Source code for camcops_server.tasks.icd10manic

#!/usr/bin/env python

"""
camcops_server/tasks/icd10manic.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
from cardinal_pythonlib.typetests import is_false
import cardinal_pythonlib.rnc_web as ws
from sqlalchemy.sql.schema import Column
from sqlalchemy.sql.sqltypes import Boolean, Date, 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 (
    get_present_absent_none,
    heading_spanning_two_columns,
    subheading_spanning_two_columns,
    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


# =============================================================================
# Icd10Manic
# =============================================================================

[docs]class Icd10Manic(TaskHasClinicianMixin, TaskHasPatientMixin, Task): """ Server implementation of the ICD10-MANIC task. """ __tablename__ = "icd10manic" shortname = "ICD10-MANIC" mood_elevated = CamcopsColumn( "mood_elevated", Boolean, permitted_value_checker=BIT_CHECKER, comment="The mood is 'elevated' [hypomania] or 'predominantly " "elevated [or] expansive' [mania] to a degree that is " "definitely abnormal for the individual concerned." ) mood_irritable = CamcopsColumn( "mood_irritable", Boolean, permitted_value_checker=BIT_CHECKER, comment="The mood is 'irritable' [hypomania] or 'predominantly " "irritable' [mania] to a degree that is definitely abnormal " "for the individual concerned." ) distractible = CamcopsColumn( "distractible", Boolean, permitted_value_checker=BIT_CHECKER, comment="Difficulty in concentration or distractibility [from " "the criteria for hypomania]; distractibility or constant " "changes in activity or plans [from the criteria for mania]." ) activity = CamcopsColumn( "activity", Boolean, permitted_value_checker=BIT_CHECKER, comment="Increased activity or physical restlessness." ) sleep = CamcopsColumn( "sleep", Boolean, permitted_value_checker=BIT_CHECKER, comment="Decreased need for sleep." ) talkativeness = CamcopsColumn( "talkativeness", Boolean, permitted_value_checker=BIT_CHECKER, comment="Increased talkativeness (pressure of speech)." ) recklessness = CamcopsColumn( "recklessness", Boolean, permitted_value_checker=BIT_CHECKER, comment="Mild spending sprees, or other types of reckless or " "irresponsible behaviour [hypomania]; behaviour which is " "foolhardy or reckless and whose risks the subject does not " "recognize e.g. spending sprees, foolish enterprises, " "reckless driving [mania]." ) social_disinhibition = CamcopsColumn( "social_disinhibition", Boolean, permitted_value_checker=BIT_CHECKER, comment="Increased sociability or over-familiarity [hypomania]; " "loss of normal social inhibitions resulting in behaviour " "which is inappropriate to the circumstances [mania]." ) sexual = CamcopsColumn( "sexual", Boolean, permitted_value_checker=BIT_CHECKER, comment="Increased sexual energy [hypomania]; marked sexual " "energy or sexual indiscretions [mania]." ) grandiosity = CamcopsColumn( "grandiosity", Boolean, permitted_value_checker=BIT_CHECKER, comment="Inflated self-esteem or grandiosity." ) flight_of_ideas = CamcopsColumn( "flight_of_ideas", Boolean, permitted_value_checker=BIT_CHECKER, comment="Flight of ideas or the subjective experience of " "thoughts racing." ) sustained4days = CamcopsColumn( "sustained4days", Boolean, permitted_value_checker=BIT_CHECKER, comment="Elevated/irritable mood sustained for at least 4 days." ) sustained7days = CamcopsColumn( "sustained7days", Boolean, permitted_value_checker=BIT_CHECKER, comment="Elevated/irritable mood sustained for at least 7 days." ) admission_required = CamcopsColumn( "admission_required", Boolean, permitted_value_checker=BIT_CHECKER, comment="Elevated/irritable mood severe enough to require " "hospital admission." ) some_interference_functioning = CamcopsColumn( "some_interference_functioning", Boolean, permitted_value_checker=BIT_CHECKER, comment="Some interference with personal functioning " "in daily living." ) severe_interference_functioning = CamcopsColumn( "severe_interference_functioning", Boolean, permitted_value_checker=BIT_CHECKER, comment="Severe interference with personal " "functioning in daily living." ) perceptual_alterations = CamcopsColumn( "perceptual_alterations", Boolean, permitted_value_checker=BIT_CHECKER, comment="Perceptual alterations (e.g. subjective hyperacusis, " "appreciation of colours as specially vivid, etc.)." ) # ... not psychotic 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)." ) date_pertains_to = Column( "date_pertains_to", Date, comment="Date the assessment pertains to" ) comments = Column( "comments", UnicodeText, comment="Clinician's comments" ) CORE_NAMES = ["mood_elevated", "mood_irritable"] HYPOMANIA_MANIA_NAMES = [ "distractible", "activity", "sleep", "talkativeness", "recklessness", "social_disinhibition", "sexual" ] MANIA_NAMES = ["grandiosity", "flight_of_ideas"] OTHER_CRITERIA_NAMES = [ "sustained4days", "sustained7days", "admission_required", "some_interference_functioning", "severe_interference_functioning" ] PSYCHOSIS_NAMES = [ "perceptual_alterations", # not psychotic "hallucinations_schizophrenic", "hallucinations_other", "delusions_schizophrenic", "delusions_other" ]
[docs] @staticmethod def longname(req: "CamcopsRequest") -> str: _ = req.gettext return _( "ICD-10 symptomatic criteria for a manic/hypomanic episode " "(as in e.g. F06.3, F25, F30, F31)" )
[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_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="category", coltype=SummaryCategoryColType, value=self.get_description(req), comment="Diagnostic category"), SummaryElement(name="psychotic_symptoms", coltype=Boolean(), value=self.psychosis_present(), comment="Psychotic symptoms present?"), ]
# Meets criteria? These also return null for unknown. def meets_criteria_mania_psychotic_schizophrenic(self) -> Optional[bool]: x = self.meets_criteria_mania_ignoring_psychosis() if not x: return x if self.hallucinations_other or self.delusions_other: return False # that counts as manic psychosis if self.hallucinations_other is None or self.delusions_other is None: return None # might be manic psychosis 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_mania_psychotic_icd(self) -> Optional[bool]: x = self.meets_criteria_mania_ignoring_psychosis() if not x: return x if self.hallucinations_other or self.delusions_other: return True if self.hallucinations_other is None or self.delusions_other is None: return None return False def meets_criteria_mania_nonpsychotic(self) -> Optional[bool]: x = self.meets_criteria_mania_ignoring_psychosis() if not x: return x if (self.hallucinations_schizophrenic is None or self.delusions_schizophrenic is None or self.hallucinations_other is None or self.delusions_other is None): return None if (self.hallucinations_schizophrenic or self.delusions_schizophrenic or self.hallucinations_other or self.delusions_other): return False return True def meets_criteria_mania_ignoring_psychosis(self) -> Optional[bool]: # When can we say "definitely not"? if is_false(self.mood_elevated) and is_false(self.mood_irritable): return False if is_false(self.sustained7days) and is_false(self.admission_required): return False t = self.count_booleans(self.HYPOMANIA_MANIA_NAMES) + \ self.count_booleans(self.MANIA_NAMES) u = self.n_fields_none(self.HYPOMANIA_MANIA_NAMES) + \ self.n_fields_none(self.MANIA_NAMES) if self.mood_elevated and (t + u < 3): # With elevated mood, need at least 3 symptoms return False if is_false(self.mood_elevated) and (t + u < 4): # With only irritable mood, need at least 4 symptoms return False if is_false(self.severe_interference_functioning): return False # OK. When can we say "yes"? if ((self.mood_elevated or self.mood_irritable) and (self.sustained7days or self.admission_required) and ((self.mood_elevated and t >= 3) or (self.mood_irritable and t >= 4)) and self.severe_interference_functioning): return True return None def meets_criteria_hypomania(self) -> Optional[bool]: # When can we say "definitely not"? if self.meets_criteria_mania_ignoring_psychosis(): return False # silly to call it hypomania if it's mania if is_false(self.mood_elevated) and is_false(self.mood_irritable): return False if is_false(self.sustained4days): return False t = self.count_booleans(self.HYPOMANIA_MANIA_NAMES) u = self.n_fields_none(self.HYPOMANIA_MANIA_NAMES) if t + u < 3: # Need at least 3 symptoms return False if is_false(self.some_interference_functioning): return False # OK. When can we say "yes"? if ((self.mood_elevated or self.mood_irritable) and self.sustained4days and t >= 3 and self.some_interference_functioning): return True return None def meets_criteria_none(self) -> Optional[bool]: h = self.meets_criteria_hypomania() m = self.meets_criteria_mania_ignoring_psychosis() if h or m: return False if is_false(h) and is_false(m): return True return None def psychosis_present(self) -> Optional[bool]: if (self.hallucinations_other or self.hallucinations_schizophrenic or self.delusions_other or self.delusions_schizophrenic): return True if (self.hallucinations_other is None or self.hallucinations_schizophrenic is None or self.delusions_other is None or self.delusions_schizophrenic is None): return None return False def get_description(self, req: CamcopsRequest) -> str: if self.meets_criteria_mania_psychotic_schizophrenic(): return self.wxstring(req, "category_manic_psychotic_schizophrenic") elif self.meets_criteria_mania_psychotic_icd(): return self.wxstring(req, "category_manic_psychotic") elif self.meets_criteria_mania_nonpsychotic(): return self.wxstring(req, "category_manic_nonpsychotic") elif self.meets_criteria_hypomania(): return self.wxstring(req, "category_hypomanic") elif self.meets_criteria_none(): return self.wxstring(req, "category_none") else: return req.sstring(SS.UNKNOWN)
[docs] def is_complete(self) -> bool: return ( self.date_pertains_to is not None and self.meets_criteria_none() is not None 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))
[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} {psychotic_symptoms} </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_description(req) ), psychotic_symptoms=tr_qa( self.wxstring(req, "psychotic_symptoms") + " <sup>[2]</sup>", get_present_absent_none(req, self.psychosis_present()) ), icd10_symptomatic_disclaimer=req.wappstring( AS.ICD10_SYMPTOMATIC_DISCLAIMER), ) h += self.text_row(req, "core") for x in self.CORE_NAMES: h += self.row_true_false(req, x) h += self.text_row(req, "hypomania_mania") for x in self.HYPOMANIA_MANIA_NAMES: h += self.row_true_false(req, x) h += self.text_row(req, "other_mania") for x in self.MANIA_NAMES: h += self.row_true_false(req, x) h += self.text_row(req, "other_criteria") for x in self.OTHER_CRITERIA_NAMES: h += self.row_true_false(req, x) h += subheading_spanning_two_columns(self.wxstring(req, "psychosis")) for x in self.PSYCHOSIS_NAMES: h += self.row_true_false(req, x) h += f""" </table> <div class="{CssClass.FOOTNOTES}"> [1] Hypomania: elevated/irritable mood + sustained for ≥4 days + at least 3 of the “other hypomania” symptoms + some interference with functioning. Mania: elevated/irritable mood + sustained for ≥7 days or hospital admission required + at least 3 of the “other mania/hypomania” symptoms (4 if mood only irritable) + severe interference with functioning. [2] ICD-10 nonpsychotic mania requires mania without hallucinations/delusions. ICD-10 psychotic mania requires mania plus hallucinations/delusions other than those that are “typically schizophrenic”. ICD-10 does not clearly categorize mania with only schizophreniform psychotic symptoms; however, Schneiderian first-rank symptoms can occur in manic psychosis (e.g. Conus P et al., 2004, PMID 15337330.). </div> {ICD10_COPYRIGHT_DIV} """ return h