const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Mood Disorders: MDD & Bipolar Disorder";
pres.author = "Kaplan & Sadock 12e / DSM-5-TR";

// ─── PALETTE ────────────────────────────────────────────────────────────────
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  blue:    "1565C0",   // section header
  teal:    "00838F",   // accent / bipolar
  amber:   "F57F17",   // accent / highlight
  plum:    "6A1B9A",   // MDD accent
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  bpAccent:  "00ACC1", // teal for Bipolar
  warn:    "FF7043",
};

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// ─── SLIDE 1: TITLE ──────────────────────────────────────────────────────────
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// ─── SLIDE 2: OUTLINE ───────────────────────────────────────────────────────
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// ═══════════════════════════════════════════════════════════════════
//  PART I — MAJOR DEPRESSIVE DISORDER
// ═══════════════════════════════════════════════════════════════════

// SLIDE 3: MDD Section Header
sectionDivider(pres,
  "PART I",
  C.mddAccent,
  "Major Depressive Disorder (MDD)"
);

// SLIDE 4: MDD — Introduction
cardSlide(pres, {
  title: "MDD — Introduction",
  accent: C.mddAccent,
  bullets: [
    "Major depressive disorder (MDD) is a primary mood disorder characterized by persistent depressed mood and/or loss of interest or pleasure (anhedonia)",
    "Represents the leading cause of disability worldwide — affects thinking, behavior, and physical health",
    "Distinguished from normal sadness by severity, duration, and functional impairment",
    "DSM-5-TR requires ≥5 symptoms persisting for ≥2 weeks; at least one must be depressed mood or anhedonia",
    "First episode most commonly occurs before age 40 (50% of patients)",
    "Associated with significant morbidity: impairs work, social, and family functioning",
    "Kaplan: 'Mood disorders are chronic, and psychiatrists must educate patients and families about future treatment strategies'"
  ]
});

// SLIDE 5: MDD — Epidemiology
cardSlide(pres, {
  title: "MDD — Epidemiology",
  accent: C.mddAccent,
  bullets: [
    "Lifetime prevalence: ~17% in the general population (US data)",
    "12-month prevalence: ~7% in adults; nearly double in adolescents (SAMHSA data)",
    "Sex ratio: Women affected ~2× more often than men (1.5–3:1 ratio)",
    "Incidence is rising among younger persons, particularly adolescents",
    "Mean age of onset: ~30–40 years; however, adolescent onset is increasingly recognized",
    "Children (prepubertal): sex ratio ~1:1; shifts to female predominance after puberty",
    "Comorbid conditions common: anxiety disorders (~50%), substance use disorder (~30%), personality disorders",
    "Higher rates in persons with chronic medical illness, chronic pain, and neurological disorders"
  ]
});

// SLIDE 6: MDD — Clinical Features (Part 1)
cardSlide(pres, {
  title: "MDD — Clinical Features: Core Symptoms (SIG E CAPS)",
  accent: C.mddAccent,
  bullets: [
    "S — Sleep: Insomnia (early morning awakening most classic) OR hypersomnia",
    "I — Interest: Markedly diminished interest or pleasure (anhedonia) in nearly all activities",
    "G — Guilt: Feelings of worthlessness or excessive/inappropriate guilt",
    "E — Energy: Fatigue or loss of energy nearly every day",
    "C — Concentration: Diminished ability to think, concentrate, or indecisiveness",
    "A — Appetite: Decreased or increased appetite; significant weight loss or gain (>5% body weight/month)",
    "P — Psychomotor: Observable agitation or retardation (not just subjective feeling)",
    "S — Suicide: Recurrent thoughts of death, suicidal ideation, plan, or attempt"
  ]
});

// SLIDE 7: MDD — Clinical Features (Part 2)
twoColSlide(pres, {
  title: "MDD — Clinical Features: Subtypes & Associated Features",
  accent: C.mddAccent,
  left: {
    header: "DSM-5-TR Specifiers",
    items: [
      "With anxious distress",
      "With melancholic features (anhedonia, early morning awakening, diurnal variation, profound guilt)",
      "With atypical features (mood reactivity, hypersomnia, hyperphagia, leaden paralysis)",
      "With psychotic features (mood-congruent or incongruent)",
      "With catatonic features",
      "With peripartum onset (within 4 weeks postpartum)",
      "With seasonal pattern (SAD)"
    ]
  },
  right: {
    header: "Associated Features",
    items: [
      "Tearfulness, irritability, rumination",
      "Somatic complaints (headaches, GI distress, pain)",
      "Hopelessness — strongest predictor of suicide",
      "Social withdrawal and isolation",
      "Cognitive impairment mimicking dementia ('pseudodementia')",
      "In children: somatic complaints, agitation, irritability more prominent than sadness",
      "In adolescents: antisocial behavior, substance use, academic decline"
    ]
  }
});

// SLIDE 8: MDD — Psychotic Features
cardSlide(pres, {
  title: "MDD — With Psychotic Features",
  accent: C.mddAccent,
  bullets: [
    "Occurs in severe MDD; reflects poor prognosis",
    "Mood-congruent delusions: guilt, worthlessness, disease, nihilism, deserved punishment",
    "Mood-incongruent symptoms suggest comorbid primary psychotic disorder (schizoaffective, schizophrenia)",
    "Hallucinations: typically a single voice from outside the head with derogatory or suicidal content",
    "Psychotic depression is rare in prepubertal children (cognitive immaturity); present in ~50% of psychotically depressed adolescents",
    "Treatment: antidepressant + antipsychotic combination, or ECT (especially effective for psychotic depression)"
  ]
});

// SLIDE 9: MDD — DSM-5-TR Criteria
criteriaSlide(pres, {
  title: "MDD — DSM-5-TR Diagnostic Criteria",
  intro: "Criterion A: ≥5 of the following symptoms for ≥2 weeks (at least 1 must be #1 or #2):",
  accent: C.mddAccent,
  criteria: [
    "1. Depressed mood most of the day, nearly every day (subjective or observed)",
    "2. Markedly diminished interest or pleasure in all/almost all activities",
    "3. Significant weight/appetite change (>5% body weight in 1 month)",
    "4. Insomnia or hypersomnia nearly every day",
    "5. Psychomotor agitation or retardation (observable by others)",
    "6. Fatigue or loss of energy nearly every day",
    "7. Feelings of worthlessness or excessive/inappropriate guilt",
    "8. Diminished concentration or indecisiveness nearly every day",
    "9. Recurrent thoughts of death, suicidal ideation, or suicide attempt"
  ],
  note: "Criteria B–E: Symptoms cause significant distress/impairment; not attributable to substances/medical condition; not better explained by psychotic disorder; no history of manic/hypomanic episode"
});

// SLIDE 10: MDD — Management Overview
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    { label: "Continuation Phase", detail: "Prevent relapse\n(4–9 months)", col: C.mddAccent },
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    "Achieve full remission (not just response) — partial remission leads to higher relapse risk",
    "Use both pharmacological AND psychotherapeutic approaches for optimal outcomes",
    "Patient education: medication adherence, recognition of early relapse warning signs",
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// SLIDE 11: MDD — Pharmacological (Antidepressants Overview)
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  title: "MDD — Pharmacological Management: First-Line",
  accent: C.mddAccent,
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    header: "SSRIs (First-Line)",
    items: [
      "Fluoxetine (20–60 mg/day)",
      "Sertraline (50–200 mg/day)",
      "Escitalopram (10–20 mg/day)",
      "Paroxetine (20–60 mg/day)",
      "Citalopram (20–40 mg/day)",
      "MOA: Block serotonin (5-HT) reuptake",
      "Side effects: GI upset, sexual dysfunction, insomnia, weight gain (variable)"
    ]
  },
  right: {
    header: "SNRIs (First-Line Alternative)",
    items: [
      "Venlafaxine (75–375 mg/day)",
      "Duloxetine (60–120 mg/day)",
      "Desvenlafaxine (50 mg/day)",
      "MOA: Block 5-HT and NE reuptake",
      "Preferred when comorbid pain or anxiety",
      "SE: dose-dependent HTN (venlafaxine), nausea",
      "Therapeutic effect: 2–6 weeks onset"
    ]
  }
});

// SLIDE 12: MDD — Pharmacological (Other Agents)
twoColSlide(pres, {
  title: "MDD — Pharmacological Management: Other Agents",
  accent: C.mddAccent,
  left: {
    header: "TCAs & MAOIs",
    items: [
      "TCAs: amitriptyline, imipramine, nortriptyline",
      "Effective but high SE burden: anticholinergic, cardiotoxic",
      "Lethal in overdose — use caution",
      "MAOIs: phenelzine, tranylcypromine",
      "Most effective for atypical depression",
      "Tyramine-free diet required (hypertensive crisis risk)",
      "Reserved for treatment-resistant cases"
    ]
  },
  right: {
    header: "Novel & Augmentation",
    items: [
      "Bupropion (NE/DA reuptake inhibitor) — no sexual SE, weight neutral",
      "Mirtazapine — sedating, weight gain; good for insomnia/anorexia",
      "Ketamine/Esketamine (Spravato) — rapid-acting NMDA antagonist; for TRD",
      "Lithium or atypical antipsychotics (aripiprazole, quetiapine) for augmentation",
      "Vortioxetine — multimodal; cognitive benefits",
      "Adequate trial: therapeutic dose × 4–6 weeks"
    ]
  }
});

// SLIDE 13: MDD — Non-pharmacological (Psychotherapy)
cardSlide(pres, {
  title: "MDD — Non-pharmacological: Psychotherapy",
  accent: C.mddAccent,
  bullets: [
    "Cognitive Behavioral Therapy (CBT): Gold standard — targets negative automatic thoughts and maladaptive behaviors; comparable to antidepressants for mild-moderate MDD",
    "Interpersonal Therapy (IPT): Focuses on grief, role disputes, transitions; particularly effective for postpartum depression",
    "Behavioral Activation (BA): Addresses avoidance behaviors; effective for all severities",
    "Psychodynamic Therapy: Addresses underlying conflicts; longer-term approach",
    "Mindfulness-Based Cognitive Therapy (MBCT): Reduces relapse risk in recurrent MDD (3+ episodes); combines CBT with mindfulness",
    "Combined therapy + medication superior to either alone for moderate-severe MDD",
    "Psychoeducation and supportive therapy for patients and families"
  ]
});

// SLIDE 14: MDD — Somatic Treatments
cardSlide(pres, {
  title: "MDD — Non-pharmacological: Somatic Treatments",
  accent: C.mddAccent,
  bullets: [
    "Electroconvulsive Therapy (ECT): Most effective treatment for severe, psychotic, or TRD; first-line in high suicidality or refusal to eat; brief seizure induced under anesthesia; bilateral > unilateral for efficacy",
    "Transcranial Magnetic Stimulation (TMS/rTMS): Non-invasive; FDA-approved after 1+ failed antidepressant; 40-min sessions × 4–6 weeks; no anesthesia; avoids cognitive SE of ECT",
    "Vagal Nerve Stimulation (VNS): Implanted device; approved for chronic, recurrent TRD; mechanism unclear",
    "Phototherapy (Light Therapy): 1,500–10,000 lux box; 1–2 hours before dawn daily; effective for Seasonal Affective Disorder (SAD); rare risk of triggering mania",
    "Ketamine infusions: Rapid (hours) — important for acute suicidal crisis"
  ]
});

// SLIDE 15: MDD — Prognosis
cardSlide(pres, {
  title: "MDD — Prognosis",
  accent: C.mddAccent,
  bullets: [
    "~50% of patients recover within the first year after first hospitalization",
    "25% recur within 6 months of leaving hospital; 30–50% within 2 years",
    "50–75% of all patients will have a recurrence within 5 years",
    "Untreated episode: 6–13 months; treated episode: ~3 months",
    "Over 20 years, mean number of episodes: 5–6",
    "With each additional episode, inter-episode intervals shorten and severity increases ('kindling effect')",
    "Good prognosis: mild severity, absence of psychotic features, good social support, no prior episodes",
    "Poor prognosis: early age of onset, psychotic features, severe episodes, comorbid anxiety/substance use, personality disorder",
    "Prophylactic maintenance therapy significantly reduces relapse rates"
  ]
});

// ═══════════════════════════════════════════════════════════════════
//  PART II — BIPOLAR DISORDER
// ═══════════════════════════════════════════════════════════════════

// SLIDE 16: Bipolar Section Header
sectionDivider(pres,
  "PART II",
  C.bpAccent,
  "Bipolar Disorder (BD)"
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// SLIDE 17: Bipolar — Introduction
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  bullets: [
    "Bipolar disorder is a cyclic mood disorder characterized by episodes of mania/hypomania and depression",
    "Formerly known as 'manic-depressive illness' — one of psychiatry's oldest recognized diagnoses",
    "DSM-5-TR distinguishes: Bipolar I (full mania), Bipolar II (hypomania + depression), Cyclothymia",
    "Represents a spectrum: from depressive predominance to manic predominance",
    "Significant impact: disability, interpersonal dysfunction, high suicide risk (~15–20% in untreated BD)",
    "Highly heritable: strongest genetic component of any psychiatric disorder",
    "Kaplan: BD is associated with 'the highest risk of suicide among all psychiatric disorders in some series'"
  ]
});

// SLIDE 18: Bipolar — Epidemiology
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    header: "Prevalence & Demographics",
    items: [
      "Bipolar I: lifetime prevalence ~1% (equal sex distribution)",
      "Bipolar II: ~1.1%; more common in women",
      "Bipolar spectrum (BD-I + BD-II + cyclothymia): ~3–5%",
      "Onset: typically late teens to mid-20s (mean ~25 years)",
      "Mean age onset BD-I: 18 years; BD-II: slightly later",
      "Pediatric BD increasingly recognized; often presents as irritability/mixed features"
    ]
  },
  right: {
    header: "Risk Factors & Genetics",
    items: [
      "First-degree relative with BD: 5–10× increased risk",
      "Monozygotic twin concordance: ~60–80%",
      "Strong genetic loading — polygenic architecture",
      "Risk precipitants: sleep deprivation, substance use (especially stimulants, cannabis)",
      "Life events and stressors may trigger first episode",
      "High comorbidity: anxiety disorders, ADHD, substance use disorders"
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// SLIDE 19: Bipolar — Types (DSM-5-TR Classification)
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      items: [
        "≥1 manic episode (may include depressive episodes)",
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        "Psychotic features common",
        "Equal sex ratio"
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        "Hypomanic episode + major depressive episode",
        "NO full manic episode ever",
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        "More common in women",
        "Depressive burden more prominent"
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// SLIDE 20: Bipolar — Mania Clinical Features
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    "D — Distractibility: easily pulled off task by irrelevant stimuli",
    "I — Impulsivity / Indiscretion: poor judgment, risky behaviors (hypersexuality, gambling, overspending)",
    "G — Grandiosity: inflated self-esteem, delusions of special powers or identity",
    "F — Flight of Ideas / Pressured Speech: thoughts race, speech rapid, difficult to interrupt",
    "A — Activity increase: goal-directed or psychomotor agitation",
    "S — Sleep decreased: markedly decreased need for sleep without fatigue (hallmark symptom)",
    "T — Talkativeness: more talkative than usual, difficult to interrupt",
    "Severe mania: psychotic features (mood-congruent grandiose or persecutory delusions, hallucinations)"
  ]
});

// SLIDE 21: Bipolar — Hypomania vs Mania
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      "Noticeable change in mood/behavior observable by others",
      "NOT severe enough to impair social/occupational functioning",
      "Does NOT require hospitalization",
      "No psychotic features",
      "Ego-syntonic — may feel productive, energized",
      "Bipolar II pattern"
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      "Duration: ≥7 days (or any duration if hospitalized)",
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      "May require hospitalization",
      "Psychotic features possible (30–50%)",
      "Ego-dystonic at severe end",
      "Rapid cycling: ≥4 episodes/year (poor prognosis)",
      "Mixed features: mania + depression simultaneously"
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// SLIDE 22: Bipolar — Depressive Episodes
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    "Depressive episodes are MORE frequent and longer than manic episodes in BD",
    "Often indistinguishable from unipolar MDD based on symptoms alone",
    "Clues pointing to bipolar depression: hypersomnia (vs. insomnia), hyperphagia, psychomotor retardation, early age of onset, postpartum onset, psychotic features, family history of BD",
    "Atypical features common: leaden paralysis, mood reactivity, hyperphagia",
    "Suicide risk: highest during depressive or mixed episodes — BD carries 15–20× higher suicide risk vs. general population",
    "Misdiagnosis as MDD is common (may persist for years before correct diagnosis)",
    "CRITICAL: Using antidepressants alone in BD can precipitate mania or rapid cycling — must combine with mood stabilizer"
  ]
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// SLIDE 23: Bipolar I — DSM-5-TR Criteria (Manic Episode)
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  title: "Bipolar I — DSM-5-TR: Manic Episode (Criterion A–E)",
  intro: "Criterion A: Distinct period of abnormally & persistently elevated/expansive/irritable mood AND increased goal-directed activity; ≥7 days (or any duration if hospitalized):",
  accent: C.bpAccent,
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    "1. Grandiosity or inflated self-esteem",
    "2. Decreased need for sleep (feels rested after only 3 hours)",
    "3. More talkative than usual or pressure to keep talking",
    "4. Flight of ideas or subjective experience that thoughts are racing",
    "5. Distractibility (attention easily drawn to unimportant stimuli)",
    "6. Increased goal-directed activity (social/occupational/sexual) or psychomotor agitation",
    "7. Excessive involvement in activities with high potential for painful consequences",
    "Criterion B: ≥3 symptoms (≥4 if mood is only irritable) — marked impairment"
  ],
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});

// SLIDE 24: Bipolar II — DSM-5-TR Criteria
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    "Hypomanic Episode: ≥4 consecutive days of elevated/expansive/irritable mood + ≥3 DIGFAST symptoms",
    "NOT severe enough to cause marked impairment or require hospitalization",
    "NO psychotic features during hypomanic episode",
    "Major Depressive Episode: meets full MDD criteria (≥5 symptoms, ≥2 weeks)",
    "EXCLUSION: No current or past manic episode (would change diagnosis to BD-I)",
    "Significant distress or impairment in social, occupational, or other important areas of functioning",
    "Depressive episodes are typically dominant, longer, and more disabling than hypomanic episodes",
    "High misdiagnosis rate as MDD — careful longitudinal history essential"
  ],
  note: "Note: One antidepressant-induced hypomanic episode does NOT count toward BD-II diagnosis (DSM-5-TR)"
});

// SLIDE 25: Bipolar — Management Overview
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    "Mood stabilizers are the backbone of BD treatment (lithium, valproate, lamotrigine, carbamazepine)",
    "Antidepressants should NOT be used as monotherapy — risk of triggering mania or rapid cycling",
    "Psychoeducation is as important as pharmacotherapy for long-term outcomes",
    "Lifestyle regulation: regular sleep schedule, avoiding stimulants/alcohol",
    "Treat to full remission; partial response predicts higher relapse rates",
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// SLIDE 26: Bipolar — Lithium (Mood Stabilizer)
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  accent: C.bpAccent,
  bullets: [
    "Mechanism: Multiple — inhibits inositol monophosphatase, modulates GSK-3β, neuroprotective effects",
    "Indications: Acute mania, maintenance/prophylaxis of BD-I and BD-II, augmentation in MDD",
    "Therapeutic serum level: 0.6–1.2 mEq/L (acute mania: 0.8–1.2; maintenance: 0.6–0.8)",
    "Response rate for acute mania: 60–80%",
    "Gold standard for suicide prevention in mood disorders (strongest evidence)",
    "Side effects: Tremor (fine postural), polyuria/polydipsia (nephrogenic DI), weight gain, hypothyroidism, acne",
    "Toxicity (>1.5 mEq/L): Coarse tremor, ataxia, confusion, seizures, cardiac arrhythmias",
    "Monitoring: Renal function, TFTs, serum levels every 3–6 months",
    "Teratogenicity: Ebstein anomaly (tricuspid valve) — avoid in 1st trimester"
  ]
});

// SLIDE 27: Bipolar — Anticonvulsants
twoColSlide(pres, {
  title: "Bipolar Disorder — Anticonvulsant Mood Stabilizers",
  accent: C.bpAccent,
  left: {
    header: "Valproate (Depakote)",
    items: [
      "Effective for acute mania (esp. mixed/rapid cycling)",
      "Therapeutic level: 50–125 μg/mL",
      "Side effects: Weight gain, sedation, hair loss, thrombocytopenia, hepatotoxicity",
      "CONTRAINDICATED in pregnancy (neural tube defects, PCOS-like effects)",
      "First-line for rapid cycling and dysphoric mania",
      "Superior to lithium for mixed features"
    ]
  },
  right: {
    header: "Lamotrigine & Carbamazepine",
    items: [
      "Lamotrigine: Best for BIPOLAR DEPRESSION prevention; not effective for acute mania",
      "Start low, titrate slowly — risk of Stevens-Johnson syndrome",
      "Carbamazepine: Esp. useful for dysphoric mania, rapid cycling, lithium non-responders",
      "Carbamazepine SE: Aplastic anemia, agranulocytosis, Stevens-Johnson, SIADH",
      "Blood monitoring required at 3, 6, 9, 12 months",
      "Carbamazepine is a potent CYP450 inducer — many drug interactions"
    ]
  }
});

// SLIDE 28: Bipolar — Antipsychotics in BD
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  title: "Bipolar Disorder — Antipsychotics",
  accent: C.bpAccent,
  bullets: [
    "Second-generation antipsychotics (SGAs) are highly effective for acute mania and increasingly used as maintenance",
    "Quetiapine: FDA-approved for BD-I mania, BD-II depression, AND maintenance; most versatile SGA in BD",
    "Olanzapine: FDA-approved for acute mania and maintenance; weight gain significant concern",
    "Aripiprazole: Mania and maintenance; metabolically neutral; available as monthly IM (Abilify Maintena)",
    "Risperidone, ziprasidone, cariprazine, asenapine: FDA-approved for BD mania",
    "Lurasidone, cariprazine: FDA-approved for bipolar depression",
    "First-generation antipsychotics (haloperidol): Effective for acute mania but higher EPS risk",
    "Combination of mood stabilizer + SGA often needed for severe or mixed mania"
  ]
});

// SLIDE 29: Bipolar — Treatment of Acute Phases
twoColSlide(pres, {
  title: "Bipolar Disorder — Pharmacotherapy by Phase",
  accent: C.bpAccent,
  left: {
    header: "Acute Mania",
    items: [
      "First-line: lithium OR valproate + SGA",
      "Lorazepam/clonazepam for agitation (adjunct)",
      "Remove precipitants (stop antidepressants, stimulants)",
      "Haloperidol IM for emergency control of severe agitation",
      "Carbamazepine: lithium non-responders or mixed mania",
      "ECT: refractory mania or when rapid response needed"
    ]
  },
  right: {
    header: "Bipolar Depression",
    items: [
      "Quetiapine monotherapy (FDA-approved, Level A evidence)",
      "Lurasidone + lithium/valproate (FDA-approved)",
      "Cariprazine (FDA-approved for BD depression)",
      "Lamotrigine for maintenance/prevention",
      "Avoid antidepressant monotherapy (risk of switching to mania)",
      "If antidepressant used: always combine with mood stabilizer"
    ]
  }
});

// SLIDE 30: Bipolar — Non-pharmacological Management
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  title: "Bipolar Disorder — Non-pharmacological Management",
  accent: C.bpAccent,
  bullets: [
    "Psychoeducation (Individual or Group): Cornerstone — recognition of early warning signs, treatment adherence, trigger identification",
    "Cognitive Behavioral Therapy (CBT): Addresses maladaptive cognitions; particularly effective for depressive phases and adherence",
    "Interpersonal & Social Rhythm Therapy (IPSRT): Stabilizes daily social rhythms and sleep-wake cycles; reduces episode frequency",
    "Family-Focused Therapy (FFT): Reduces expressed emotion; improves family communication and crisis management",
    "Lifestyle measures: Regular sleep schedule, avoiding alcohol/stimulants, exercise, stress reduction",
    "ECT: Effective for severe BD depression and acute mania; first-line in pregnancy and medical emergencies",
    "TMS: Emerging evidence for bipolar depression"
  ]
});

// SLIDE 31: Bipolar — Prognosis
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  title: "Bipolar Disorder — Prognosis",
  accent: C.bpAccent,
  bullets: [
    "BD is a lifelong, recurrent disorder — most patients experience multiple episodes",
    "Without treatment: 90% of patients have recurrence; many cycle continuously",
    "With optimal treatment: 50–60% achieve good functional outcomes",
    "Rapid cycling (≥4 episodes/year): poorer prognosis; associated with hypothyroidism, antidepressant use",
    "Mixed features associated with higher suicide risk and poorer treatment response",
    "Suicide: 15–20× higher risk than general population; 10–15% of BD patients die by suicide",
    "Predictors of poor prognosis: early onset, psychotic features, substance use, medication non-adherence, poor social support",
    "Predictors of good prognosis: good inter-episode functioning, social support, medication compliance, absence of psychosis"
  ]
});

// ═══════════════════════════════════════════════════════════════════
//  PART III — COMPARISON
// ═══════════════════════════════════════════════════════════════════

// SLIDE 32: Section Header — Comparison
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// SLIDE 33: MDD vs BD — Comparison Table
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    ["Core Mood", "Depressed / Anhedonic only", "Mania + Depression (cyclical)"],
    ["Prevalence", "~17% lifetime", "~1–3% (BD spectrum)"],
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    ["First-Line Rx", "SSRIs/SNRIs + psychotherapy", "Mood stabilizers + SGAs"],
    ["Psychotherapy", "CBT, IPT, MBCT", "IPSRT, CBT, FFT, psychoeducation"],
    ["Antidepressants", "Safe and effective", "CAUTION — can trigger mania"],
    ["Prognosis", "50–75% recur within 5 yrs", "Lifelong; 90% recur untreated"],
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// SLIDE 34: Differential Diagnosis & Red Flags
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    header: "Differential Diagnosis",
    items: [
      "Persistent depressive disorder (dysthymia)",
      "Cyclothymic disorder",
      "Schizoaffective disorder",
      "Adjustment disorder with depressed mood",
      "Grief reaction (normal bereavement)",
      "Hypothyroidism, Cushing's, anemia",
      "Substance-induced mood disorder",
      "ADHD (overlaps with hypomania in children)"
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    header: "Clinical Red Flags",
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      "Suicidal ideation — always assess plan, intent, means",
      "Psychotic features — increase risk and alter treatment",
      "Antidepressant-triggered elation → reconsider BD",
      "Rapid switching → workup for BD, substance use",
      "Family history of BD in a 'depressed' patient",
      "Postpartum psychosis (emergency — risk of infanticide)",
      "Mixed states — highest suicide risk"
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// SLIDE 35: Summary — Take-Home Messages
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// SLIDE 36: References
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    "Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 12th ed. Wolters Kluwer; 2021.",
    "Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th ed. Wolters Kluwer; 2017.",
    "American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR). APA; 2022.",
    "Goodwin FK, Jamison KR. Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression. 2nd ed. Oxford University Press; 2007.",
    "National Institute for Health and Care Excellence (NICE). Depression in adults: treatment and management. NICE guideline [NG222]; 2022.",
    "National Institute for Health and Care Excellence (NICE). Bipolar disorder: assessment and management. NICE guideline [CG185]; 2020.",
    "Cipriani A, et al. Comparative efficacy and acceptability of 21 antidepressant drugs. Lancet 2018; 391(10128):1357–1366."
  ]
});

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