

<?php $__env->startSection('content'); ?>
<div class="container py-4">
    <!-- Main Header with Right-Aligned Button -->
    <div class="main-header mb-4 d-flex justify-content-between align-items-center">
        <h1 class="h2">Mental Status Examination (MSE)</h1>
        <button type="button" class="btn btn-sm btn-outline-secondary show-view" data-view="dashboard">
            <i class="bi bi-arrow-left"></i> Back to Dashboard
        </button>
    </div>

</div>
<form id="questionForm" onsubmit="submitForm(event)" class="ajax-form forms-sample" method="post" action="<?php echo e(route('mentalHealth.bsdsStore')); ?>">     
<!-- Centered Content with Card and Progress Bar --> 
<div class="d-flex justify-content-center min-vh-75 align-items-center">
    <div class="col-sm-12 col-xl-6">  

        <!-- Progress Bar -->
        <div class="progress mb-4">
          <div class="progress-bar bg-primary" id="progress-bar" role="progressbar" style="width: 0%;" 
               aria-valuenow="0" aria-valuemin="0" aria-valuemax="100">0%</div>
        </div>
            

 
        <!-- Question 1 -->
        <div class="bg-secondary border border-white rounded h-100 p-4 question" data-question="1">
        <h4>Appearance</h4>
            <h6 class="mb-4 text-white">
            General Appearance:
            </h6>
            <input type="hidden" name="question" value="General Appearance:">
            
            <?php for($i = 0; $i <= 3; $i++): ?>
                <div class="form-check form-check-inline">
                    <input class="form-check-input" type="radio" onclick="toggleDetails1(false)" name="question1" id="question1_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
                    <label class="form-check-label text-white" onclick="toggleDetails1(false)"  for="question1_<?php echo e($i); ?>">
                        <?php echo e(['Meticulous', 'Unkempt', 'Disheveled', 'Well-groomed'][$i]); ?>

                    </label>
                </div>
                <hr>
            <?php endfor; ?>
            <!-- Yes/No Options -->
            <div class="form-check">
                <input class="form-check-input" type="radio" name="question1" id="question1_other" value="other" onclick="toggleDetails1(true)">
                <label class="form-check-label text-white" for="question1_other">other</label>
            </div>

            <div id="attemptDetails1" style="display: none;">
                <div class="mt-3">
                    <label for="attempt_description_1" class="text-white">What did you do?</label>
                    <textarea class="form-control" id="attempt_description_1" name="attempt_description_1" rows="3"></textarea>
                </div>    
            </div>
            
            <!-- Buttons -->
            <div class="d-flex justify-content-between mt-4">
                <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
                <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
            </div>
        </div>
        
        <!-- Question 2 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="2">
<h4>Appearance</h4>
    <h6 class="mb-4 text-white">Apparent Age:</h6>
    <input type="hidden" name="question" value="Apparent Age:">
    
    <?php for($i = 0; $i <= 2; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question2" id="question2_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question2_<?php echo e($i); ?>">
                <?php echo e(['Appears stated age', 'Appears older', 'Appears younger'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 3 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="3">
<h4>Appearance</h4>
    <h6 class="mb-4 text-white">Hygiene:</h6>
    <input type="hidden" name="question" value="Hygiene:">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question3" id="question3_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question3_<?php echo e($i); ?>">
                <?php echo e(['Good', 'Fair', 'Poor', 'Malodorous'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 4 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="4">
<h4>Appearance</h4>
    <h6 class="mb-4 text-white">Dress:</h6>
    <input type="hidden" name="question" value="Dress:">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" onclick="toggleDetails4(false)" name="question4" id="question4_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" onclick="toggleDetails4(false)" for="question4_<?php echo e($i); ?>">
                <?php echo e(['Appropriate', 'Inappropriate', 'Bizarre', 'Provocative'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Yes/No Options -->
    <div class="form-check">
        <input class="form-check-input" type="radio" name="question4" id="question4_other" value="other" onclick="toggleDetails4(true)">
        <label class="form-check-label text-white" for="question4_other">other</label>
    </div>

    <div id="attemptDetails4" style="display: none;">
        <div class="mt-3">
            <label for="attempt_description_4" class="text-white">Specify?</label>
            <textarea class="form-control" id="attempt_description_4" name="attempt_description_4" rows="3"></textarea>
        </div>    
    </div>
    
    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 5 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="5">
<h4>Appearance</h4>
    <h6 class="mb-4 text-white">Posture:</h6>
    <input type="hidden" name="question" value="Posture:">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" onclick="toggleDetails5(false)" name="question5" id="question5_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" onclick="toggleDetails5(false)" for="question5_<?php echo e($i); ?>">
                <?php echo e(['Relaxed', 'Rigid', 'Slouched', 'Restless'][$i]); ?>

            </label>

        </div>
        <hr>
    <?php endfor; ?>

    <!-- Yes/No Options -->
    <div class="form-check">
        <input class="form-check-input" type="radio" name="question5" id="question5_other" value="other" onclick="toggleDetails5(true)">
        <label class="form-check-label text-white" for="question5_other">other</label>
    </div>

    <div id="attemptDetails5" style="display: none;">
        <div class="mt-3">
            <label for="attempt_description_5" class="text-white">Specify?</label>
            <textarea class="form-control" id="attempt_description_5" name="attempt_description_5" rows="3"></textarea>
        </div>    
    </div>
    
    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 6 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="6">
<h4>Appearance</h4>
    <h6 class="mb-4 text-white">Physical Abnormalities:</h6>
    <input type="hidden" name="question" value="Physical Abnormalities:">
    
    <?php for($i = 0; $i <= 1; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" onclick="toggleDetails6(false)" name="question6" id="question6_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" onclick="toggleDetails6(false)" for="question6_<?php echo e($i); ?>">
                <?php echo e(['None', 'Yes'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Yes/No Options -->
    <div class="form-check">
        <input class="form-check-input" type="radio" name="question6" id="question6_other" value="other" onclick="toggleDetails6(true)">
        <label class="form-check-label text-white" for="question6_other">other</label>
    </div>

    <div id="attemptDetails6" style="display: none;">
        <div class="mt-3">
            <label for="attempt_description_6" class="text-white">Specify?</label>
            <textarea class="form-control" id="attempt_description_6" name="attempt_description_6" rows="3"></textarea>
        </div>    
    </div>
    
    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>



      <!-- Question 7 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="7">
    <h4>Behavior</h4>
    <h6 class="mb-4 text-white">Level of Consciousness</h6>
    <input type="hidden" name="question" value="Level of Consciousness:">
    
    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question7" id="question7_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question7_<?php echo e($i); ?>">
                <?php echo e(['Alert', 'Drowsy', 'Somnolent', 'Stuporous', 'Comatose'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>
    
    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 8 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="8">
    <h4>Behavior</h4>
    <h6 class="mb-4 text-white">Psychomotor Activity</h6>
    <input type="hidden" name="question" value="Psychomotor Activity:">
    
    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question8" id="question8_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question8_<?php echo e($i); ?>">
                <?php echo e(['Normal', 'Increased', 'Decreased', 'Agitated', 'Retarded'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>
    
    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 9 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="9">
    <h4>Behavior</h4>
    <h6 class="mb-4 text-white">Eye Contact</h6>
    <input type="hidden" name="question" value="Eye Contact:">
    
    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question9" id="question9_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question9_<?php echo e($i); ?>">
                <?php echo e(['Good', 'Fair', 'Poor', 'Avoidant', 'Intense/Staring'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>
    
    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 10 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="10">
    <h4>Behavior</h4>
    <h6 class="mb-4 text-white">Attitude Toward Examiner</h6>
    <input type="hidden" name="question" value="Attitude Toward Examiner:">
    
    <?php for($i = 0; $i <= 6; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question10" id="question10_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question10_<?php echo e($i); ?>">
                <?php echo e(['Cooperative', 'Uncooperative', 'Guarded', 'Suspicious', 'Hostile', 'Evasive', 'Seductive'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>
    
    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>


<!-- Question 11: Abnormal Movements -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="11">
    <h4>Behavior</h4>
    <h6 class="mb-4 text-white">Abnormal Movements</h6>
    <input type="hidden" name="question" value="Abnormal Movements">

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="none" name="abnormal_movements[]" value="None">
        <label class="form-check-label text-white" for="none">None</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="tremor" name="abnormal_movements[]" value="Tremor">
        <label class="form-check-label text-white" for="tremor">Tremor</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="tics" name="abnormal_movements[]" value="Tics">
        <label class="form-check-label text-white" for="tics">Tics</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="tardive_dyskinesia" name="abnormal_movements[]" value="Tardive dyskinesia">
        <label class="form-check-label text-white" for="tardive_dyskinesia">Tardive dyskinesia</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="akathisia" name="abnormal_movements[]" value="Akathisia">
        <label class="form-check-label text-white" for="akathisia">Akathisia</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="dystonia" name="abnormal_movements[]" value="Dystonia">
        <label class="form-check-label text-white" for="dystonia">Dystonia</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="choreoathetoid_movements" name="abnormal_movements[]" value="Choreoathetoid movements">
        <label class="form-check-label text-white" for="choreoathetoid_movements">Choreoathetoid movements</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="compulsions" name="abnormal_movements[]" value="Compulsions">
        <label class="form-check-label text-white" for="compulsions">Compulsions</label>
    </div>


    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="other_abnormal" name="abnormal_movements[]" value="Other">
        <label class="form-check-label text-white" for="other_abnormal">Other:</label>
    </div>
    <div id="other_abnormal_input" style="display:none; margin-left: 20px;">
        <input type="text" class="form-control" name="other_abnormal_other" placeholder="">
    </div>


    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)" id="prevBtn">Previous</button>
        <button class="btn btn-primary" id="nextBtn" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>




<!-- Question 12 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="12">
    <h4>Speech</h4>
    <h6 class="mb-4 text-white">Rate</h6>
    <input type="hidden" name="question" value="Rate">
    
    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question12" id="question12_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question12_<?php echo e($i); ?>">
                <?php echo e(['Normal', 'Rapid', 'Slow', 'Pressured', 'Poverty of speech'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 13 -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="13">
    <h4>Speech</h4>
    <h6 class="mb-4 text-white">Volume</h6>
    <input type="hidden" name="question" value="Volume">
    
    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question13" id="question13_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question13_<?php echo e($i); ?>">
                <?php echo e(['Normal', 'Loud', 'Soft', 'Whispered', 'Mute'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 14 - Articulation -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="14">
    <h4>Speech</h4>
    <h6 class="mb-4 text-white">Articulation</h6>
    <input type="hidden" name="question" value="Articulation">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question14" id="question14_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question14_<?php echo e($i); ?>">
                <?php echo e(['Clear', 'Slurred', 'Mumbled', 'Stuttering'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>


<!-- Question 15 - Rhythm/Prosody -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="15">
    <h4>Speech</h4>
    <h6 class="mb-4 text-white">Rhythm/Prosody</h6>
    <input type="hidden" name="question" value="Rhythm/Prosody">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question15" id="question15_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question15_<?php echo e($i); ?>">
                <?php echo e(['Normal', 'Monotonous', 'Sing-song', 'Dysarthric'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 16 - Quantity -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="16">
    <h4>Speech</h4>
    <h6 class="mb-4 text-white">Quantity</h6>
    <input type="hidden" name="question" value="Quantity">
    
    <?php for($i = 0; $i <= 3; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question16" id="question16_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question16_<?php echo e($i); ?>">
                <?php echo e(['Normal', 'Verbose', 'Poverty of speech', 'Mutism'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>

<!-- Question 17 - Latency -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="17">
    <h4>Speech</h4>
    <h6 class="mb-4 text-white">Latency</h6>
    <input type="hidden" name="question" value="Latency">
    
    <?php for($i = 0; $i <= 1; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question17" id="question17_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question17_<?php echo e($i); ?>">
                <?php echo e(['Normal', 'Delayed'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
        <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>



<!-- Question 18: Abnormal Movements -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="18">
    <h4>Speech</h4>
    <h6 class="mb-4 text-white">Speech Movements</h6>
    <input type="hidden" name="question" value="Speech Movements">

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="none" name="speech_movements[]" value="None">
        <label class="form-check-label text-white" for="none">None</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="aphasia" name="speech_movements[]" value="Aphasia">
        <label class="form-check-label text-white" for="aphasia">Aphasia</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="wordsalad" name="speech_movements[]" value="Word salad">
        <label class="form-check-label text-white" for="wordsalad">Word salad</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="neologisms" name="speech_movements[]" value="Neologisms">
        <label class="form-check-label text-white" for="neologisms">Neologisms</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="echolalia" name="speech_movements[]" value="Echolalia">
        <label class="form-check-label text-white" for="echolalia">Echolalia</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="clanging" name="speech_movements[]" value="Clanging">
        <label class="form-check-label text-white" for="clanging">Clanging</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="perseveration" name="speech_movements[]" value="Perseveration">
        <label class="form-check-label text-white" for="perseveration">Perseveration</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="other_speech" name="speech_movements[]" value="Other">
        <label class="form-check-label text-white" for="other_speech">Other:</label>
    </div>
    <div id="other_speech_input" style="display:none; margin-left: 20px;">
        <input type="text" class="form-control" name="other_speech_other" placeholder="">
    </div>


    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)" id="prevBtn">Previous</button>
        <button class="btn btn-primary" id="nextBtn" onclick="navigateQuestion(1, event)">Next</button>
    </div>
</div>



<!-- Question 19: Mood & Affect -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="19">
    <h4>Mood & Affect</h4>
    <h5>Self-Reported Mood</h5>
    <input type="hidden" name="question" value="Self-Reported Mood">

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="euthymic" name="self_reported_mood[]" value="Euthymic">
        <label class="form-check-label text-white" for="euthymic">Euthymic</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="anxious" name="self_reported_mood[]" value="Anxious">
        <label class="form-check-label text-white" for="anxious">Anxious</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="depressed" name="self_reported_mood[]" value="Depressed">
        <label class="form-check-label text-white" for="depressed">Depressed</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="irritable" name="self_reported_mood[]" value="Irritable">
        <label class="form-check-label text-white" for="irritable">Irritable</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="angry" name="self_reported_mood[]" value="Angry">
        <label class="form-check-label text-white" for="angry">Angry</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="euphoric" name="self_reported_mood[]" value="Euphoric">
        <label class="form-check-label text-white" for="euphoric">Euphoric</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="scared" name="self_reported_mood[]" value="Scared">
        <label class="form-check-label text-white" for="scared">Scared</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="empty" name="self_reported_mood[]" value="Empty">
        <label class="form-check-label text-white" for="empty">Empty</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="numb" name="self_reported_mood[]" value="Numb">
        <label class="form-check-label text-white" for="numb">Numb</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="guilty" name="self_reported_mood[]" value="Guilty">
        <label class="form-check-label text-white" for="guilty">Guilty</label>
    </div>

    <div class="form-check">
        <input type="checkbox" class="form-check-input" id="other_self_reported" name="self_reported_mood[]" value="Other">
        <label class="form-check-label text-white" for="other_self_reported">Other:</label>
    </div>
    <div id="other_self_reported_input" style="display:none; margin-left: 20px;">
        <input type="text" class="form-control" name="other_self_reported_other" placeholder="">
    </div>


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        <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)" id="prevBtn">Previous</button>
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    </div>
</div>


<!-- Question 20 - Quality -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="20">
    <h4>Mood & Affect</h4>
    <h5>Self-Reported Mood</h5>
    <h6 class="mb-4 text-white">Intensity</h6>
    <input type="hidden" name="question" value="Intensity">
    
    <?php for($i = 0; $i <= 2; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question20" id="question20_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question20_<?php echo e($i); ?>">
                <?php echo e(['Mild', 'Moderate', 'Severe'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Buttons -->
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    </div>
</div>

<!-- Question 21 - Quality -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="21">
    <h4>Mood & Affect</h4>
    <h5>Observed Affect</h5>
    <h6 class="mb-4 text-white">Quality</h6>
    <input type="hidden" name="question" value="Quality">
    
    <?php for($i = 0; $i <= 4; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question21" id="question21_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question21_<?php echo e($i); ?>">
                <?php echo e(['Full range', 'Restricted', 'Blunted', 'Flat', 'Constricted'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Buttons -->
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</div>

<!-- Question 22 - Appropriateness -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="22">
    <h4>Mood & Affect</h4>
    <h5>Observed Affect</h5>
    <h6 class="mb-4 text-white">Appropriateness</h6>
    <input type="hidden" name="question" value="Appropriateness">
    
    <?php for($i = 0; $i <= 2; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question22" id="question22_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question22_<?php echo e($i); ?>">
                <?php echo e(['Appropriate', 'Inappropriate', 'Incongruent with mood'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
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</div>



<!-- Question 23 - Stability -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="23">
    <h4>Mood & Affect</h4>
    <h5>Observed Affect</h5>
    <h6 class="mb-4 text-white">Stability</h6>
    <input type="hidden" name="question" value="Stability">
    
    <?php for($i = 0; $i <= 2; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question23" id="question23_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question23_<?php echo e($i); ?>">
                <?php echo e(['Stable', 'Labile', 'Fluctuating'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
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    </div>
</div>

<!-- Question 24 - Mood Congruence -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="24">
    <h4>Mood & Affect</h4>
    <h5>Observed Affect</h5>
    <h6 class="mb-4 text-white">Mood Congruence</h6>
    <input type="hidden" name="question" value="Mood Congruence">
    
    <?php for($i = 0; $i <= 1; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question24" id="question24_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question24_<?php echo e($i); ?>">
                <?php echo e(['Congruent', 'Incongruent'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Buttons -->
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    </div>
</div>

<!-- Question 25 - Reactivity -->
<div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="25">
    <h4>Mood & Affect</h4>
    <h5>Observed Affect</h5>
    <h6 class="mb-4 text-white">Reactivity</h6>
    <input type="hidden" name="question" value="Reactivity">
    
    <?php for($i = 0; $i <= 1; $i++): ?>
        <div class="form-check form-check-inline">
            <input class="form-check-input" type="radio" name="question25" id="question25_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
            <label class="form-check-label text-white" for="question25_<?php echo e($i); ?>">
                <?php echo e(['Reactive', 'Nonreactive'][$i]); ?>

            </label>
        </div>
        <hr>
    <?php endfor; ?>

    <!-- Buttons -->
    <div class="d-flex justify-content-between mt-4">
        <button class="btn btn-outline-light" id="prevBtn" onclick="navigateQuestion(-1, event)">Previous</button>
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    </div>
</div>

        <!-- Question 11 -->
        <div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="11">
        <h4>Part 1: Narrative Description</h4>
            <h6 class="mb-4 text-white">Their energy increases above what is normal for them, and they often get many things done they would not ordinarily be able to do.</h6>
            <input type="hidden" name="question" value="Their energy increases above what is normal for them, and they often get many things done they would not ordinarily be able to do.">
            
            <?php for($i = 0; $i <= 1; $i++): ?>
                <div class="form-check form-check-inline">
                    <input class="form-check-input" type="radio" name="question11" id="question11_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
                    <label class="form-check-label text-white" for="question11_<?php echo e($i); ?>">
                        <?php echo e(['No', 'Yes'][$i]); ?>

                    </label>
                </div>
                <hr>
            <?php endfor; ?>
            
            <div class="d-flex justify-content-between mt-4">
                <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
                <button class="btn btn-primary" onclick="navigateQuestion(1, event)">Next</button>
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        </div>
        
        
        <!-- Question 12 -->
        <div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="12">
        <h4>Part 1: Narrative Description</h4>
            <h6 class="mb-4 text-white">Sometimes, during these "high" periods, these individuals feel as if they have too much energy or feel "hyper".</h6>
            <input type="hidden" name="question" value="Sometimes, during these 'high' periods, these individuals feel as if they have too much energy or feel 'hyper'.">
            
            <?php for($i = 0; $i <= 1; $i++): ?>
                <div class="form-check form-check-inline">
                    <input class="form-check-input" type="radio" name="question12" id="question12_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
                    <label class="form-check-label text-white" for="question12_<?php echo e($i); ?>">
                        <?php echo e(['No', 'Yes'][$i]); ?>

                    </label>
                </div>
                <hr>
            <?php endfor; ?>
            
            <div class="d-flex justify-content-between mt-4">
                <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
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        </div>
        
        <!-- Question 13 -->
        <div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="13">
        <h4>Part 1: Narrative Description</h4>
            <h6 class="mb-4 text-white">Some individuals, during these high periods, may feel irritable, "on edge", or aggressive.</h6>
            <input type="hidden" name="question" value="Some individuals, during these high periods, may feel irritable, 'on edge', or aggressive.">
            
            <?php for($i = 0; $i <= 1; $i++): ?>
                <div class="form-check form-check-inline">
                    <input class="form-check-input" type="radio" name="question13" id="question13_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
                    <label class="form-check-label text-white" for="question13_<?php echo e($i); ?>">
                        <?php echo e(['No', 'Yes'][$i]); ?>

                    </label>
                </div>
                <hr>
            <?php endfor; ?>
            
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        <!-- Question 14 -->
        <div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="14">
        <h4>Part 1: Narrative Description</h4>
            <h6 class="mb-4 text-white">Some individuals, during these high periods, take on too many activities at once.</h6>
            <input type="hidden" name="question" value="Some individuals, during these high periods, take on too many activities at once.">
            
            <?php for($i = 0; $i <= 1; $i++): ?>
                <div class="form-check form-check-inline">
                    <input class="form-check-input" type="radio" name="question14" id="question14_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
                    <label class="form-check-label text-white" for="question14_<?php echo e($i); ?>">
                        <?php echo e(['No', 'Yes'][$i]); ?>

                    </label>
                </div>
                <hr>
            <?php endfor; ?>
            
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                <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
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        </div>
        
        <!-- Question 15 -->
        <div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="15">
        <h4>Part 1: Narrative Description</h4>
            <h6 class="mb-4 text-white">During these high periods, some individuals may spend money in ways that cause them trouble.</h6>
            <input type="hidden" name="question" value="During these high periods, some individuals may spend money in ways that cause them trouble.">
            
            <?php for($i = 0; $i <= 1; $i++): ?>
                <div class="form-check form-check-inline">
                    <input class="form-check-input" type="radio" name="question15" id="question15_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
                    <label class="form-check-label text-white" for="question15_<?php echo e($i); ?>">
                        <?php echo e(['No', 'Yes'][$i]); ?>

                    </label>
                </div>
                <hr>
            <?php endfor; ?>
            
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        <!-- Question 16 -->
        <div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="16">
        <h4>Part 1: Narrative Description</h4>
            <h6 class="mb-4 text-white">They may be more talkative, outgoing, or sexual during these periods.</h6>
            <input type="hidden" name="question" value="They may be more talkative, outgoing, or sexual during these periods.">
            
            <?php for($i = 0; $i <= 1; $i++): ?>
                <div class="form-check form-check-inline">
                    <input class="form-check-input" type="radio" name="question16" id="question16_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
                    <label class="form-check-label text-white" for="question16_<?php echo e($i); ?>">
                        <?php echo e(['No', 'Yes'][$i]); ?>

                    </label>
                </div>
                <hr>
            <?php endfor; ?>
            
            <div class="d-flex justify-content-between mt-4">
                <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
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        <!-- Question 17 -->
        <div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="17">
        <h4>Part 1: Narrative Description</h4>
            <h6 class="mb-4 text-white">Sometimes, their behavior during these high periods seems strange or annoying to others.</h6>
            <input type="hidden" name="question" value="Sometimes, their behavior during these high periods seems strange or annoying to others.">
            
            <?php for($i = 0; $i <= 1; $i++): ?>
                <div class="form-check form-check-inline">
                    <input class="form-check-input" type="radio" name="question17" id="question17_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
                    <label class="form-check-label text-white" for="question17_<?php echo e($i); ?>">
                        <?php echo e(['No', 'Yes'][$i]); ?>

                    </label>
                </div>
                <hr>
            <?php endfor; ?>
            
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                <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
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        <!-- Question 18 -->
        <div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="18">
        <h4>Part 1: Narrative Description</h4>
            <h6 class="mb-4 text-white">Sometimes, these individuals get into difficulty with co-workers or the police during these high periods.</h6>
            <input type="hidden" name="question" value="Sometimes, these individuals get into difficulty with co-workers or the police during these high periods.">
            
            <?php for($i = 0; $i <= 1; $i++): ?>
                <div class="form-check form-check-inline">
                    <input class="form-check-input" type="radio" name="question18" id="question18_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
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                        <?php echo e(['No', 'Yes'][$i]); ?>

                    </label>
                </div>
                <hr>
            <?php endfor; ?>
            
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        <!-- Question 19 -->
        <div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="19">
        <h4>Part 1: Narrative Description</h4>
            <h6 class="mb-4 text-white">Sometimes, they increase their alcohol or non-prescription drug use during these high periods.</h6>
            <input type="hidden" name="question" value="Sometimes, they increase their alcohol or non-prescription drug use during these high periods.">
            
            <?php for($i = 0; $i <= 1; $i++): ?>
                <div class="form-check form-check-inline">
                    <input class="form-check-input" type="radio" name="question19" id="question19_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
                    <label class="form-check-label text-white" for="question19_<?php echo e($i); ?>">
                        <?php echo e(['No', 'Yes'][$i]); ?>

                    </label>
                </div>
                <hr>
            <?php endfor; ?>
            
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                <button class="btn btn-outline-light" onclick="navigateQuestion(-1, event)">Previous</button>
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        </div>

        <!-- Question 20 -->
        <div class="bg-secondary border border-white rounded h-100 p-4 question d-none" data-question="20">
        <h4>Part 2: Overall Assessment</h4>
            <h6 class="mb-4 text-white">
            Now that you have completed the checklist, please mark ONE of the following four statements:
            </h6>
            <input type="hidden" name="question" value="Now that you have completed the checklist, please mark ONE of the following four statements:">
            
            <?php for($i = 0; $i <= 3; $i++): ?>
                <div class="form-check form-check-inline">
                    <input class="form-check-input" type="radio" name="question20" id="question20_<?php echo e($i); ?>" value="<?php echo e($i); ?>">
                    <label class="form-check-label text-white" for="question20_<?php echo e($i); ?>">
                        <?php echo e(['This story doesn"t really describe me at all', 'This story fits me to some degree, but not in most respects', 'This story fits me fairly well', 'This story fits me very well, or almost perfectly'][$i]); ?>

                    </label>
                </div>
                <hr>
            <?php endfor; ?>  
        
            <div class="d-flex justify-content-between mt-4">
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});


});
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<?php echo $__env->make('mental.layouts.app', array_diff_key(get_defined_vars(), ['__data' => 1, '__path' => 1]))->render(); ?><?php /**PATH /var/www/html/resources/views/mental/general_psychological_distress/mse-template.blade.php ENDPATH**/ ?>