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const cases = [
  {
    title: "Case 1: Major Depressive Disorder, Severe Without Psychotic Symptoms",
    cc: "Low mood, decreased interest in work, fatigue, and sleep disturbance for 3 months.",
    history: "34-year-old married female, school teacher, with insidious onset of persistent sadness, anhedonia, early morning awakening, reduced appetite, poor concentration, hopelessness, and passive death wishes. No manic symptoms. No substance use. Psychosocial stressor: recent financial burden.",
    diagnosis: "ICD-10: F32.2 Severe depressive episode without psychotic symptoms",
    rx: "Escitalopram 10 mg HS (titrate to 20 mg as tolerated), Clonazepam 0.25 mg HS short-term, psychoeducation, sleep hygiene, CBT referral, suicide risk monitoring."
  },
  {
    title: "Case 2: Recurrent Depressive Disorder, Current Episode Moderate",
    cc: "Recurrent episodes of sadness, crying spells, and poor sleep.",
    history: "41-year-old male accountant with third depressive episode in 7 years. Current episode 6 weeks: low mood, anergia, guilt, social withdrawal, reduced productivity. Inter-episode recovery present. Family history positive for depression in mother.",
    diagnosis: "ICD-10: F33.1 Recurrent depressive disorder, current episode moderate",
    rx: "Sertraline 50 mg OD (up-titrate), structured activity scheduling, CBT, relapse prevention plan, continue treatment for maintenance phase after remission."
  },
  {
    title: "Case 3: Bipolar Affective Disorder, Current Episode Mania Without Psychotic Symptoms",
    cc: "Overtalkative behavior, reduced need for sleep, irritability, overspending for 10 days.",
    history: "27-year-old male with abrupt onset increased activity, pressured speech, grandiose plans, distractibility, and disinhibition. Slept 2–3 hours/night without fatigue. No hallucinations/delusions. Prior depressive episode 1 year ago.",
    diagnosis: "ICD-10: F31.1 Bipolar affective disorder, current episode manic without psychotic symptoms",
    rx: "Valproate 500 mg BD (titrate by levels/response), Olanzapine 5–10 mg HS, Lorazepam PRN for agitation, psychoeducation, family counselling, monitor LFT/CBC/metabolic profile."
  },
  {
    title: "Case 4: Bipolar Affective Disorder, Current Episode Depression",
    cc: "Sadness, low energy, and suicidal thoughts in a known bipolar patient.",
    history: "30-year-old female with known bipolar disorder, currently 2 months of depressive symptoms with psychomotor retardation and worthlessness. One prior manic episode requiring hospitalization. No current psychotic features.",
    diagnosis: "ICD-10: F31.3 Bipolar affective disorder, current episode mild/moderate depression",
    rx: "Quetiapine 50 mg HS up-titrate, Lamotrigine slow titration, avoid antidepressant monotherapy, safety planning, psychotherapy, regular follow-up for mood switch monitoring."
  },
  {
    title: "Case 5: Schizophrenia, Paranoid Type",
    cc: "Suspiciousness, hearing voices, social withdrawal for 8 months.",
    history: "23-year-old unmarried male with persecutory delusions, third-person auditory hallucinations, reduced self-care, blunted affect, and decline in academic function. No mood syndrome meeting full criteria. Poor insight.",
    diagnosis: "ICD-10: F20.0 Paranoid schizophrenia",
    rx: "Risperidone 2 mg HS increasing to 4–6 mg/day, Trihexyphenidyl if EPS appears, family psychoeducation, adherence counselling, consider LAI antipsychotic if poor compliance."
  },
  {
    title: "Case 6: Acute and Transient Psychotic Disorder",
    cc: "Sudden onset fearfulness, irrelevant talk, and suspiciousness for 5 days.",
    history: "29-year-old male developed acute psychosis after major interpersonal stress. Features: perplexity, delusions of reference, second-person hallucinations, disturbed sleep. No prior psychiatric illness. No substance intoxication evidence.",
    diagnosis: "ICD-10: F23 Acute and transient psychotic disorder",
    rx: "Olanzapine 5–10 mg/day, short-term benzodiazepine for sleep/agitation, evaluate organic causes, supportive psychotherapy, close follow-up over 1–3 months."
  },
  {
    title: "Case 7: Persistent Delusional Disorder",
    cc: "Fixed belief that neighbors are plotting against him for 2 years.",
    history: "46-year-old married male with systematized persecutory delusion, preserved personality and function otherwise, no prominent hallucinations, no formal thought disorder.",
    diagnosis: "ICD-10: F22 Persistent delusional disorder",
    rx: "Risperidone 1 mg HS titrate slowly, build therapeutic alliance, avoid direct confrontation of delusion, family guidance, monitor risk to self/others."
  },
  {
    title: "Case 8: Obsessive-Compulsive Disorder (Contamination/Washing Type)",
    cc: "Recurrent contamination thoughts and excessive hand washing for 4 years.",
    history: "21-year-old female with ego-dystonic intrusive thoughts of dirt/germs and compulsive washing rituals (3–4 hours/day), distress and academic impairment, partial insight present.",
    diagnosis: "ICD-10: F42 Obsessive-compulsive disorder",
    rx: "Fluoxetine 20 mg OD up-titrate to high therapeutic dose, ERP-based CBT, family involvement to reduce reassurance/ritual accommodation."
  },
  {
    title: "Case 9: Panic Disorder",
    cc: "Repeated sudden attacks of palpitations, breathlessness, chest tightness.",
    history: "32-year-old female with recurrent panic attacks for 6 months, anticipatory anxiety, avoidance of crowded places. Cardiac workup normal. No substance use.",
    diagnosis: "ICD-10: F41.0 Panic disorder",
    rx: "Paroxetine 12.5–25 mg/day or Sertraline 25–50 mg/day titration, Clonazepam 0.25 mg PRN short-term bridge, panic-focused CBT, breathing retraining."
  },
  {
    title: "Case 10: Generalized Anxiety Disorder",
    cc: "Excessive worry, restlessness, muscle tension, poor sleep for 1 year.",
    history: "38-year-old male office worker with pervasive free-floating anxiety about routine matters, irritability, concentration difficulty, somatic symptoms, no panic episodes predominance.",
    diagnosis: "ICD-10: F41.1 Generalized anxiety disorder",
    rx: "Escitalopram 10 mg OD, Buspirone augmentation if needed, relaxation training, CBT for worry control, sleep hygiene."
  },
  {
    title: "Case 11: Social Anxiety Disorder",
    cc: "Marked fear of speaking in meetings and social embarrassment.",
    history: "25-year-old postgraduate student with intense anxiety during presentations, tremors, blushing, avoidance of viva/seminars, preserved one-to-one communication.",
    diagnosis: "ICD-10: F40.1 Social phobias",
    rx: "Sertraline 25–50 mg/day titration, performance CBT with exposure, propranolol 20 mg PRN for performance situations (if no contraindication)."
  },
  {
    title: "Case 12: Somatic Symptom Disorder (Somatization)",
    cc: "Multiple bodily complaints with repeated consultations despite normal reports.",
    history: "36-year-old female with headaches, abdominal discomfort, fatigue, and generalized pains for 3 years; high health anxiety; frequent doctor shopping; investigations repeatedly non-contributory.",
    diagnosis: "ICD-10: F45.0 Somatization disorder",
    rx: "Regular scheduled follow-up with single clinician, limit unnecessary investigations, low-dose SSRI if comorbid anxiety/depression, CBT focusing symptom reinterpretation."
  },
  {
    title: "Case 13: Dissociative (Conversion) Disorder",
    cc: "Sudden inability to move both legs after family conflict.",
    history: "19-year-old female presented with acute lower limb weakness without neurological correlate; inconsistent findings on exam, identifiable stressor, la belle indifference present.",
    diagnosis: "ICD-10: F44 Dissociative [conversion] disorder",
    rx: "Psychoeducation, reassurance after ruling out organic pathology, brief supportive psychotherapy, stressor-focused intervention, physiotherapy-assisted mobilization."
  },
  {
    title: "Case 14: Alcohol Dependence Syndrome",
    cc: "Daily alcohol use with morning drinking and inability to cut down.",
    history: "42-year-old male consuming 750 ml country liquor/day for 10 years, tolerance and withdrawal (tremor, sweating), occupational dysfunction, family conflict.",
    diagnosis: "ICD-10: F10.24 Dependence syndrome, currently using alcohol",
    rx: "Motivational enhancement, detox protocol (benzodiazepine guided), Thiamine supplementation, relapse prevention with Acamprosate/ Naltrexone as indicated, family therapy, AA referral."
  },
  {
    title: "Case 15: Opioid Dependence Syndrome",
    cc: "Craving for smack, withdrawal body aches, repeated failed quit attempts.",
    history: "28-year-old male with inhalational heroin use for 4 years, tolerance, withdrawal symptoms, legal/financial problems, high relapse pattern.",
    diagnosis: "ICD-10: F11.24 Opioid dependence syndrome",
    rx: "Buprenorphine-naloxone based OST after assessment, symptomatic withdrawal management if needed, motivational therapy, harm-reduction counselling, infection screening (HIV/HBV/HCV)."
  },
  {
    title: "Case 16: Tobacco Dependence Syndrome",
    cc: "Unable to stop smoking despite chronic cough and family pressure.",
    history: "35-year-old male smoking 20 cigarettes/day for 12 years, strong craving, irritability on abstinence, multiple unsuccessful quit attempts.",
    diagnosis: "ICD-10: F17.24 Tobacco dependence syndrome",
    rx: "Brief intervention (5As), Nicotine replacement therapy, Varenicline/Bupropion as suitable, quit date planning, relapse prevention follow-up."
  },
  {
    title: "Case 17: Delirium (Referred from Medicine)",
    cc: "Acute confusion, disorientation, sleep-wake reversal since 2 days.",
    history: "67-year-old male with fever and UTI developed fluctuating consciousness, inattention, visual hallucinations, nighttime agitation. No prior dementia diagnosis.",
    diagnosis: "ICD-10: F05 Delirium, not induced by alcohol and other psychoactive substances",
    rx: "Treat underlying medical cause urgently, environmental reorientation, avoid restraints where possible, low-dose haloperidol for severe agitation, monitor vitals/electrolytes."
  },
  {
    title: "Case 18: Dementia (Probable Alzheimer Type)",
    cc: "Progressive forgetfulness and misplacing objects for 2 years.",
    history: "71-year-old female with gradual memory decline, impaired recent recall, repetition of questions, reduced IADL function, no focal deficits, caregiver burden significant.",
    diagnosis: "ICD-10: F00 Dementia in Alzheimer disease",
    rx: "Donepezil 5 mg HS (titrate), caregiver psychoeducation, cognitive stimulation strategies, safety planning (wandering/medication/finances), manage behavioral symptoms supportively."
  },
  {
    title: "Case 19: Adult Attention-Deficit/Hyperactivity Disorder",
    cc: "Poor concentration, disorganization, unfinished tasks since childhood.",
    history: "24-year-old male software trainee with lifelong inattentiveness, forgetfulness, impulsive decisions, academic underachievement, functional impairment in work setting.",
    diagnosis: "ICD-10 equivalent hyperkinetic syndrome history; DSM-5 framework supports Adult ADHD",
    rx: "Psychoeducation, structured planning tools, atomoxetine/methylphenidate after formal assessment, CBT for executive dysfunction, monitor sleep/substance risks."
  },
  {
    title: "Case 20: Borderline Personality Disorder",
    cc: "Repeated self-harm threats, unstable relationships, emotional outbursts.",
    history: "22-year-old female with affective instability, fear of abandonment, chronic emptiness, impulsive spending/self-harm gestures, interpersonal chaos, episodic dissociation under stress.",
    diagnosis: "ICD-10: F60.3 Emotionally unstable personality disorder, borderline type",
    rx: "Crisis/safety plan, DBT-oriented psychotherapy, treat comorbid anxiety/depression symptom-targeted medication only, family psychoeducation, regular risk review."
  },
  {
    title: "Case 21: Adjustment Disorder",
    cc: "Sadness and anxiety after failing competitive exam.",
    history: "20-year-old male developed low mood, crying, reduced appetite, insomnia and worry within 1 month of exam failure; symptoms disproportionate yet subthreshold for major depressive episode.",
    diagnosis: "ICD-10: F43.2 Adjustment disorders",
    rx: "Supportive psychotherapy, problem-solving counselling, sleep regulation, brief SSRI only if persistent moderate symptoms, family support mobilization."
  },
  {
    title: "Case 22: Post-Traumatic Stress Disorder",
    cc: "Nightmares, flashbacks, and hypervigilance after road traffic accident.",
    history: "31-year-old male with intrusive memories, avoidance of driving, exaggerated startle, irritability, and poor sleep for 4 months post trauma.",
    diagnosis: "ICD-10: F43.1 Post-traumatic stress disorder",
    rx: "Trauma-focused CBT, SSRIs (sertraline/paroxetine) if needed, sleep intervention, gradual exposure plan, monitor depression/suicide risk."
  },
  {
    title: "Case 23: Insomnia Disorder (Comorbid Anxiety Traits)",
    cc: "Difficulty initiating sleep and non-restorative sleep for 8 months.",
    history: "33-year-old female with prolonged sleep latency, rumination at bedtime, daytime fatigue, maladaptive sleep habits, no evidence of mania/substance cause.",
    diagnosis: "ICD-10: F51.0 Nonorganic insomnia",
    rx: "CBT-I first line, strict sleep hygiene and stimulus control, short course non-benzodiazepine hypnotic if required, treat comorbid anxiety."
  },
  {
    title: "Case 24: Illness Anxiety Disorder (Hypochondriacal Disorder)",
    cc: "Persistent fear of serious disease despite repeated normal tests.",
    history: "39-year-old male preoccupied with cancer fear for 2 years, repeatedly checks body signs and seeks reassurance, significant distress and internet health searching behavior.",
    diagnosis: "ICD-10: F45.2 Hypochondriacal disorder",
    rx: "Scheduled review visits, CBT targeting catastrophic misinterpretation, restrict repeated investigations, consider SSRI for severe anxiety/depressive overlap."
  },
  {
    title: "Case 25: Erectile Dysfunction with Performance Anxiety",
    cc: "Inability to maintain erection in partnered situations for 6 months.",
    history: "29-year-old married male with situational erectile difficulty, marked anticipatory anxiety, normal morning erections, no diabetes/HTN/substance dependence, relationship stress present.",
    diagnosis: "ICD-10: F52.2 Failure of genital response (psychogenic predominant)",
    rx: "Sex therapy with couple counselling, sensate focus exercises, anxiety management, trial PDE5 inhibitor when appropriate, address relational communication issues."
  }
];

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children.push(new Paragraph({
  text: "Psychiatry OPD Case Series (25 Common Cases)",
  heading: HeadingLevel.TITLE,
  alignment: AlignmentType.CENTER,
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children.push(new Paragraph({
  text: "Structured for HOD Presentation (Brief Format: Chief Complaint, History, Diagnosis, Rx)",
  alignment: AlignmentType.CENTER,
}));

children.push(new Paragraph({ text: "" }));

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    children: [
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    children: [
      new TextRun({ text: "Provisional Diagnosis: ", bold: true }),
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      new TextRun(c.rx)
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  children.push(new Paragraph({ text: "" }));
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