Source code for camcops_server.tasks.icd10depressive

#!/usr/bin/env python

"""
camcops_server/tasks/icd10depressive.py

===============================================================================

    Copyright (C) 2012-2019 Rudolf Cardinal (rudolf@pobox.com).

    This file is part of CamCOPS.

    CamCOPS is free software: you can redistribute it and/or modify
    it under the terms of the GNU General Public License as published by
    the Free Software Foundation, either version 3 of the License, or
    (at your option) any later version.

    CamCOPS is distributed in the hope that it will be useful,
    but WITHOUT ANY WARRANTY; without even the implied warranty of
    MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
    GNU General Public License for more details.

    You should have received a copy of the GNU General Public License
    along with CamCOPS. If not, see <http://www.gnu.org/licenses/>.

===============================================================================

"""

from typing import List, Optional

from cardinal_pythonlib.datetimefunc import format_datetime
import cardinal_pythonlib.rnc_web as ws
from sqlalchemy.sql.schema import Column
from sqlalchemy.sql.sqltypes import Boolean, Date, Integer, UnicodeText

from camcops_server.cc_modules.cc_constants import (
    CssClass,
    DateFormat,
    ICD10_COPYRIGHT_DIV,
)
from camcops_server.cc_modules.cc_ctvinfo import CTV_INCOMPLETE, CtvInfo
from camcops_server.cc_modules.cc_html import (
    answer,
    get_present_absent_none,
    heading_spanning_two_columns,
    tr,
    tr_qa,
)
from camcops_server.cc_modules.cc_request import CamcopsRequest
from camcops_server.cc_modules.cc_sqla_coltypes import (
    BIT_CHECKER,
    CamcopsColumn,
    SummaryCategoryColType,
)
from camcops_server.cc_modules.cc_string import AS
from camcops_server.cc_modules.cc_summaryelement import SummaryElement
from camcops_server.cc_modules.cc_task import (
    Task,
    TaskHasClinicianMixin,
    TaskHasPatientMixin,
)
from camcops_server.cc_modules.cc_text import SS


# =============================================================================
# Icd10Depressive
# =============================================================================

[docs]class Icd10Depressive(TaskHasClinicianMixin, TaskHasPatientMixin, Task): """ Server implementation of the ICD10-DEPR task. """ __tablename__ = "icd10depressive" shortname = "ICD10-DEPR" mood = CamcopsColumn( "mood", Boolean, permitted_value_checker=BIT_CHECKER, comment="Depressed mood to a degree that is definitely abnormal " "for the individual, present for most of the day and almost " "every day, largely uninfluenced by circumstances, and " "sustained for at least 2 weeks." ) anhedonia = CamcopsColumn( "anhedonia", Boolean, permitted_value_checker=BIT_CHECKER, comment="Loss of interest or pleasure in activities that are " "normally pleasurable." ) energy = CamcopsColumn( "energy", Boolean, permitted_value_checker=BIT_CHECKER, comment="Decreased energy or increased fatiguability." ) sleep = CamcopsColumn( "sleep", Boolean, permitted_value_checker=BIT_CHECKER, comment="Sleep disturbance of any type." ) worth = CamcopsColumn( "worth", Boolean, permitted_value_checker=BIT_CHECKER, comment="Loss of confidence and self-esteem." ) appetite = CamcopsColumn( "appetite", Boolean, permitted_value_checker=BIT_CHECKER, comment="Change in appetite (decrease or increase) with " "corresponding weight change." ) guilt = CamcopsColumn( "guilt", Boolean, permitted_value_checker=BIT_CHECKER, comment="Unreasonable feelings of self-reproach or excessive and " "inappropriate guilt." ) concentration = CamcopsColumn( "concentration", Boolean, permitted_value_checker=BIT_CHECKER, comment="Complaints or evidence of diminished ability to think " "or concentrate, such as indecisiveness or vacillation." ) activity = CamcopsColumn( "activity", Boolean, permitted_value_checker=BIT_CHECKER, comment="Change in psychomotor activity, with agitation or " "retardation (either subjective or objective)." ) death = CamcopsColumn( "death", Boolean, permitted_value_checker=BIT_CHECKER, comment="Recurrent thoughts of death or suicide, or any " "suicidal behaviour." ) somatic_anhedonia = CamcopsColumn( "somatic_anhedonia", Boolean, permitted_value_checker=BIT_CHECKER, comment="Marked loss of interest or pleasure in activities that " "are normally pleasurable" ) somatic_emotional_unreactivity = CamcopsColumn( "somatic_emotional_unreactivity", Boolean, permitted_value_checker=BIT_CHECKER, comment="Lack of emotional reactions to events or " "activities that normally produce an emotional response" ) somatic_early_morning_waking = CamcopsColumn( "somatic_early_morning_waking", Boolean, permitted_value_checker=BIT_CHECKER, comment="Waking in the morning 2 hours or more before " "the usual time" ) somatic_mood_worse_morning = CamcopsColumn( "somatic_mood_worse_morning", Boolean, permitted_value_checker=BIT_CHECKER, comment="Depression worse in the morning" ) somatic_psychomotor = CamcopsColumn( "somatic_psychomotor", Boolean, permitted_value_checker=BIT_CHECKER, comment="Objective evidence of marked psychomotor retardation or " "agitation (remarked on or reported by other people)" ) somatic_appetite = CamcopsColumn( "somatic_appetite", Boolean, permitted_value_checker=BIT_CHECKER, comment="Marked loss of appetite" ) somatic_weight = CamcopsColumn( "somatic_weight", Boolean, permitted_value_checker=BIT_CHECKER, comment="Weight loss (5 percent or more of body weight in the past " "month)" # 2017-08-24: AVOID A PERCENT SYMBOL (%) FOR NOW; SEE THIS BUG: # https://bitbucket.org/zzzeek/sqlalchemy/issues/4052/comment-attribute-causes-crash-during # noqa ) somatic_libido = CamcopsColumn( "somatic_libido", Boolean, permitted_value_checker=BIT_CHECKER, comment="Marked loss of libido" ) hallucinations_schizophrenic = CamcopsColumn( "hallucinations_schizophrenic", Boolean, permitted_value_checker=BIT_CHECKER, comment="Hallucinations that are 'typically schizophrenic' " "(hallucinatory voices giving a running commentary on the " "patient's behaviour, or discussing him between themselves, " "or other types of hallucinatory voices coming from some part " "of the body)." ) hallucinations_other = CamcopsColumn( "hallucinations_other", Boolean, permitted_value_checker=BIT_CHECKER, comment="Hallucinations (of any other kind)." ) delusions_schizophrenic = CamcopsColumn( "delusions_schizophrenic", Boolean, permitted_value_checker=BIT_CHECKER, comment="Delusions that are 'typically schizophrenic' (delusions " "of control, influence or passivity, clearly referred to body " "or limb movements or specific thoughts, actions, or " "sensations; delusional perception; persistent delusions of " "other kinds that are culturally inappropriate and completely " "impossible).") delusions_other = CamcopsColumn( "delusions_other", Boolean, permitted_value_checker=BIT_CHECKER, comment="Delusions (of any other kind)." ) stupor = CamcopsColumn( "stupor", Boolean, permitted_value_checker=BIT_CHECKER, comment="Depressive stupor." ) date_pertains_to = CamcopsColumn( "date_pertains_to", Date, comment="Date the assessment pertains to" ) comments = Column( "comments", UnicodeText, comment="Clinician's comments" ) duration_at_least_2_weeks = CamcopsColumn( "duration_at_least_2_weeks", Boolean, permitted_value_checker=BIT_CHECKER, comment="Depressive episode lasts at least 2 weeks?" ) severe_clinically = CamcopsColumn( "severe_clinically", Boolean, permitted_value_checker=BIT_CHECKER, comment="Clinical impression of severe depression, in a " "patient unwilling or unable to describe many symptoms in " "detail" ) CORE_NAMES = ["mood", "anhedonia", "energy"] ADDITIONAL_NAMES = ["sleep", "worth", "appetite", "guilt", "concentration", "activity", "death"] SOMATIC_NAMES = [ "somatic_anhedonia", "somatic_emotional_unreactivity", "somatic_early_morning_waking", "somatic_mood_worse_morning", "somatic_psychomotor", "somatic_appetite", "somatic_weight", "somatic_libido" ] PSYCHOSIS_NAMES = [ "hallucinations_schizophrenic", "hallucinations_other", "delusions_schizophrenic", "delusions_other", "stupor" ]
[docs] @staticmethod def longname(req: "CamcopsRequest") -> str: _ = req.gettext return _( "ICD-10 symptomatic criteria for a depressive episode " "(as in e.g. F06.3, F25, F31, F32, F33)" )
[docs] def get_clinical_text(self, req: CamcopsRequest) -> List[CtvInfo]: if not self.is_complete(): return CTV_INCOMPLETE infolist = [CtvInfo( content="Pertains to: {}. Category: {}.".format( format_datetime(self.date_pertains_to, DateFormat.LONG_DATE), self.get_full_description(req) ) )] if self.comments: infolist.append(CtvInfo(content=ws.webify(self.comments))) return infolist
[docs] def get_summaries(self, req: CamcopsRequest) -> List[SummaryElement]: return self.standard_task_summary_fields() + [ SummaryElement( name="n_core", coltype=Integer(), value=self.n_core(), comment="Number of core diagnostic symptoms (/3)"), SummaryElement( name="n_additional", coltype=Integer(), value=self.n_additional(), comment="Number of additional diagnostic symptoms (/7)"), SummaryElement( name="n_total", coltype=Integer(), value=self.n_total(), comment="Total number of diagnostic symptoms (/10)"), SummaryElement( name="n_somatic", coltype=Integer(), value=self.n_somatic(), comment="Number of somatic syndrome symptoms (/8)"), SummaryElement( name="category", coltype=SummaryCategoryColType, value=self.get_full_description(req), comment="Diagnostic category"), SummaryElement( name="psychosis_or_stupor", coltype=Boolean(), value=self.is_psychotic_or_stupor(), comment="Psychotic symptoms or stupor present?"), ]
# Scoring def n_core(self) -> int: return self.count_booleans(self.CORE_NAMES) def n_additional(self) -> int: return self.count_booleans(self.ADDITIONAL_NAMES) def n_total(self) -> int: return self.n_core() + self.n_additional() def n_somatic(self) -> int: return self.count_booleans(self.SOMATIC_NAMES) def main_complete(self) -> bool: return ( self.duration_at_least_2_weeks is not None and self.all_fields_not_none(self.CORE_NAMES) and self.all_fields_not_none(self.ADDITIONAL_NAMES) ) or bool( self.severe_clinically ) # Meets criteria? These also return null for unknown. def meets_criteria_severe_psychotic_schizophrenic(self) -> Optional[bool]: x = self.meets_criteria_severe_ignoring_psychosis() if not x: return x if self.stupor or self.hallucinations_other or self.delusions_other: return False # that counts as F32.3 if (self.stupor is None or self.hallucinations_other is None or self.delusions_other is None): return None # might be F32.3 if self.hallucinations_schizophrenic or self.delusions_schizophrenic: return True if (self.hallucinations_schizophrenic is None or self.delusions_schizophrenic is None): return None return False def meets_criteria_severe_psychotic_icd(self) -> Optional[bool]: x = self.meets_criteria_severe_ignoring_psychosis() if not x: return x if self.stupor or self.hallucinations_other or self.delusions_other: return True if (self.stupor is None or self.hallucinations_other is None or self.delusions_other is None): return None return False def meets_criteria_severe_nonpsychotic(self) -> Optional[bool]: x = self.meets_criteria_severe_ignoring_psychosis() if not x: return x if self.any_fields_none(self.PSYCHOSIS_NAMES): return None return self.count_booleans(self.PSYCHOSIS_NAMES) == 0 def meets_criteria_severe_ignoring_psychosis(self) -> Optional[bool]: if self.severe_clinically: return True if self.duration_at_least_2_weeks is not None \ and not self.duration_at_least_2_weeks: return False # too short if self.n_core() >= 3 and self.n_total() >= 8: return True if not self.main_complete(): return None # addition of more information might increase severity return False def meets_criteria_moderate(self) -> Optional[bool]: if self.severe_clinically: return False # too severe if self.duration_at_least_2_weeks is not None \ and not self.duration_at_least_2_weeks: return False # too short if self.n_core() >= 3 and self.n_total() >= 8: return False # too severe; that's severe if not self.main_complete(): return None # addition of more information might increase severity if self.n_core() >= 2 and self.n_total() >= 6: return True return False def meets_criteria_mild(self) -> Optional[bool]: if self.severe_clinically: return False # too severe if self.duration_at_least_2_weeks is not None \ and not self.duration_at_least_2_weeks: return False # too short if self.n_core() >= 2 and self.n_total() >= 6: return False # too severe; that's moderate if not self.main_complete(): return None # addition of more information might increase severity if self.n_core() >= 2 and self.n_total() >= 4: return True return False def meets_criteria_none(self) -> Optional[bool]: if self.severe_clinically: return False # too severe if self.duration_at_least_2_weeks is not None \ and not self.duration_at_least_2_weeks: return True # too short for depression if self.n_core() >= 2 and self.n_total() >= 4: return False # too severe if not self.main_complete(): return None # addition of more information might increase severity return True def meets_criteria_somatic(self) -> Optional[bool]: t = self.n_somatic() u = self.n_fields_none(self.SOMATIC_NAMES) if t >= 4: return True elif t + u < 4: return False else: return None def get_somatic_description(self, req: CamcopsRequest) -> str: s = self.meets_criteria_somatic() if s is None: return self.wxstring(req, "category_somatic_unknown") elif s: return self.wxstring(req, "category_with_somatic") else: return self.wxstring(req, "category_without_somatic") def get_main_description(self, req: CamcopsRequest) -> str: if self.meets_criteria_severe_psychotic_schizophrenic(): return self.wxstring(req, "category_severe_psychotic_schizophrenic") elif self.meets_criteria_severe_psychotic_icd(): return self.wxstring(req, "category_severe_psychotic") elif self.meets_criteria_severe_nonpsychotic(): return self.wxstring(req, "category_severe_nonpsychotic") elif self.meets_criteria_moderate(): return self.wxstring(req, "category_moderate") elif self.meets_criteria_mild(): return self.wxstring(req, "category_mild") elif self.meets_criteria_none(): return self.wxstring(req, "category_none") else: return req.sstring(SS.UNKNOWN) def get_full_description(self, req: CamcopsRequest) -> str: skip_somatic = self.main_complete() and self.meets_criteria_none() return ( self.get_main_description(req) + ("" if skip_somatic else " " + self.get_somatic_description(req)) ) def is_psychotic_or_stupor(self) -> Optional[bool]: if self.count_booleans(self.PSYCHOSIS_NAMES) > 0: return True elif self.all_fields_not_none(self.PSYCHOSIS_NAMES) > 0: return False else: return None
[docs] def is_complete(self) -> bool: return ( self.date_pertains_to is not None and self.main_complete() and self.field_contents_valid() )
def text_row(self, req: CamcopsRequest, wstringname: str) -> str: return heading_spanning_two_columns(self.wxstring(req, wstringname)) def row_true_false(self, req: CamcopsRequest, fieldname: str) -> str: return self.get_twocol_bool_row_true_false( req, fieldname, self.wxstring(req, "" + fieldname)) def row_present_absent(self, req: CamcopsRequest, fieldname: str) -> str: return self.get_twocol_bool_row_present_absent( req, fieldname, self.wxstring(req, "" + fieldname))
[docs] def get_task_html(self, req: CamcopsRequest) -> str: h = """ {clinician_comments} <div class="{CssClass.SUMMARY}"> <table class="{CssClass.SUMMARY}"> {tr_is_complete} {date_pertains_to} {category} {n_core} {n_total} {n_somatic} {psychotic_symptoms_or_stupor} </table> </div> <div class="{CssClass.EXPLANATION}"> {icd10_symptomatic_disclaimer} </div> <table class="{CssClass.TASKDETAIL}"> <tr> <th width="80%">Question</th> <th width="20%">Answer</th> </tr> """.format( clinician_comments=self.get_standard_clinician_comments_block( req, self.comments), CssClass=CssClass, tr_is_complete=self.get_is_complete_tr(req), date_pertains_to=tr_qa( req.wappstring(AS.DATE_PERTAINS_TO), format_datetime(self.date_pertains_to, DateFormat.LONG_DATE, default=None) ), category=tr_qa( req.sstring(SS.CATEGORY) + " <sup>[1,2]</sup>", self.get_full_description(req) ), n_core=tr( self.wxstring(req, "n_core"), answer(self.n_core()) + " / 3" ), n_total=tr( self.wxstring(req, "n_total"), answer(self.n_total()) + " / 10" ), n_somatic=tr( self.wxstring(req, "n_somatic"), answer(self.n_somatic()) + " / 8" ), psychotic_symptoms_or_stupor=tr( self.wxstring(req, "psychotic_symptoms_or_stupor") + " <sup>[2]</sup>", answer(get_present_absent_none( req, self.is_psychotic_or_stupor())) ), icd10_symptomatic_disclaimer=req.wappstring( AS.ICD10_SYMPTOMATIC_DISCLAIMER), ) h += self.text_row(req, "duration_text") h += self.row_true_false(req, "duration_at_least_2_weeks") h += self.text_row(req, "core") for x in self.CORE_NAMES: h += self.row_present_absent(req, x) h += self.text_row(req, "additional") for x in self.ADDITIONAL_NAMES: h += self.row_present_absent(req, x) h += self.text_row(req, "clinical_text") h += self.row_true_false(req, "severe_clinically") h += self.text_row(req, "somatic") for x in self.SOMATIC_NAMES: h += self.row_present_absent(req, x) h += self.text_row(req, "psychotic") for x in self.PSYCHOSIS_NAMES: h += self.row_present_absent(req, x) extradetail = [ f"n_core() = {self.n_core()}", f"n_additional() = {self.n_additional()}", f"n_total() = {self.n_total()}", f"n_somatic() = {self.n_somatic()}", f"main_complete() = {self.main_complete()}", f"meets_criteria_severe_psychotic_schizophrenic() = {self.meets_criteria_severe_psychotic_schizophrenic()}", # noqa f"meets_criteria_severe_psychotic_icd() = {self.meets_criteria_severe_psychotic_icd()}", # noqa f"meets_criteria_severe_nonpsychotic() = {self.meets_criteria_severe_nonpsychotic()}", # noqa f"meets_criteria_severe_ignoring_psychosis() = {self.meets_criteria_severe_ignoring_psychosis()}", # noqa f"meets_criteria_moderate() = {self.meets_criteria_moderate()}", f"meets_criteria_mild() = {self.meets_criteria_mild()}", f"meets_criteria_none() = {self.meets_criteria_none()}", f"meets_criteria_somatic() = {self.meets_criteria_somatic()}", ] h += f""" </table> <div class="{CssClass.HEADING}">Working</div> <div class="{CssClass.EXTRADETAIL2}"> <pre>{"<br>".join(ws.webify(f"‣ {x}") for x in extradetail)}</pre> </div> <div class="{CssClass.FOOTNOTES}"> [1] Mild depression requires ≥2 core symptoms and ≥4 total diagnostic symptoms. Moderate depression requires ≥2 core and ≥6 total. Severe depression requires 3 core and ≥8 total. All three require a duration of ≥2 weeks. In addition, the diagnosis of severe depression is allowed with a clinical impression of “severe” in a patient unable/unwilling to describe symptoms in detail. [2] ICD-10 nonpsychotic severe depression requires severe depression without hallucinations/delusions/depressive stupor. ICD-10 psychotic depression requires severe depression plus hallucinations/delusions other than those that are “typically schizophrenic”, or stupor. ICD-10 does not clearly categorize severe depression with only schizophreniform psychotic symptoms; however, such symptoms can occur in severe depression with psychosis (e.g. Tandon R &amp; Greden JF, 1987, PMID 2884810). Moreover, psychotic symptoms can occur in mild/moderate depression (Maj M et al., 2007, PMID 17915981). </div> {ICD10_COPYRIGHT_DIV} """ # noqa return h