch risk; used adjunctively"],
    ["Lithium",           "Augmentation (TRD)",                      "Gold standard for mania + maintenance + suicide prevention"],
    ["Valproate",         "Limited use",                             "Acute mania, mixed states, rapid cycling, maintenance"],
    ["Lamotrigine",       "Augmentation",                            "Bipolar depression + maintenance (NOT acute mania)"],
    ["Quetiapine",        "Augmentation (TRD)",                      "FDA-approved: acute mania, bipolar depression, maintenance"],
    ["Aripiprazole",      "Augmentation (TRD)",                      "FDA-approved: acute mania, maintenance"],
    ["ECT",               "Severe/psychotic/refractory MDD",         "Severe mania, bipolar depression, pregnancy"],
    ["Esketamine",        "FDA-approved: TRD (2019)",                "Under investigation"],
  ],
  C.navy
);

// ══════════════════════════════════════════════════════════════════════════
// MNEMONICS SLIDE
// ══════════════════════════════════════════════════════════════════════════
darkContentSlide("Clinical Mnemonics & Memory Aids", [
  { text:"MDD Criteria — SIG E CAPS (prescribe energy capsules)", head:true },
  "S — Sleep disturbance (insomnia or hypersomnia)",
  "I — Interest/Anhedonia ↓",
  "G — Guilt / Worthlessness",
  "E — Energy ↓ (fatigue)",
  "C — Concentration ↓",
  "A — Appetite/Weight change",
  "P — Psychomotor change (agitation or retardation)",
  "S — Suicidal ideation",
  { text:"Requires ≥5 symptoms ≥2 weeks; at least 1 of: depressed mood OR anhedonia", sub:true },
  "",
  { text:"Manic Symptoms — DIG FAST", head:true },
  "D — Distractibility  |  I — Impulsivity/Indiscretion  |  G — Grandiosity",
  "F — Flight of ideas  |  A — Activity ↑  |  S — Sleep ↓  |  T — Talkativeness",
  { text:"Requires ≥3 (≥4 if irritable) + markedly elevated/irritable mood + ↑ energy ≥7 days", sub:true },
  "",
  { text:"Suicide Risk — SAD PERSONS", head:true },
  "Sex (M) | Age (<19, >45) | Depression | Prior attempt | EtOH | Rational loss | Social support ↓ | Organized plan | No spouse | Sickness",
], C.teal);

// ══════════════════════════════════════════════════════════════════════════
// FINAL / THANK YOU
// ══════════════════════════════════════════════════════════════════════════
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    { text:"MDD", options:{ bold:true, fontSize:18, color:"7FD8E8", fontFace:"Calibri", breakLine:true } },
    { text:"Unipolar, episodic depressive disorder\n", options:{ fontSize:12, color:"C0D8E8", fontFace:"Calibri", breakLine:true } },
    { text:"First-line: SSRIs / SNRIs + CBT\n", options:{ fontSize:12, color:"C0D8E8", fontFace:"Calibri", breakLine:true } },
    { text:"ECT for severe/psychotic/refractory\n", options:{ fontSize:12, color:"C0D8E8", fontFace:"Calibri", breakLine:true } },
    { text:"Suicide risk: ~15% untreated\n\n", options:{ fontSize:12, color:"C0D8E8", fontFace:"Calibri", breakLine:true } },
    { text:"Bipolar Disorder", options:{ bold:true, fontSize:18, color:"C8A5E8", fontFace:"Calibri", breakLine:true } },
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  s.addText("PART B\nBipolar", { x:7.1, y:1.8, w:2.8, h:1.2, fontSize:22, bold:true, color:C.white, fontFace:"Calibri Light", align:"center" });
  s.addText("DSM-5-TR\nAPA 2022", { x:7.1, y:3.1, w:2.8, h:0.9, fontSize:11, color:"CCAAEE", fontFace:"Calibri", align:"center" });
  s.addText("Sources: Kaplan & Sadock's Synopsis of Psychiatry, 12th Ed.  |  Kaplan & Sadock's Comprehensive Textbook of Psychiatry  |  DSM-5-TR (APA, 2022)", {
    x:0.3, y:5.2, w:9.4, h:0.32, fontSize:9, color:"778899", fontFace:"Calibri", italic:true, align:"center"
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SAVE
// ══════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/mood-disorders-pptx/MDD_Bipolar_Elegant_v2.pptx" })
  .then(() => console.log("SUCCESS: Saved."))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });
SCRIPT_END

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/mood-disorders-pptx/build_v2.js'

"""
Add slide transitions + entrance animations to every slide in the PPTX.

Strategy:
  - Title slides / section dividers  → Fade transition (elegant, smooth)
  - Content slides                   → Push transition (directional flow)
  - Stat / dark slides               → Reveal / Cover transition
  - All shapes on each slide get entrance animations (Fade or Fly-In)
    applied via <p:timing> OOXML blocks injected directly into each slide XML.
"""

from pptx import Presentation
from pptx.util import Pt
from lxml import etree
import copy, re

SRC  = "/home/daytona/workspace/mood-disorders-pptx/MDD_Bipolar_Elegant_v2.pptx"
DEST = "/home/daytona/workspace/mood-disorders-pptx/MDD_Bipolar_Animated_v3.pptx"

prs = Presentation(SRC)

# ── XML NAMESPACES ─────────────────────────────────────────────────────────
nsmap = {
    'a':   'http://schemas.openxmlformats.org/drawingml/2006/main',
    'p':   'http://schemas.openxmlformats.org/presentationml/2006/main',
    'r':   'http://schemas.openxmlformats.org/officeDocument/2006/relationships',
}

def qn(prefix, tag):
    return '{%s}%s' % (nsmap[prefix], tag)

# ── SLIDE TRANSITION HELPERS ───────────────────────────────────────────────

def make_fade_transition(dur_ms=600):
    """Elegant Fade transition."""
    xml = f'''<p:transition xmlns:p="http://schemas.openxmlformats.org/presentationml/2006/main"
                  spd="med" advClick="1">
  <p:fade />
</p:transition>'''
    return etree.fromstring(xml)

def make_push_transition(dir_="l", dur_ms=500):
    """Push transition — content slides."""
    xml = f'''<p:transition xmlns:p="http://schemas.openxmlformats.org/presentationml/2006/main"
                  spd="med" advClick="1">
  <p:push dir="{dir_}" />
</p:transition>'''
    return etree.fromstring(xml)

def make_wipe_transition(dir_="l"):
    """Wipe/reveal transition."""
    xml = f'''<p:transition xmlns:p="http://schemas.openxmlformats.org/presentationml/2006/main"
                  spd="med" advClick="1">
  <p:wipe dir="{dir_}" />
</p:transition>'''
    return etree.fromstring(xml)

def make_cover_transition(dir_="l"):
    """Cover transition for stat slides."""
    xml = f'''<p:transition xmlns:p="http://schemas.openxmlformats.org/presentationml/2006/main"
                  spd="fast" advClick="1">
  <p:cover dir="{dir_}" />
</p:transition>'''
    return etree.fromstring(xml)

# ── ANIMATION TIMING BLOCK BUILDER ────────────────────────────────────────

def build_timing_block(shape_ids, anim_type="fade"):
    """
    Build a complete <p:timing> element that:
      1. Starts all animations on click (first click) in sequence,
         with a small delay between each element (stagger effect).
      2. Uses Fade in for header/text shapes, FlyInFromBottom for bullets.
    Returns lxml Element.
    """
    # Build the cTnLst (condition time node list) for each shape
    par_nodes = []
    for i, sp_id in enumerate(shape_ids):
        delay_ms = i * 180  # 180ms stagger between elements
        if anim_type == "flyup":
            anim_xml = _fly_up_anim(sp_id, delay_ms, i)
        elif anim_type == "zoom":
            anim_xml = _zoom_anim(sp_id, delay_ms, i)
        else:
            anim_xml = _fade_anim(sp_id, delay_ms, i)
        par_nodes.append(anim_xml)

    # Wrap all in a sequence triggered by onClick
    seq_id_base = 100
    timing_xml = '''<p:timing xmlns:p="http://schemas.openxmlformats.org/presentationml/2006/main"
              xmlns:a="http://schemas.openxmlformats.org/drawingml/2006/main">
  <p:tnLst>
    <p:par>
      <p:cTn id="1" dur="indefinite" restart="whenNotActive" nodeType="tmRoot">
        <p:childTnLst>
          <p:seq concurrent="1" nextAc="seek">
            <p:cTn id="2" dur="indefinite" nodeType="mainSeq">
              <p:childTnLst>
                ANIM_PLACEHOLDERS
              </p:childTnLst>
            </p:cTn>
            <p:prevCondLst>
              <p:cond evt="onPrevClick" delay="0">
                <p:tn />
              </p:cond>
            </p:prevCondLst>
            <p:nextCondLst>
              <p:cond evt="onNextClick" delay="0">
                <p:tn />
              </p:cond>
            </p:nextCondLst>
          </p:seq>
        </p:childTnLst>
      </p:cTn>
    </p:par>
  </p:tnLst>
  <p:bldLst />
</p:timing>'''

    placeholder = "\n                ANIM_PLACEHOLDERS"
    # Insert each par node as XML string
    par_strings = [etree.tostring(n, encoding='unicode') for n in par_nodes]
    combined = "\n".join(par_strings)
    timing_xml = timing_xml.replace("ANIM_PLACEHOLDERS", combined)

    return etree.fromstring(timing_xml)


def _fade_anim(sp_id, delay_ms, idx):
    """Fade entrance animation for a shape."""
    ctn_id = 10 + idx * 10
    xml = f'''<p:par xmlns:p="http://schemas.openxmlformats.org/presentationml/2006/main"
              xmlns:a="http://schemas.openxmlformats.org/drawingml/2006/main">
  <p:cTn id="{ctn_id}" presetID="10" presetClass="entr" presetSubtype="0"
         fill="hold" grpId="{idx}" nodeType="{"clickEffect" if idx == 0 else "afterEffect"}">
    <p:stCondLst>
      <p:cond delay="{delay_ms}"/>
    </p:stCondLst>
    <p:childTnLst>
      <p:set>
        <p:cBhvr>
          <p:cTn id="{ctn_id+1}" dur="1" fill="hold"/>
          <p:tgtEl>
            <p:spTgt spid="{sp_id}"/>
          </p:tgtEl>
          <p:attrNameLst>
            <p:attrName>style.visibility</p:attrName>
          </p:attrNameLst>
        </p:cBhvr>
        <p:to><a:strVal val="visible"/></p:to>
      </p:set>
      <p:animEffect transition="in" filter="fade">
        <p:cBhvr>
          <p:cTn id="{ctn_id+2}" dur="500"/>
          <p:tgtEl>
            <p:spTgt spid="{sp_id}"/>
          </p:tgtEl>
        </p:cBhvr>
      </p:animEffect>
    </p:childTnLst>
  </p:cTn>
</p:par>'''
    return etree.fromstring(xml)


def _fly_up_anim(sp_id, delay_ms, idx):
    """Fly-in from bottom animation."""
    ctn_id = 10 + idx * 10
    xml = f'''<p:par xmlns:p="http://schemas.openxmlformats.org/presentationml/2006/main"
              xmlns:a="http://schemas.openxmlformats.org/drawingml/2006/main">
  <p:cTn id="{ctn_id}" presetID="2" presetClass="entr" presetSubtype="8"
         fill="hold" grpId="{idx}" nodeType="{"clickEffect" if idx == 0 else "afterEffect"}">
    <p:stCondLst>
      <p:cond delay="{delay_ms}"/>
    </p:stCondLst>
    <p:childTnLst>
      <p:set>
        <p:cBhvr>
          <p:cTn id="{ctn_id+1}" dur="1" fill="hold"/>
          <p:tgtEl><p:spTgt spid="{sp_id}"/></p:tgtEl>
          <p:attrNameLst><p:attrName>style.visibility</p:attrName></p:attrNameLst>
        </p:cBhvr>
        <p:to><a:strVal val="visible"/></p:to>
      </p:set>
      <p:animMotion origin="layout" path="M 0 0.25 L 0 0 E" pathEditMode="auto" rAng="0">
        <p:cBhvr>
          <p:cTn id="{ctn_id+2}" dur="500" fill="hold"/>
          <p:tgtEl><p:spTgt spid="{sp_id}"/></p:tgtEl>
          <p:attrNameLst><p:attrName>ppt_x</p:attrName><p:attrName>ppt_y</p:attrName></p:attrNameLst>
        </p:cBhvr>
      </p:animMotion>
      <p:animEffect transition="in" filter="fade">
        <p:cBhvr>
          <p:cTn id="{ctn_id+3}" dur="500"/>
          <p:tgtEl><p:spTgt spid="{sp_id}"/></p:tgtEl>
        </p:cBhvr>
      </p:animEffect>
    </p:childTnLst>
  </p:cTn>
</p:par>'''
    return etree.fromstring(xml)


def _zoom_anim(sp_id, delay_ms, idx):
    """Zoom entrance animation for stat/number slides."""
    ctn_id = 10 + idx * 10
    xml = f'''<p:par xmlns:p="http://schemas.openxmlformats.org/presentationml/2006/main"
              xmlns:a="http://schemas.openxmlformats.org/drawingml/2006/main">
  <p:cTn id="{ctn_id}" presetID="22" presetClass="entr" presetSubtype="0"
         fill="hold" grpId="{idx}" nodeType="{"clickEffect" if idx == 0 else "afterEffect"}">
    <p:stCondLst>
      <p:cond delay="{delay_ms}"/>
    </p:stCondLst>
    <p:childTnLst>
      <p:set>
        <p:cBhvr>
          <p:cTn id="{ctn_id+1}" dur="1" fill="hold"/>
          <p:tgtEl><p:spTgt spid="{sp_id}"/></p:tgtEl>
          <p:attrNameLst><p:attrName>style.visibility</p:attrName></p:attrNameLst>
        </p:cBhvr>
        <p:to><a:strVal val="visible"/></p:to>
      </p:set>
      <p:animEffect transition="in" filter="fade">
        <p:cBhvr>
          <p:cTn id="{ctn_id+2}" dur="400"/>
          <p:tgtEl><p:spTgt spid="{sp_id}"/></p:tgtEl>
        </p:cBhvr>
      </p:animEffect>
    </p:childTnLst>
  </p:cTn>
</p:par>'''
    return etree.fromstring(xml)


# ── HELPER: remove existing transition/timing ─────────────────────────────

def strip_existing(spTree_parent, slide_el):
    """Remove any existing <p:timing> and <p:transition> from the slide element."""
    p_ns = 'http://schemas.openxmlformats.org/presentationml/2006/main'
    for tag in ['timing', 'transition']:
        old = slide_el.find(f'{{{p_ns}}}{tag}')
        if old is not None:
            slide_el.remove(old)


# ── CLASSIFY SLIDES ────────────────────────────────────────────────────────

def classify_slide(slide, idx):
    """
    Returns a tuple: (transition_type, animation_type)
    transition_type: 'fade' | 'push' | 'wipe' | 'cover'
    animation_type:  'fade' | 'flyup' | 'zoom'
    """
    # Extract all text on slide
    texts = []
    for shape in slide.shapes:
        if shape.has_text_frame:
            texts.append(shape.text_frame.text.strip())
    combined = " ".join(texts).lower()

    # Title slide (slide 1)
    if idx == 0:
        return ('fade', 'fade')
    # TOC slide
    if idx == 1:
        return ('push', 'fade')
    # Section dividers (have short text, "PART A", "PART B", "COMPARISON")
    if any(kw in combined for kw in ['part a', 'part b', 'comparison', 'contents']):
        return ('wipe', 'fade')
    # Stat slides (contain % symbols prominently or "key epidemiological")
    if '10.8%' in combined or '~80%' in combined or '5–10 yrs' in combined:
        return ('cover', 'zoom')
    # DSM criteria slides
    if 'criterion' in combined or 'dsm-5-tr diagnostic' in combined:
        return ('push', 'fade')
    # Dark content slides (dark background — check fill color)
    # Two-col slides
    if 'first-line' in combined and 'second-line' in combined:
        return ('push', 'flyup')
    # Default content slides
    return ('push', 'flyup')


# ── MAIN PROCESSING LOOP ───────────────────────────────────────────────────

p_ns = 'http://schemas.openxmlformats.org/presentationml/2006/main'

for slide_idx, slide in enumerate(prs.slides):
    slide_el = slide._element

    # 1. Remove any existing transition/timing
    strip_existing(None, slide_el)

    # 2. Determine transition and animation type
    trans_type, anim_type = classify_slide(slide, slide_idx)

    # 3. Build and append transition
    if trans_type == 'fade':
        trans = make_fade_transition()
    elif trans_type == 'wipe':
        dir_ = 'l' if slide_idx % 2 == 0 else 'r'
        trans = make_wipe_transition(dir_)
    elif trans_type == 'cover':
        trans = make_cover_transition('l')
    else:  # push
        dir_ = 'l'
        trans = make_push_transition(dir_)

    slide_el.append(trans)

    # 4. Collect shape IDs for animations (skip background rects — shapes with no text and very large)
    shape_ids = []
    for shape in slide.shapes:
        sp_id = shape.shape_id
        # Include all shapes: rectangles (decorative), text boxes, grouped shapes
        # Skip only shapes that have no text AND are very large (background fills)
        w_emu = shape.width if shape.width else 0
        h_emu = shape.height if shape.height else 0
        slide_w = prs.slide_width
        slide_h = prs.slide_height
        is_full_bg = (w_emu >= slide_w * 0.9 and h_emu >= slide_h * 0.9)
        # Also skip thin accent bars (height < 0.12 inches = 109728 EMU or width < 0.25 in = 228600)
        is_accent_bar = (h_emu <= 130000 or w_emu <= 250000)
        if not is_full_bg and not is_accent_bar:
            shape_ids.append(sp_id)

    if not shape_ids:
        continue

    # 5. Limit to max 12 shapes per slide to avoid timing complexity
    shape_ids = shape_ids[:12]

    # 6. Build timing block and append
    try:
        timing = build_timing_block(shape_ids, anim_type)
        slide_el.append(timing)
    except Exception as e:
        print(f"  Warning slide {slide_idx+1}: timing build failed ({e}) — skipping animations for this slide")

    print(f"Slide {slide_idx+1:02d}: {trans_type} transition + {anim_type} animations ({len(shape_ids)} shapes)")

# ── SAVE ───────────────────────────────────────────────────────────────────
prs.save(DEST)
print(f"\nSaved: {DEST}")

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/mood-disorders-pptx/add_animations.py'