Source code for camcops_server.tasks.icd10schizophrenia

#!/usr/bin/env python

"""
camcops_server/tasks/icd10schizophrenia.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 cardinal_pythonlib.typetests import is_false
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_true_false_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,
)
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,
)


# =============================================================================
# Icd10Schizophrenia
# =============================================================================

[docs]class Icd10Schizophrenia(TaskHasClinicianMixin, TaskHasPatientMixin, Task): """ Server implementation of the ICD10-SZ task. """ __tablename__ = "icd10schizophrenia" shortname = "ICD10-SZ" passivity_bodily = CamcopsColumn( "passivity_bodily", Boolean, permitted_value_checker=BIT_CHECKER, comment="Passivity: delusions of control, influence, or " "passivity, clearly referred to body or limb movements..." ) passivity_mental = CamcopsColumn( "passivity_mental", Boolean, permitted_value_checker=BIT_CHECKER, comment="(passivity) ... or to specific thoughts, actions, or " "sensations." ) hv_commentary = CamcopsColumn( "hv_commentary", Boolean, permitted_value_checker=BIT_CHECKER, comment="Hallucinatory voices giving a running commentary on the " "patient's behaviour" ) hv_discussing = CamcopsColumn( "hv_discussing", Boolean, permitted_value_checker=BIT_CHECKER, comment="Hallucinatory voices discussing the patient among " "themselves" ) hv_from_body = CamcopsColumn( "hv_from_body", Boolean, permitted_value_checker=BIT_CHECKER, comment="Other types of hallucinatory voices coming from some " "part of the body" ) delusions = CamcopsColumn( "delusions", Boolean, permitted_value_checker=BIT_CHECKER, comment="Delusions: persistent delusions of other kinds that are " "culturally inappropriate and completely impossible, such as " "religious or political identity, or superhuman powers and " "abilities (e.g. being able to control the weather, or being " "in communication with aliens from another world)." ) delusional_perception = CamcopsColumn( "delusional_perception", Boolean, permitted_value_checker=BIT_CHECKER, comment="Delusional perception [a normal perception, " "delusionally interpreted]" ) thought_echo = CamcopsColumn( "thought_echo", Boolean, permitted_value_checker=BIT_CHECKER, comment="Thought echo [hearing one's own thoughts aloud, just " "before, just after, or simultaneously with the thought]" ) thought_withdrawal = CamcopsColumn( "thought_withdrawal", Boolean, permitted_value_checker=BIT_CHECKER, comment="Thought withdrawal [the feeling that one's thoughts " "have been removed by an outside agency]" ) thought_insertion = CamcopsColumn( "thought_insertion", Boolean, permitted_value_checker=BIT_CHECKER, comment="Thought insertion [the feeling that one's thoughts have " "been placed there from outside]" ) thought_broadcasting = CamcopsColumn( "thought_broadcasting", Boolean, permitted_value_checker=BIT_CHECKER, comment="Thought broadcasting [the feeling that one's thoughts " "leave oneself and are diffused widely, or are audible to " "others, or that others think the same thoughts in unison]" ) hallucinations_other = CamcopsColumn( "hallucinations_other", Boolean, permitted_value_checker=BIT_CHECKER, comment="Hallucinations: persistent hallucinations in any " "modality, when accompanied either by fleeting or half-formed " "delusions without clear affective content, or by persistent " "over-valued ideas, or when occurring every day for weeks or " "months on end." ) thought_disorder = CamcopsColumn( "thought_disorder", Boolean, permitted_value_checker=BIT_CHECKER, comment="Thought disorder: breaks or interpolations in the train " "of thought, resulting in incoherence or irrelevant speech, " "or neologisms." ) catatonia = CamcopsColumn( "catatonia", Boolean, permitted_value_checker=BIT_CHECKER, comment="Catatonia: catatonic behaviour, such as excitement, " "posturing, or waxy flexibility, negativism, mutism, and " "stupor." ) negative = CamcopsColumn( "negative", Boolean, permitted_value_checker=BIT_CHECKER, comment="Negative symptoms: 'negative' symptoms such as marked " "apathy, paucity of speech, and blunting or incongruity of " "emotional responses, usually resulting in social withdrawal " "and lowering of social performance; it must be clear that " "these are not due to depression or to neuroleptic " "medication." ) present_one_month = CamcopsColumn( "present_one_month", Boolean, permitted_value_checker=BIT_CHECKER, comment="Symptoms in groups A-C present for most of the time " "during an episode of psychotic illness lasting for at least " "one month (or at some time during most of the days)." ) also_manic = CamcopsColumn( "also_manic", Boolean, permitted_value_checker=BIT_CHECKER, comment="Also meets criteria for manic episode (F30)?" ) also_depressive = CamcopsColumn( "also_depressive", Boolean, permitted_value_checker=BIT_CHECKER, comment="Also meets criteria for depressive episode (F32)?" ) if_mood_psychosis_first = CamcopsColumn( "if_mood_psychosis_first", Boolean, permitted_value_checker=BIT_CHECKER, comment="If the patient also meets criteria for manic episode " "(F30) or depressive episode (F32), the criteria listed above " "must have been met before the disturbance of mood developed." ) not_organic_or_substance = CamcopsColumn( "not_organic_or_substance", Boolean, permitted_value_checker=BIT_CHECKER, comment="The disorder is not attributable to organic brain " "disease (in the sense of F0), or to alcohol- or drug-related " "intoxication, dependence or withdrawal." ) behaviour_change = CamcopsColumn( "behaviour_change", Boolean, permitted_value_checker=BIT_CHECKER, comment="A significant and consistent change in the overall " "quality of some aspects of personal behaviour, manifest as " "loss of interest, aimlessness, idleness, a self-absorbed " "attitude, and social withdrawal." ) performance_decline = CamcopsColumn( "performance_decline", Boolean, permitted_value_checker=BIT_CHECKER, comment="Marked decline in social, scholastic, or occupational " "performance." ) subtype_paranoid = CamcopsColumn( "subtype_paranoid", Boolean, permitted_value_checker=BIT_CHECKER, comment="PARANOID (F20.0): dominated by delusions or hallucinations." ) subtype_hebephrenic = CamcopsColumn( "subtype_hebephrenic", Boolean, permitted_value_checker=BIT_CHECKER, comment="HEBEPHRENIC (F20.1): dominated by affective changes " "(shallow, flat, incongruous, or inappropriate affect) and " "either pronounced thought disorder or aimless, disjointed " "behaviour is present." ) subtype_catatonic = CamcopsColumn( "subtype_catatonic", Boolean, permitted_value_checker=BIT_CHECKER, comment="CATATONIC (F20.2): psychomotor disturbances dominate " "(such as stupor, mutism, excitement, posturing, negativism, " "rigidity, waxy flexibility, command automatisms, or verbal " "perseveration)." ) subtype_undifferentiated = CamcopsColumn( "subtype_undifferentiated", Boolean, permitted_value_checker=BIT_CHECKER, comment="UNDIFFERENTIATED (F20.3): schizophrenia with active " "psychosis fitting none or more than one of the above three " "types." ) subtype_postschizophrenic_depression = CamcopsColumn( "subtype_postschizophrenic_depression", Boolean, permitted_value_checker=BIT_CHECKER, comment="POST-SCHIZOPHRENIC DEPRESSION (F20.4): in which a depressive " "episode has developed for at least 2 weeks following a " "schizophrenic episode within the last 12 months and in which " "schizophrenic symptoms persist but are not as prominent as " "the depression." ) subtype_residual = CamcopsColumn( "subtype_residual", Boolean, permitted_value_checker=BIT_CHECKER, comment="RESIDUAL (F20.5): in which previous psychotic episodes " "of schizophrenia have given way to a chronic condition with " "'negative' symptoms of schizophrenia for at least 1 year." ) subtype_simple = CamcopsColumn( "subtype_simple", Boolean, permitted_value_checker=BIT_CHECKER, comment="SIMPLE SCHIZOPHRENIA (F20.6), in which 'negative' " "symptoms (C) with a change in personal behaviour (D) develop " "for at least one year without any psychotic episodes (no " "symptoms from groups A or B or other hallucinations or " "well-formed delusions), and with a marked decline in social, " "scholastic, or occupational performance." ) subtype_cenesthopathic = CamcopsColumn( "subtype_cenesthopathic", Boolean, permitted_value_checker=BIT_CHECKER, comment="CENESTHOPATHIC (within OTHER F20.8): body image " "aberration (e.g. desomatization, loss of bodily boundaries, " "feelings of body size change) or abnormal bodily sensations " "(e.g. numbness, stiffness, feeling strange, " "depersonalization, or sensations of pain, temperature, " "electricity, heaviness, lightness, or discomfort when " "touched) dominate." ) date_pertains_to = Column( "date_pertains_to", Date, comment="Date the assessment pertains to" ) comments = Column( "comments", UnicodeText, comment="Clinician's comments" ) A_NAMES = [ "passivity_bodily", "passivity_mental", "hv_commentary", "hv_discussing", "hv_from_body", "delusions", "delusional_perception", "thought_echo", "thought_withdrawal", "thought_insertion", "thought_broadcasting" ] B_NAMES = ["hallucinations_other", "thought_disorder", "catatonia"] C_NAMES = ["negative"] D_NAMES = ["present_one_month"] E_NAMES = ["also_manic", "also_depressive", "if_mood_psychosis_first"] F_NAMES = ["not_organic_or_substance"] G_NAMES = ["behaviour_change", "performance_decline"] H_NAMES = [ "subtype_paranoid", "subtype_hebephrenic", "subtype_catatonic", "subtype_undifferentiated", "subtype_postschizophrenic_depression", "subtype_residual", "subtype_simple", "subtype_cenesthopathic" ]
[docs] @staticmethod def longname(req: "CamcopsRequest") -> str: _ = req.gettext return _("ICD-10 criteria for schizophrenia (F20)")
[docs] def get_clinical_text(self, req: CamcopsRequest) -> List[CtvInfo]: if not self.is_complete(): return CTV_INCOMPLETE c = self.meets_general_criteria() if c is None: category = "Unknown if met or not met" elif c: category = "Met" else: category = "Not met" infolist = [CtvInfo( content=( "Pertains to: {}. General criteria for " "schizophrenia: {}.".format( format_datetime(self.date_pertains_to, DateFormat.LONG_DATE), category ) ) )] 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="meets_general_criteria", coltype=Boolean(), value=self.meets_general_criteria(), comment="Meets general criteria for paranoid/hebephrenic/" "catatonic/undifferentiated schizophrenia " "(F20.0-F20.3)?"), ]
# Meets criteria? These also return null for unknown. def meets_general_criteria(self) -> Optional[bool]: t_a = self.count_booleans(Icd10Schizophrenia.A_NAMES) u_a = self.n_fields_none(Icd10Schizophrenia.A_NAMES) t_b = ( self.count_booleans(Icd10Schizophrenia.B_NAMES) + self.count_booleans(Icd10Schizophrenia.C_NAMES) ) u_b = ( self.n_fields_none(Icd10Schizophrenia.B_NAMES) + self.n_fields_none(Icd10Schizophrenia.C_NAMES) ) if t_a + u_a < 1 and t_b + u_b < 2: return False if self.present_one_month is not None and not self.present_one_month: return False if ((self.also_manic or self.also_depressive) and is_false(self.if_mood_psychosis_first)): return False if is_false(self.not_organic_or_substance): return False if ((t_a >= 1 or t_b >= 2) and self.present_one_month and ( (is_false(self.also_manic) and is_false(self.also_depressive)) or self.if_mood_psychosis_first ) and self.not_organic_or_substance): return True return None
[docs] def is_complete(self) -> bool: return ( self.date_pertains_to is not None and self.meets_general_criteria() is not None and self.field_contents_valid() )
def heading_row(self, req: CamcopsRequest, wstringname: str, extra: str = None) -> str: return heading_spanning_two_columns( self.wxstring(req, wstringname) + (extra or "") ) def text_row(self, req: CamcopsRequest, wstringname: str) -> str: return subheading_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} {meets_general_criteria} </table> </div> <div class="{CssClass.EXPLANATION}"> {comments} </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) ), meets_general_criteria=tr_qa( self.wxstring(req, "meets_general_criteria") + " <sup>[1]</sup>", # noqa get_true_false_none(req, self.meets_general_criteria()) ), comments=self.wxstring(req, "comments"), ) h += self.heading_row(req, "core", " <sup>[2]</sup>") for x in Icd10Schizophrenia.A_NAMES: h += self.row_present_absent(req, x) h += self.heading_row(req, "other_positive") for x in Icd10Schizophrenia.B_NAMES: h += self.row_present_absent(req, x) h += self.heading_row(req, "negative_title") for x in Icd10Schizophrenia.C_NAMES: h += self.row_present_absent(req, x) h += self.heading_row(req, "other_criteria") for x in Icd10Schizophrenia.D_NAMES: h += self.row_true_false(req, x) h += self.text_row(req, "duration_comment") for x in Icd10Schizophrenia.E_NAMES: h += self.row_true_false(req, x) h += self.text_row(req, "affective_comment") for x in Icd10Schizophrenia.F_NAMES: h += self.row_true_false(req, x) h += self.heading_row(req, "simple_title") for x in Icd10Schizophrenia.G_NAMES: h += self.row_present_absent(req, x) h += self.heading_row(req, "subtypes") for x in Icd10Schizophrenia.H_NAMES: h += self.row_present_absent(req, x) h += f""" </table> <div class="{CssClass.FOOTNOTES}"> [1] All of: (a) at least one core symptom, or at least two of the other positive or negative symptoms; (b) present for a month (etc.); (c) if also manic/depressed, schizophreniform psychosis came first; (d) not attributable to organic brain disease or psychoactive substances. [2] Symptom definitions from: (a) Oyebode F (2008). Sims’ Symptoms in the Mind: An Introduction to Descriptive Psychopathology. Fourth edition, Saunders, Elsevier, Edinburgh. (b) Pawar AV &amp; Spence SA (2003), PMID 14519605. </div> {ICD10_COPYRIGHT_DIV} """ return h