@oriro/orirocli 0.1.8 → 0.1.11

package/skills/health/health-mens/SKILL.md

@@ -1,53 +1,53 @@
----
-watermark: ORIRO
-disable-model-invocation: true
-name: health-mens
-provider: ORIRO.ai
-copyright: Copyright (c) 2026 ORIRO.ai
-description: >
-  Men's health — prostate health, testosterone, heart disease risk, mental health
-  in men, preventive screening, and men-specific health concerns. Activate for
-  questions about men's health screenings, prostate, testosterone, or any
-  men's health topic. Sources: AUA, USPSTF, NIH men's health resources.
----
-
-# Men's Health
-
-## Preventive screenings for men
-
-**Blood pressure:** Every 2 years if normal; annually if elevated.
-**Cholesterol:** Every 5 years starting at 35; earlier if risk factors.
-**Diabetes:** Every 3 years starting at 35.
-**Colorectal cancer:** Start at 45. Colonoscopy every 10 years preferred.
-**Abdominal aortic aneurysm:** Once at 65-75 for men who have ever smoked.
-**Prostate (PSA):** Discuss with doctor at age 50 (45 if African American or father/brother with prostate cancer before 65; 40 if strong family history). Screening decision is individual — discuss risks and benefits.
-**Testicular self-exam:** Monthly. Know your normal. Report changes to doctor promptly.
-
-## Prostate health
-
-**BPH (Benign Prostatic Hyperplasia):** Prostate enlargement with aging. Very common after 50.
-Symptoms: Frequent urination, urgency, weak stream, incomplete emptying, nighttime urination.
-Treatment: Lifestyle modifications → medications (alpha-blockers, 5-alpha reductase inhibitors) → procedures.
-
-**Prostate cancer:** Most common cancer in men (excluding skin). Usually slow-growing.
-Most prostate cancers are diagnosed and treated without causing death.
-PSA screening is controversial — benefits vs. overdiagnosis/overtreatment.
-Active surveillance is appropriate for low-grade cancers.
-
-## Testosterone
-
-**Normal range:** 300-1000 ng/dL total testosterone (labs vary). Below 300 = low.
-**Symptoms of low T:** Low energy, decreased libido, depression, difficulty concentrating, loss of muscle mass, increased body fat, anemia, bone loss.
-**Causes:** Aging (normal decline ~1%/year after 30), hypogonadism, obesity, chronic illness, medications.
-**Before treating:** Test twice (morning levels most accurate). Rule out reversible causes (obesity, poor sleep, alcohol, medication side effects).
-**TRT (Testosterone Replacement Therapy):** Options include injections, gels, patches, pellets. Monitor hematocrit (increases). Reduces fertility while on treatment.
-**Not a fountain of youth:** Lifestyle (exercise, sleep, weight loss) often dramatically improves T and symptoms.
-
-## Men and mental health
-
-Men experience depression and anxiety but less likely to seek help. Different presentation: Anger, irritability, risk-taking rather than sadness.
-**Male suicide rate:** 3-4× higher than women in US. Men less likely to seek help.
-**Barriers:** Stigma ("men don't show weakness"), socialized self-reliance, fewer social support networks.
-**Encouraging help-seeking:** Frame as strength and practical problem-solving. Online/app-based therapy reduces stigma barrier.
-
-Sources: AUA (auanet.org — free patient education), USPSTF (uspreventiveservicestaskforce.org — free), CDC men's health (cdc.gov/men — free), Mental Health America (mhanational.org — free)
+---
+watermark: ORIRO
+disable-model-invocation: true
+name: health-mens
+provider: ORIRO.ai
+copyright: Copyright (c) 2026 ORIRO.ai
+description: >
+  Men's health — prostate health, testosterone, heart disease risk, mental health
+  in men, preventive screening, and men-specific health concerns. Activate for
+  questions about men's health screenings, prostate, testosterone, or any
+  men's health topic. Sources: AUA, USPSTF, NIH men's health resources.
+---
+
+# Men's Health
+
+## Preventive screenings for men
+
+**Blood pressure:** Every 2 years if normal; annually if elevated.
+**Cholesterol:** Every 5 years starting at 35; earlier if risk factors.
+**Diabetes:** Every 3 years starting at 35.
+**Colorectal cancer:** Start at 45. Colonoscopy every 10 years preferred.
+**Abdominal aortic aneurysm:** Once at 65-75 for men who have ever smoked.
+**Prostate (PSA):** Discuss with doctor at age 50 (45 if African American or father/brother with prostate cancer before 65; 40 if strong family history). Screening decision is individual — discuss risks and benefits.
+**Testicular self-exam:** Monthly. Know your normal. Report changes to doctor promptly.
+
+## Prostate health
+
+**BPH (Benign Prostatic Hyperplasia):** Prostate enlargement with aging. Very common after 50.
+Symptoms: Frequent urination, urgency, weak stream, incomplete emptying, nighttime urination.
+Treatment: Lifestyle modifications → medications (alpha-blockers, 5-alpha reductase inhibitors) → procedures.
+
+**Prostate cancer:** Most common cancer in men (excluding skin). Usually slow-growing.
+Most prostate cancers are diagnosed and treated without causing death.
+PSA screening is controversial — benefits vs. overdiagnosis/overtreatment.
+Active surveillance is appropriate for low-grade cancers.
+
+## Testosterone
+
+**Normal range:** 300-1000 ng/dL total testosterone (labs vary). Below 300 = low.
+**Symptoms of low T:** Low energy, decreased libido, depression, difficulty concentrating, loss of muscle mass, increased body fat, anemia, bone loss.
+**Causes:** Aging (normal decline ~1%/year after 30), hypogonadism, obesity, chronic illness, medications.
+**Before treating:** Test twice (morning levels most accurate). Rule out reversible causes (obesity, poor sleep, alcohol, medication side effects).
+**TRT (Testosterone Replacement Therapy):** Options include injections, gels, patches, pellets. Monitor hematocrit (increases). Reduces fertility while on treatment.
+**Not a fountain of youth:** Lifestyle (exercise, sleep, weight loss) often dramatically improves T and symptoms.
+
+## Men and mental health
+
+Men experience depression and anxiety but less likely to seek help. Different presentation: Anger, irritability, risk-taking rather than sadness.
+**Male suicide rate:** 3-4× higher than women in US. Men less likely to seek help.
+**Barriers:** Stigma ("men don't show weakness"), socialized self-reliance, fewer social support networks.
+**Encouraging help-seeking:** Frame as strength and practical problem-solving. Online/app-based therapy reduces stigma barrier.
+
+Sources: AUA (auanet.org — free patient education), USPSTF (uspreventiveservicestaskforce.org — free), CDC men's health (cdc.gov/men — free), Mental Health America (mhanational.org — free)

package/skills/health/health-mental/LICENSE

@@ -1,21 +1,21 @@
-MIT License
-
-Copyright (c) 2026 ORIRO.ai
-
-Permission is hereby granted, free of charge, to any person obtaining a copy
-of this software and associated documentation files (the "Software"), to deal
-in the Software without restriction, including without limitation the rights
-to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
-copies of the Software, and to permit persons to whom the Software is
-furnished to do so, subject to the following conditions:
-
-The above copyright notice and this permission notice shall be included in all
-copies or substantial portions of the Software.
-
-THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
-IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
-FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
-AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
-LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
-OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE
-SOFTWARE.
+MIT License
+
+Copyright (c) 2026 ORIRO.ai
+
+Permission is hereby granted, free of charge, to any person obtaining a copy
+of this software and associated documentation files (the "Software"), to deal
+in the Software without restriction, including without limitation the rights
+to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
+copies of the Software, and to permit persons to whom the Software is
+furnished to do so, subject to the following conditions:
+
+The above copyright notice and this permission notice shall be included in all
+copies or substantial portions of the Software.
+
+THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
+IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
+FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
+AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
+LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
+OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE
+SOFTWARE.

package/skills/health/health-mental/SKILL.md

@@ -1,221 +1,221 @@
----
-watermark: ORIRO
-disable-model-invocation: true
-name: health-mental
-provider: ORIRO.ai
-copyright: Copyright (c) 2026 ORIRO.ai
-description: >
-  Mental health fundamentals — recognizing mental health conditions, understanding
-  treatment options, medication basics, crisis recognition, and navigating
-  mental health care. Activate for questions about depression, anxiety, mental
-  health conditions, psychiatric medications, therapy types, mental health
-  crisis, or how to help someone struggling. Sources: NIMH, WHO mental health,
-  APA clinical guidelines, SAMHSA. Consult a licensed mental health professional
-  for diagnosis and treatment. Call 988 for crisis support.
----
-
-# Mental Health Fundamentals
-
-## Common mental health conditions
-
-### Depression (Major Depressive Disorder)
-
-**Diagnostic criteria (DSM-5):** 5+ of these symptoms for 2+ weeks, including #1 or #2:
-
-1. Depressed mood most of the day
-2. Loss of interest or pleasure in activities
-3. Significant weight/appetite change
-4. Sleep disturbance (too much or too little)
-5. Psychomotor agitation or slowing (observable by others)
-6. Fatigue or loss of energy
-7. Feelings of worthlessness or excessive guilt
-8. Difficulty concentrating or making decisions
-9. Recurrent thoughts of death or suicidal ideation
-
-**Spectrum:** Major depression → Persistent Depressive Disorder (dysthymia, lower grade but chronic) → Adjustment disorder → Grief
-
-**Treatment:** Psychotherapy (CBT, IPT) + medication (antidepressants) most effective combined.
-Mild-moderate: therapy alone often sufficient.
-Moderate-severe: medication + therapy.
-
-### Anxiety Disorders
-
-**Generalized Anxiety Disorder (GAD):** Excessive worry about multiple areas of life, difficult to control.
-6+ months, with 3+ physical symptoms (restlessness, fatigue, concentration problems, irritability, muscle tension, sleep disturbance).
-
-**Panic Disorder:** Recurrent unexpected panic attacks + ongoing worry about attacks.
-Panic attack: abrupt surge of fear with 4+ physical symptoms (racing heart, sweating, shaking, shortness of breath, chest pain, dizziness, feeling of unreality, fear of dying or losing control).
-
-**Social Anxiety:** Marked fear of social/performance situations; feared as embarrassing or humiliating.
-Most common anxiety disorder. Often mistaken for shyness.
-
-**Treatment:** CBT is first-line. Exposure therapy for specific phobias. Medications adjunct.
-
-### Bipolar Disorder
-
-**Type I:** At least one manic episode (with or without depressive episodes).
-Mania: elevated/irritable mood, decreased need for sleep, grandiosity, racing thoughts, increased goal-directed activity, risky behavior — 7+ days, severe enough to impair function.
-
-**Type II:** Hypomanic episodes (less severe than mania) + major depressive episodes.
-Never full mania.
-
-**Cyclothymia:** Hypomanic symptoms + depressive symptoms, not meeting full criteria, 2+ years.
-
-**Treatment:** Mood stabilizers (lithium, valproate, lamotrigine) + therapy.
-Antidepressants alone can trigger manic episodes — never use without mood stabilizer.
-
-### PTSD (Post-Traumatic Stress Disorder)
-
-Follows exposure to trauma (direct, witnessed, learned about, repeated exposure).
-Symptoms in four clusters:
-
-1. Intrusion: flashbacks, nightmares, intrusive memories
-2. Avoidance: of trauma reminders
-3. Negative alterations in cognition/mood: inability to recall aspects, negative beliefs, blame, negative emotions, estrangement, restricted emotion
-4. Hyperarousal: hypervigilance, exaggerated startle, aggression, sleep problems, reckless behavior
-
-1+ month duration, causes significant impairment.
-
-**Treatment:** Trauma-focused CBT, EMDR (Eye Movement Desensitization and Reprocessing), Prolonged Exposure, CPT (Cognitive Processing Therapy).
-
-### OCD (Obsessive-Compulsive Disorder)
-
-**Obsessions:** Unwanted, intrusive, distressing thoughts, images, or urges.
-**Compulsions:** Repetitive behaviors or mental acts to reduce obsession-related distress.
-Time-consuming (>1 hour/day) or causes significant impairment.
-
-Common themes: contamination, harm, symmetry, forbidden thoughts.
-**Key distinction:** Compulsions provide temporary relief but maintain the OCD cycle.
-
-**Treatment:** ERP (Exposure and Response Prevention) is first-line behavioral treatment.
-SSRIs at high doses often helpful.
-
----
-
-## Psychiatric medications
-
-### Antidepressants
-
-**SSRIs (Selective Serotonin Reuptake Inhibitors):** First-line for depression and anxiety.
-Examples: fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), citalopram (Celexa).
-Side effects: nausea, sexual dysfunction, weight gain, insomnia. Usually improve over weeks.
-Onset: 2-6 weeks for mood effects. Full effect: 6-8 weeks.
-
-**SNRIs:** Also affect norepinephrine. Examples: venlafaxine (Effexor), duloxetine (Cymbalta).
-May have better pain and energy effects.
-
-**Bupropion (Wellbutrin):** Different mechanism. Less sexual dysfunction. No weight gain. Helpful for attention. Avoid with seizure risk or eating disorders.
-
-**Mirtazapine:** Helps sleep and appetite. Good for underweight, sleep-disturbed depression.
-
-**Important warnings:**
-
-- Do not stop SSRIs abruptly — taper slowly to avoid discontinuation syndrome.
-- Black box warning for suicidal thoughts in children/adolescents — monitor closely when starting.
-- 2-4 weeks before any effect; don't conclude "it's not working" before then.
-- If no effect at 8 weeks at therapeutic dose → try different medication.
-
-### Mood stabilizers (for bipolar)
-
-**Lithium:** Gold standard. Effective for mania and depression. Narrow therapeutic window — requires blood monitoring. Requires adequate hydration and consistent sodium intake.
-
-**Valproate (Depakote):** Effective for mania. Teratogenic — extreme caution in women of childbearing age.
-
-**Lamotrigine (Lamictal):** Excellent for bipolar depression. Must titrate slowly (risk of serious rash if increased too quickly).
-
-**Atypical antipsychotics:** Quetiapine, olanzapine, aripiprazole — FDA approved for bipolar.
-
-### Anti-anxiety medications
-
-**SSRIs/SNRIs:** First-line for chronic anxiety disorders. Takes weeks to work.
-**Buspirone:** Non-habit-forming, non-sedating for GAD. Takes 2-4 weeks. No abuse potential.
-**Benzodiazepines (BZDs):** Rapid anxiety relief. High abuse/dependence potential. Use short-term only.
-Examples: alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin), diazepam (Valium).
-Dangerous: respiratory depression with alcohol or opioids.
-
-### Antipsychotics
-
-**First-generation (typical):** Haloperidol, chlorpromazine. Higher extrapyramidal side effects.
-**Second-generation (atypical):** Risperidone, olanzapine, quetiapine, aripiprazole, clozapine.
-Broader use: schizophrenia, bipolar, treatment-resistant depression, agitation.
-Monitor: metabolic effects (weight gain, diabetes risk, cholesterol).
-
----
-
-## Types of therapy
-
-| Type               | Good for                                   | What happens                                              |
-| ------------------ | ------------------------------------------ | --------------------------------------------------------- |
-| **CBT**            | Depression, anxiety, OCD, PTSD             | Identify/challenge thought patterns + behavioral changes  |
-| **DBT**            | Borderline PD, self-harm, eating disorders | CBT + mindfulness + distress tolerance                    |
-| **EMDR**           | PTSD, trauma                               | Bilateral stimulation while processing trauma memories    |
-| **IPT**            | Depression, grief, relationship issues     | Focus on interpersonal relationships and life transitions |
-| **ACT**            | Anxiety, chronic pain, depression          | Accept difficult feelings, commit to values-based action  |
-| **Psychodynamic**  | Personality patterns, long-standing issues | Explore unconscious patterns, childhood experiences       |
-| **Family therapy** | Relationship/family conflict, youth issues | Work with family system, not just individual              |
-
----
-
-## Recognizing a mental health crisis
-
-### Suicidal crisis
-
-**Warning signs:**
-
-- Talking about wanting to die or kill themselves
-- Looking for ways to kill themselves (searching online, obtaining means)
-- Talking about being a burden, no reason to live
-- Giving away possessions
-- Saying goodbye to people
-- Sudden calmness after depression (may have made a decision)
-- Increased alcohol or drug use
-- Social withdrawal
-
-**If someone is in crisis:**
-
-1. Ask directly: "Are you thinking about suicide?" (Asking does NOT increase risk)
-2. Stay with them
-3. Remove means if possible (medications, weapons)
-4. Call 988 (Suicide and Crisis Lifeline) together
-5. Take to emergency room if immediate danger
-
-**Never promise to keep suicidal thoughts secret.** Safety > confidentiality.
-
-### Psychiatric emergency
-
-- Psychosis (delusions, hallucinations, disorganized behavior)
-- Severe mania (not sleeping for days, extremely erratic behavior)
-- Active self-harm
-- Substance overdose
-  → Call 911 or go to emergency room.
-
----
-
-## Getting help
-
-**Levels of care:**
-
-- **Self-help / apps:** Headspace, Woebot — appropriate for mild symptoms only
-- **Therapy:** Most conditions — starting point for mild-moderate
-- **Medication management:** Primary care or psychiatrist
-- **Intensive outpatient (IOP):** More than weekly therapy, less than 24-hour care
-- **Partial hospitalization (PHP):** Day program, return home at night
-- **Inpatient:** 24-hour psychiatric care for safety
-
-**Finding a therapist:**
-
-- Psychology Today therapist finder: psychologytoday.com/us/therapists
-- Open Path Collective: lower-cost therapy
-- Community mental health centers: sliding scale fees
-- Employer EAP (Employee Assistance Program): often 6+ free sessions
-
-**Cost barriers:**
-
-- Most insurance covers mental health (Mental Health Parity and Addiction Equity Act)
-- Federally Qualified Health Centers: sliding scale
-- University training clinics: lower cost
-- Online therapy platforms: more affordable than in-person
-
-Sources: NIMH (nimh.nih.gov), SAMHSA (samhsa.gov),
-APA clinical practice guidelines, DSM-5 criteria summaries,
-988lifeline.org, NAMI (nami.org)
+---
+watermark: ORIRO
+disable-model-invocation: true
+name: health-mental
+provider: ORIRO.ai
+copyright: Copyright (c) 2026 ORIRO.ai
+description: >
+  Mental health fundamentals — recognizing mental health conditions, understanding
+  treatment options, medication basics, crisis recognition, and navigating
+  mental health care. Activate for questions about depression, anxiety, mental
+  health conditions, psychiatric medications, therapy types, mental health
+  crisis, or how to help someone struggling. Sources: NIMH, WHO mental health,
+  APA clinical guidelines, SAMHSA. Consult a licensed mental health professional
+  for diagnosis and treatment. Call 988 for crisis support.
+---
+
+# Mental Health Fundamentals
+
+## Common mental health conditions
+
+### Depression (Major Depressive Disorder)
+
+**Diagnostic criteria (DSM-5):** 5+ of these symptoms for 2+ weeks, including #1 or #2:
+
+1. Depressed mood most of the day
+2. Loss of interest or pleasure in activities
+3. Significant weight/appetite change
+4. Sleep disturbance (too much or too little)
+5. Psychomotor agitation or slowing (observable by others)
+6. Fatigue or loss of energy
+7. Feelings of worthlessness or excessive guilt
+8. Difficulty concentrating or making decisions
+9. Recurrent thoughts of death or suicidal ideation
+
+**Spectrum:** Major depression → Persistent Depressive Disorder (dysthymia, lower grade but chronic) → Adjustment disorder → Grief
+
+**Treatment:** Psychotherapy (CBT, IPT) + medication (antidepressants) most effective combined.
+Mild-moderate: therapy alone often sufficient.
+Moderate-severe: medication + therapy.
+
+### Anxiety Disorders
+
+**Generalized Anxiety Disorder (GAD):** Excessive worry about multiple areas of life, difficult to control.
+6+ months, with 3+ physical symptoms (restlessness, fatigue, concentration problems, irritability, muscle tension, sleep disturbance).
+
+**Panic Disorder:** Recurrent unexpected panic attacks + ongoing worry about attacks.
+Panic attack: abrupt surge of fear with 4+ physical symptoms (racing heart, sweating, shaking, shortness of breath, chest pain, dizziness, feeling of unreality, fear of dying or losing control).
+
+**Social Anxiety:** Marked fear of social/performance situations; feared as embarrassing or humiliating.
+Most common anxiety disorder. Often mistaken for shyness.
+
+**Treatment:** CBT is first-line. Exposure therapy for specific phobias. Medications adjunct.
+
+### Bipolar Disorder
+
+**Type I:** At least one manic episode (with or without depressive episodes).
+Mania: elevated/irritable mood, decreased need for sleep, grandiosity, racing thoughts, increased goal-directed activity, risky behavior — 7+ days, severe enough to impair function.
+
+**Type II:** Hypomanic episodes (less severe than mania) + major depressive episodes.
+Never full mania.
+
+**Cyclothymia:** Hypomanic symptoms + depressive symptoms, not meeting full criteria, 2+ years.
+
+**Treatment:** Mood stabilizers (lithium, valproate, lamotrigine) + therapy.
+Antidepressants alone can trigger manic episodes — never use without mood stabilizer.
+
+### PTSD (Post-Traumatic Stress Disorder)
+
+Follows exposure to trauma (direct, witnessed, learned about, repeated exposure).
+Symptoms in four clusters:
+
+1. Intrusion: flashbacks, nightmares, intrusive memories
+2. Avoidance: of trauma reminders
+3. Negative alterations in cognition/mood: inability to recall aspects, negative beliefs, blame, negative emotions, estrangement, restricted emotion
+4. Hyperarousal: hypervigilance, exaggerated startle, aggression, sleep problems, reckless behavior
+
+1+ month duration, causes significant impairment.
+
+**Treatment:** Trauma-focused CBT, EMDR (Eye Movement Desensitization and Reprocessing), Prolonged Exposure, CPT (Cognitive Processing Therapy).
+
+### OCD (Obsessive-Compulsive Disorder)
+
+**Obsessions:** Unwanted, intrusive, distressing thoughts, images, or urges.
+**Compulsions:** Repetitive behaviors or mental acts to reduce obsession-related distress.
+Time-consuming (>1 hour/day) or causes significant impairment.
+
+Common themes: contamination, harm, symmetry, forbidden thoughts.
+**Key distinction:** Compulsions provide temporary relief but maintain the OCD cycle.
+
+**Treatment:** ERP (Exposure and Response Prevention) is first-line behavioral treatment.
+SSRIs at high doses often helpful.
+
+---
+
+## Psychiatric medications
+
+### Antidepressants
+
+**SSRIs (Selective Serotonin Reuptake Inhibitors):** First-line for depression and anxiety.
+Examples: fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), citalopram (Celexa).
+Side effects: nausea, sexual dysfunction, weight gain, insomnia. Usually improve over weeks.
+Onset: 2-6 weeks for mood effects. Full effect: 6-8 weeks.
+
+**SNRIs:** Also affect norepinephrine. Examples: venlafaxine (Effexor), duloxetine (Cymbalta).
+May have better pain and energy effects.
+
+**Bupropion (Wellbutrin):** Different mechanism. Less sexual dysfunction. No weight gain. Helpful for attention. Avoid with seizure risk or eating disorders.
+
+**Mirtazapine:** Helps sleep and appetite. Good for underweight, sleep-disturbed depression.
+
+**Important warnings:**
+
+- Do not stop SSRIs abruptly — taper slowly to avoid discontinuation syndrome.
+- Black box warning for suicidal thoughts in children/adolescents — monitor closely when starting.
+- 2-4 weeks before any effect; don't conclude "it's not working" before then.
+- If no effect at 8 weeks at therapeutic dose → try different medication.
+
+### Mood stabilizers (for bipolar)
+
+**Lithium:** Gold standard. Effective for mania and depression. Narrow therapeutic window — requires blood monitoring. Requires adequate hydration and consistent sodium intake.
+
+**Valproate (Depakote):** Effective for mania. Teratogenic — extreme caution in women of childbearing age.
+
+**Lamotrigine (Lamictal):** Excellent for bipolar depression. Must titrate slowly (risk of serious rash if increased too quickly).
+
+**Atypical antipsychotics:** Quetiapine, olanzapine, aripiprazole — FDA approved for bipolar.
+
+### Anti-anxiety medications
+
+**SSRIs/SNRIs:** First-line for chronic anxiety disorders. Takes weeks to work.
+**Buspirone:** Non-habit-forming, non-sedating for GAD. Takes 2-4 weeks. No abuse potential.
+**Benzodiazepines (BZDs):** Rapid anxiety relief. High abuse/dependence potential. Use short-term only.
+Examples: alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin), diazepam (Valium).
+Dangerous: respiratory depression with alcohol or opioids.
+
+### Antipsychotics
+
+**First-generation (typical):** Haloperidol, chlorpromazine. Higher extrapyramidal side effects.
+**Second-generation (atypical):** Risperidone, olanzapine, quetiapine, aripiprazole, clozapine.
+Broader use: schizophrenia, bipolar, treatment-resistant depression, agitation.
+Monitor: metabolic effects (weight gain, diabetes risk, cholesterol).
+
+---
+
+## Types of therapy
+
+| Type               | Good for                                   | What happens                                              |
+| ------------------ | ------------------------------------------ | --------------------------------------------------------- |
+| **CBT**            | Depression, anxiety, OCD, PTSD             | Identify/challenge thought patterns + behavioral changes  |
+| **DBT**            | Borderline PD, self-harm, eating disorders | CBT + mindfulness + distress tolerance                    |
+| **EMDR**           | PTSD, trauma                               | Bilateral stimulation while processing trauma memories    |
+| **IPT**            | Depression, grief, relationship issues     | Focus on interpersonal relationships and life transitions |
+| **ACT**            | Anxiety, chronic pain, depression          | Accept difficult feelings, commit to values-based action  |
+| **Psychodynamic**  | Personality patterns, long-standing issues | Explore unconscious patterns, childhood experiences       |
+| **Family therapy** | Relationship/family conflict, youth issues | Work with family system, not just individual              |
+
+---
+
+## Recognizing a mental health crisis
+
+### Suicidal crisis
+
+**Warning signs:**
+
+- Talking about wanting to die or kill themselves
+- Looking for ways to kill themselves (searching online, obtaining means)
+- Talking about being a burden, no reason to live
+- Giving away possessions
+- Saying goodbye to people
+- Sudden calmness after depression (may have made a decision)
+- Increased alcohol or drug use
+- Social withdrawal
+
+**If someone is in crisis:**
+
+1. Ask directly: "Are you thinking about suicide?" (Asking does NOT increase risk)
+2. Stay with them
+3. Remove means if possible (medications, weapons)
+4. Call 988 (Suicide and Crisis Lifeline) together
+5. Take to emergency room if immediate danger
+
+**Never promise to keep suicidal thoughts secret.** Safety > confidentiality.
+
+### Psychiatric emergency
+
+- Psychosis (delusions, hallucinations, disorganized behavior)
+- Severe mania (not sleeping for days, extremely erratic behavior)
+- Active self-harm
+- Substance overdose
+  → Call 911 or go to emergency room.
+
+---
+
+## Getting help
+
+**Levels of care:**
+
+- **Self-help / apps:** Headspace, Woebot — appropriate for mild symptoms only
+- **Therapy:** Most conditions — starting point for mild-moderate
+- **Medication management:** Primary care or psychiatrist
+- **Intensive outpatient (IOP):** More than weekly therapy, less than 24-hour care
+- **Partial hospitalization (PHP):** Day program, return home at night
+- **Inpatient:** 24-hour psychiatric care for safety
+
+**Finding a therapist:**
+
+- Psychology Today therapist finder: psychologytoday.com/us/therapists
+- Open Path Collective: lower-cost therapy
+- Community mental health centers: sliding scale fees
+- Employer EAP (Employee Assistance Program): often 6+ free sessions
+
+**Cost barriers:**
+
+- Most insurance covers mental health (Mental Health Parity and Addiction Equity Act)
+- Federally Qualified Health Centers: sliding scale
+- University training clinics: lower cost
+- Online therapy platforms: more affordable than in-person
+
+Sources: NIMH (nimh.nih.gov), SAMHSA (samhsa.gov),
+APA clinical practice guidelines, DSM-5 criteria summaries,
+988lifeline.org, NAMI (nami.org)

package/skills/health/health-naturopathy-ayurveda/LICENSE

@@ -1,21 +1,21 @@
-MIT License
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-of this software and associated documentation files (the "Software"), to deal
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-SOFTWARE.
+MIT License
+
+Copyright (c) 2026 ORIRO.ai
+
+Permission is hereby granted, free of charge, to any person obtaining a copy
+of this software and associated documentation files (the "Software"), to deal
+in the Software without restriction, including without limitation the rights
+to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
+copies of the Software, and to permit persons to whom the Software is
+furnished to do so, subject to the following conditions:
+
+The above copyright notice and this permission notice shall be included in all
+copies or substantial portions of the Software.
+
+THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
+IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
+FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
+AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
+LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
+OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE
+SOFTWARE.