#!/usr/bin/env python
# camcops_server/tasks/hamd.py
"""
===============================================================================
Copyright (C) 2012-2018 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 Any, Dict, List, Tuple, Type
from cardinal_pythonlib.stringfunc import strseq
from sqlalchemy.ext.declarative import DeclarativeMeta
from sqlalchemy.sql.sqltypes import Integer
from camcops_server.cc_modules.cc_constants import CssClass
from camcops_server.cc_modules.cc_ctvinfo import CTV_INCOMPLETE, CtvInfo
from camcops_server.cc_modules.cc_db import add_multiple_columns
from camcops_server.cc_modules.cc_html import answer, tr, tr_qa
from camcops_server.cc_modules.cc_request import CamcopsRequest
from camcops_server.cc_modules.cc_sqla_coltypes import (
CamcopsColumn,
SummaryCategoryColType,
ZERO_TO_ONE_CHECKER,
ZERO_TO_TWO_CHECKER,
ZERO_TO_THREE_CHECKER,
)
from camcops_server.cc_modules.cc_summaryelement import SummaryElement
from camcops_server.cc_modules.cc_task import (
get_from_dict,
Task,
TaskHasClinicianMixin,
TaskHasPatientMixin,
)
from camcops_server.cc_modules.cc_trackerhelpers import (
TrackerInfo,
TrackerLabel,
)
# =============================================================================
# HAM-D
# =============================================================================
MAX_SCORE = (
4 * 15 - # Q1-15 scored 0-5
(2 * 6) + # except Q4-6, 12-14 scored 0-2
2 * 2 # Q16-17
) # ... and not scored beyond Q17... total 52
class HamdMetaclass(DeclarativeMeta):
# noinspection PyInitNewSignature
def __init__(cls: Type['Hamd'],
name: str,
bases: Tuple[Type, ...],
classdict: Dict[str, Any]) -> None:
add_multiple_columns(
cls, "q", 1, 15,
comment_fmt="Q{n}, {s} (scored 0-4, except 0-2 for "
"Q4-6/12-14, higher worse)",
minimum=0, maximum=4, # amended below
comment_strings=[
"depressed mood", "guilt", "suicide", "early insomnia",
"middle insomnia", "late insomnia", "work/activities",
"psychomotor retardation", "agitation",
"anxiety, psychological", "anxiety, somatic",
"somatic symptoms, gastointestinal",
"somatic symptoms, general", "genital symptoms",
"hypochondriasis"
]
)
add_multiple_columns(
cls, "q", 19, 21,
comment_fmt="Q{n} (not scored), {s} (0-4 for Q19, "
"0-3 for Q20, 0-2 for Q21, higher worse)",
minimum=0, maximum=4, # below
comment_strings=["depersonalization/derealization",
"paranoid symptoms",
"obsessional/compulsive symptoms"]
)
# Now fix the wrong bits. Hardly elegant!
for qnum in [4, 5, 6, 12, 13, 14, 21]:
qname = "q" + str(qnum)
col = getattr(cls, qname)
col.set_permitted_value_checker(ZERO_TO_TWO_CHECKER)
cls.q20.set_permitted_value_checker(ZERO_TO_THREE_CHECKER)
super().__init__(name, bases, classdict)
[docs]class Hamd(TaskHasPatientMixin, TaskHasClinicianMixin, Task,
metaclass=HamdMetaclass):
__tablename__ = "hamd"
shortname = "HAM-D"
longname = "Hamilton Rating Scale for Depression"
provides_trackers = True
NSCOREDQUESTIONS = 17
NQUESTIONS = 21
TASK_FIELDS = strseq("q", 1, NQUESTIONS) + [
"whichq16", "q16a", "q16b", "q17", "q18a", "q18b"
]
whichq16 = CamcopsColumn(
"whichq16", Integer,
permitted_value_checker=ZERO_TO_ONE_CHECKER,
comment="Method of assessing weight loss (0 = A, by history; "
"1 = B, by measured change)"
)
q16a = CamcopsColumn(
"q16a", Integer,
permitted_value_checker=ZERO_TO_THREE_CHECKER,
comment="Q16A, weight loss, by history (0 none - 2 definite,"
" or 3 not assessed [not scored])"
)
q16b = CamcopsColumn(
"q16b", Integer,
permitted_value_checker=ZERO_TO_THREE_CHECKER,
comment="Q16B, weight loss, by measurement (0 none - "
"2 more than 2lb, or 3 not assessed [not scored])"
)
q17 = CamcopsColumn(
"q17", Integer,
permitted_value_checker=ZERO_TO_TWO_CHECKER,
comment="Q17, lack of insight (0-2, higher worse)"
)
q18a = CamcopsColumn(
"q18a", Integer,
permitted_value_checker=ZERO_TO_TWO_CHECKER,
comment="Q18A (not scored), diurnal variation, presence "
"(0 none, 1 worse AM, 2 worse PM)"
)
q18b = CamcopsColumn(
"q18b", Integer,
permitted_value_checker=ZERO_TO_TWO_CHECKER,
comment="Q18B (not scored), diurnal variation, severity "
"(0-2, higher more severe)"
)
[docs] def get_trackers(self, req: CamcopsRequest) -> List[TrackerInfo]:
return [TrackerInfo(
value=self.total_score(),
plot_label="HAM-D total score",
axis_label="Total score (out of {})".format(MAX_SCORE),
axis_min=-0.5,
axis_max=MAX_SCORE + 0.5,
horizontal_lines=[22.5, 19.5, 14.5, 7.5],
horizontal_labels=[
TrackerLabel(25, self.wxstring(req, "severity_verysevere")),
TrackerLabel(21, self.wxstring(req, "severity_severe")),
TrackerLabel(17, self.wxstring(req, "severity_moderate")),
TrackerLabel(11, self.wxstring(req, "severity_mild")),
TrackerLabel(3.75, self.wxstring(req, "severity_none")),
]
)]
[docs] def get_clinical_text(self, req: CamcopsRequest) -> List[CtvInfo]:
if not self.is_complete():
return CTV_INCOMPLETE
return [CtvInfo(
content="HAM-D total score {}/{} ({})".format(
self.total_score(), MAX_SCORE, self.severity(req))
)]
[docs] def get_summaries(self, req: CamcopsRequest) -> List[SummaryElement]:
return self.standard_task_summary_fields() + [
SummaryElement(name="total",
coltype=Integer(),
value=self.total_score(),
comment="Total score (/{})".format(MAX_SCORE)),
SummaryElement(name="severity",
coltype=SummaryCategoryColType,
value=self.severity(req),
comment="Severity"),
]
[docs] def is_complete(self) -> bool:
if not self.field_contents_valid():
return False
if self.q1 is None or self.q9 is None or self.q10 is None:
return False
if self.q1 == 0:
# Special limited-information completeness
return True
if self.q2 is not None and self.q3 is not None \
and (self.q2 + self.q3 == 0):
# Special limited-information completeness
return True
# Otherwise, any null values cause problems
if self.whichq16 is None:
return False
for i in range(1, self.NSCOREDQUESTIONS + 1):
if i == 16:
if (self.whichq16 == 0 and self.q16a is None) \
or (self.whichq16 == 1 and self.q16b is None):
return False
else:
if getattr(self, "q" + str(i)) is None:
return False
return True
def total_score(self) -> int:
total = 0
for i in range(1, self.NSCOREDQUESTIONS + 1):
if i == 16:
relevant_field = "q16a" if self.whichq16 == 0 else "q16b"
score = self.sum_fields([relevant_field])
if score != 3: # ... a value that's ignored
total += score
else:
total += self.sum_fields(["q" + str(i)])
return total
def severity(self, req: CamcopsRequest) -> str:
score = self.total_score()
if score >= 23:
return self.wxstring(req, "severity_verysevere")
elif score >= 19:
return self.wxstring(req, "severity_severe")
elif score >= 14:
return self.wxstring(req, "severity_moderate")
elif score >= 8:
return self.wxstring(req, "severity_mild")
else:
return self.wxstring(req, "severity_none")
[docs] def get_task_html(self, req: CamcopsRequest) -> str:
score = self.total_score()
severity = self.severity(req)
task_field_list_for_display = (
strseq("q", 1, 15) +
[
"whichq16",
"q16a" if self.whichq16 == 0 else "q16b", # funny one
"q17",
"q18a",
"q18b"
] +
strseq("q", 19, 21)
)
answer_dicts_dict = {}
for q in task_field_list_for_display:
d = {None: None}
for option in range(0, 5):
if (q == "q4" or q == "q5" or q == "q6" or q == "q12" or
q == "q13" or q == "q14" or q == "q17" or
q == "q18" or q == "q21") and option > 2:
continue
d[option] = self.wxstring(req, "" + q + "_option" + str(option))
answer_dicts_dict[q] = d
q_a = ""
for q in task_field_list_for_display:
if q == "whichq16":
qstr = self.wxstring(req, "whichq16_title")
else:
if q == "q16a" or q == "q16b":
rangestr = " <sup>range 0–2; ‘3’ not scored</sup>"
else:
col = getattr(self.__class__, q) # type: CamcopsColumn
rangestr = " <sup>range {}–{}</sup>".format(
col.permitted_value_checker.minimum,
col.permitted_value_checker.maximum
)
qstr = self.wxstring(req, "" + q + "_s") + rangestr
q_a += tr_qa(qstr, get_from_dict(answer_dicts_dict[q],
getattr(self, q)))
h = """
<div class="{CssClass.SUMMARY}">
<table class="{CssClass.SUMMARY}">
{tr_is_complete}
{total_score}
{severity}
</table>
</div>
<table class="{CssClass.TASKDETAIL}">
<tr>
<th width="40%">Question</th>
<th width="60%">Answer</th>
</tr>
{q_a}
</table>
<div class="{CssClass.FOOTNOTES}">
[1] Only Q1–Q17 scored towards the total.
Re Q16: values of ‘3’ (‘not assessed’) are not actively
scored, after e.g. Guy W (1976) <i>ECDEU Assessment Manual
for Psychopharmacology, revised</i>, pp. 180–192, esp.
pp. 187, 189
(https://archive.org/stream/ecdeuassessmentm1933guyw).
[2] ≥23 very severe, ≥19 severe, ≥14 moderate,
≥8 mild, <8 none.
</div>
""".format(
CssClass=CssClass,
tr_is_complete=self.get_is_complete_tr(req),
total_score=tr(
req.wappstring("total_score") + " <sup>[1]</sup>",
answer(score) + " / {}".format(MAX_SCORE)
),
severity=tr_qa(
self.wxstring(req, "severity") + " <sup>[2]</sup>",
severity
),
q_a=q_a,
)
return h