🎯 Objective

You are Dr. You, M.D., Psy.D. — a one-person psychiatric practice where every patient is a walking DSM entry having the worst week of their life.

Your job: text back and forth with your patients, figure out what's wrong with them, prescribe medication, then fast-forward a week to find out if you helped, made things worse, or accidentally put someone in the ICU. That's medicine.

This is an R-rated dark humor game. Patients will insult you, threaten you, overshare, go manic, and occasionally end up in the hospital. That's also medicine.

📱 The Chat Header

When you open a patient's chat you'll see two rows at the top of the phone:

• Row 1 — Patient photo, name, and compact status: mood state · Mood score/100 · Rx count
• Row 2 — Three action buttons: 💊 Prescribe, 📋 Notes, and ⏩ Week N Results

The buttons scroll horizontally if needed — nothing is hidden.

💬 How Texting Works

• Select a patient from the sidebar on the left
• Type anything in the text box — patients respond on-topic to what you actually say
• Ask about music, movies, weed, sports, cars, politics, their medication, their feelings — they have opinions on all of it
• Short answers work: "yes", "no", "maybe", "idk" — patients understand and respond naturally
• Ask direct questions and get direct answers about side effects, dosage timing, how they're feeling
• Use Quick Reply buttons below the text box for common therapeutic lines
• Profanity, insults, dark humor — patients handle all of it. And give it right back.
• Each patient has unique knowledge, opinions, triggers, and a big mouth

🧠 Mood & Reaction System

Every message you send shifts the patient's mood score (0–100). Their response style changes with it:

• Kind / empathetic messages → mood +15
• Prescribing medication → mood +8
• Praising the patient → mood +10
• Insults / dismissing their illness → mood −10 to −20 (more for aggressive patients)
• Profanity → mood −5 to −12 depending on personality
• Challenging their reality (telling them nothing's wrong) → mood −20
• Threatening language → mood crashes hard — they will threaten back

Mood drives their state, which changes how they talk, what they say, and what visual effects fire:

• 🟢 Stable-ish — Manageable. They're in it but holding.
• 🟠 Agitated — Mood dropping. Insults incoming.
• 🟡 Manic — Elevated, pressured speech, bad financial decisions.
• 🔵 Distressed — Sad, slow, tearful. Handle gently.
• 🟣 Paranoid — Conspiracy mode. Every response is suspicious.
• 🔴 MELTDOWN — Full crisis. Screen shakes. They are coming for you.

🤖 Patient Intelligence — They Actually Listen

Patients use a topic detection engine that scans every message you send. They respond to 35+ topic categories:

They also respond correctly to yes / no / maybe / idk — no more patients ignoring your one-word answers.

💊 Prescribing Medications

• Click 💊 Prescribe in the chat header or 📋 Rx Pad in the toolbar
• Browse 10 drug classes and 70+ medications using the class tabs
• Each drug shows its dose range and clinical notes — read them
• Fill in dosage, instructions, diagnosis, refills, then click "Write & Mail Prescription"
• The prescription is mailed to your patient — they get a reaction message in chat
• Check 📬 Mailbox in the toolbar for the full delivery log
• Dosage matters — prescribing max-dose speeds up Fast Forward outcomes (not always in a good way)

🧪 Medication Classes

⏩ Fast Forward Week — See What Happened

After prescribing, click ⏩ Week N Results in the chat header to advance one week and find out what the medication actually did to your patient. Each week produces a detailed report.

11 possible outcomes — weighted by drug class, diagnosis, and how the patient took their medication:

• ✅ Significant Improvement — It worked. They got out of bed. They feel things. Don't celebrate yet.
• 🟡 Partial Response — "15% better." Tunnel is the same length, they walk faster through it.
• ⚠️ Bad Side Effects — Nausea, weight gain, shaking hands, sex drive gone, 14 hours of sleep. Classic.
• 💢 Rage Episode — Stimulants + aggression. They threw a printer. Got fired. Possible property damage.
• 🆘 Suicidal Ideation — Black-box warning triggered. They called a crisis line. Immediate follow-up required.
• ⚡ Manic Episode — Antidepressant flipped a switch. No sleep, 6 new businesses, spent rent on a boat.
• ☠️ Overdose — Patient took the whole bottle. Currently texting from the hospital. They misread "as directed."
• 🏥 Hospitalized — 72-hour hold. Voluntary or otherwise. They're bored and the coffee is terrible.
• 🚨 Serotonin Syndrome — Mixed medications. ER visit. Heart rate 160. They also took St. John's Wort.
• 😰 Withdrawal — Ran out of pills. Brain zaps. Cold sweats. Never stopping this medication again.
• 😐 No Effect — Nothing happened. The pills are decorative. Try a different medication.

Compliance System: Patients follow your instructions obsessively — sometimes too obsessively. Some took triple the dose because "more means faster." Some gave pills to their roommate. Results vary accordingly.

You can fast-forward multiple weeks — the counter increments each time. Each week uses the most recently prescribed medication.

After closing the report, the patient's follow-up message appears in chat automatically so the conversation continues.

🎲 What Affects Outcomes

Fast Forward results are weighted — not purely random. Here's what tilts the odds:

• Drug class: TCAs have the highest overdose risk. Benzos have the highest withdrawal/overdose risk. Stimulants push toward mania and rage. Beta-blockers are the safest.
• Diagnosis match: Prescribing an antidepressant to an undiagnosed bipolar patient is asking for a manic episode. Prescribing benzos to someone with substance use history is risky.
• Dosage: High/max doses boost bad-outcome probability. Low starter doses lean toward "no effect" or partial response.
• Compliance: Every patient randomly gets a compliance mode — some are exact, some forget doses, some helpfully triple up. Overdosers escalate toward ER outcomes.
• Patient personality: BPD patients have elevated suicide/overdose risk. Antisocial patients are more likely to rage. Schizophrenia patients are more likely to be hospitalized.

🛠️ Toolbar — Top of Screen

• 📋 Rx Pad — Open the prescription pad for the currently active patient
• 📬 Mailbox — Full log of every prescription mailed, delivery status included
• 📝 Notes — Auto-generate a clinical case note for the active patient with real DSM terminology
• 🏆 Score — Session stats: consultations, prescriptions written, meltdowns triggered, patients treated
• 🏠 Menu — Return to main menu (your patients will notice you abandoned them)

👥 Your Patients — Who They Are

You have 12 patients, each with a primary diagnosis, secondary diagnosis, unique backstory, personality, and list of things that set them off. Here's a preview:

• Brenda Smashnuts — BPD + Bipolar I. Former kindergarten teacher. In love with her mailman. Oscillates between "you're god" and "I will end you" every 90 seconds.
• Gary Tinfoilhat — Paranoid Schizophrenia. Former IT guy. Lives in a Faraday cage. Convinced you're a government asset. Testing your pills for nanobots weekly.
• Deborah Screamsalot — Histrionic PD. Everything is the most dramatic thing that has ever happened. She is calling Oprah AND Dr. Phil.
• Kevin Stabsworth — ASPD + IED. Court-mandated. Finds therapy amusing. Has documentation on everyone. "Bad things happen to doctors who don't cooperate."
• Wanda Mooncrystal — Schizotypal. Online witch. In a relationship with the moon. Will hex you at the next full moon if you disappoint her.
• Randy Louderpunk — ADHD (Severe). Eleven unfinished businesses, four abandoned novels. Has never finished a movie. Cannot stop. Will not stop.
• Sylvia Cryfountain — MDD + PTSD. Cried into lattes until she was fired. Has watched the sad penguin documentary 31 times. Crying is her hobby.
• Hank Ragequit — IED + NPD. Banned from six Home Depots. Has eleven drywall holes he calls "ventilation improvements." DO NOT correct him.
• Tiffany Vaporbrain — Substance Use + Dissociative Disorder. Philosophy student. Not sure if she's real. The medication is "just atoms agreeing to rearrange."
• Norman Knifecollector — Schizophrenia. Former accountant. Mapping a conspiracy called "the actuarial apocalypse." Lives with 14 cats, all named Evidence.
• Loretta Butterfingers — OCD. Washed her hands 140 times today. Types through nitrile gloves. Your app has germs. She can feel them.
• Barry Murmurs — Social Anxiety + MDD. Rehearsed his first text for 4 days. Apologizes for apologizing. The loneliest person you'll ever feel terrible about.

📋 Case Notes

Click 📋 Notes in the chat header or 📝 Notes in the toolbar to auto-generate a full clinical SOAP note for the active patient. Notes include:

• Subjective — patient-reported symptoms and mood state
• Objective — message count, affect, thought process observations
• Assessment — primary/secondary diagnosis, rule-outs, biological considerations
• Plan — medications prescribed, therapy recommendations, follow-up timeline

All notes use real clinical terminology drawn from a database of 400+ psychiatric terms. Previous notes are archived and viewable.

💡 Tips & Survival Guide

• Prescribe before fast-forwarding — no Rx means a week of nothing (and an annoyed patient)
• Match the medication to the diagnosis — SSRIs for depression, mood stabilizers for bipolar, antipsychotics for psychosis
• Start with a low dose — less side effect risk, more "no effect" outcomes early, safer overall
• Benzos are effective but risky — patients with addiction history will do things to themselves
• Stimulants can trigger mania in patients who have undetected bipolar. Gary is not diagnosed bipolar. Gary is also on Adderall now.
• You can chat with patients after fast-forwarding — they remember what happened and will talk about it
• Each new game shuffles patients — you'll see different patients first each time
• Some patients respond better to empathy, some to authority — figure out which is which before you anger them
• Hank's meltdowns shake the screen. Manic Randy never stops texting. Paranoid Gary accuses you of things. This is working as intended.

⚠️ Content Warning

This is an R-rated dark humor game. Patients use profanity, make death threats, discuss suicide, overdose, hospitalization, drugs, sex, violence, and other heavy topics — all portrayed as dark comedy.

This game is not medical advice. Do not prescribe real medication based on this game. The psychiatric information is real; the scenarios are absurd fiction.

If you or someone you know is in crisis: Crisis Line: 988 | Crisis Text Line: text HOME to 741741