MedITron/PTSRaiAgent
4
0
Fork 0
Code Issues 21 Pull Requests Actions Packages Projects Releases Wiki Activity

fix(clinical): red flags, one crisis rule, callback after a crisis, one table of numbers

Browse Source 
Clinical review of the questionnaires (ADR-013):
- Red-flag block first in stage 1 (config/instruments/red_flags.yaml); any «Да» stops the
  questionnaire with an acute alert and the help screen of its category.
- One crisis rule: the crisis screen opens at a HIGH C-SSRS risk only; moderate stops and goes
  to a psychiatrist (24 h as a guide), low is a flag with the safety plan. PHQ-9 item 9 with a
  negative screener is a discrepancy flag; without a completed screener it asks the C-SSRS at once.
  config/questionnaire.yaml: cssrs_positive_policy graded (C01).
- Every crisis leaves a callback task for the doctor on duty (post_crisis_call, one per patient)
  and the app asks how the person is the next day, the safety plan one tap away.
- Routing: risk and flags first, scales second; PCL-5 >= 50 no longer means a priority
  appointment (pcl5_severe is moderate on the dashboard too).
- Crisis numbers live only in config/texts/crisis.yaml; texts and the agent prompt refer to them
  via {phone:<key>}. Fixes the children's helpline offered to adults by the chat agent.

Refs #92

Co-Authored-By: Claude Opus 5.5 <noreply@anthropic.com>
This commit is contained in:
Arxip222
2026-10-04 16:21:16 +03:00
co-authored by Claude Opus 5.5
parent bde6ec6855
commit 44814b7293
29 changed files with 365 additions and 56 deletions
Download Patch File Download Diff File Expand all files Collapse all files
app/dialog/flows/intake.py
+66 -6
View File
@@ -14,6 +14,7 @@ from app.core.intake_questions import (
diary_questions,
group_answers,
next_intake,
red_flag_category,
scale_question,
texts,
)
@@ -27,6 +28,7 @@ from app.dialog.contracts import Button, Event, Reply
from app.dialog.crisis import crisis_open, open_crisis
from app.dialog.fsm import Step, on_enter, state, trigger
from app.services import questionnaire as service
from app.services.followup import schedule_post_crisis_call
def allowed(ctx):
@@ -105,6 +107,7 @@ async def urgent(ctx, row=None, *, code="help_now", categories=None):
level=AlertLevel.ACUTE,
params={"record_id": row.id if row else None, "flags": flags},
)
await schedule_post_crisis_call(ctx.session, ctx.token, ctx.now, source="questionnaire:" + code)
step = open_crisis(ctx, categories or [], source="questionnaire:" + code)
step.data["questionnaire_record"] = None
step.data["intake_review_required"] = True
@@ -113,6 +116,41 @@ async def urgent(ctx, row=None, *, code="help_now", categories=None):
return step
async def item9_discrepancy(ctx, row):
profile = await ctx.profile()
if profile:
profile.enhanced_monitoring = True
await service.alert(
ctx.session,
ctx.token,
row.id + ":phq9_cssrs_discrepancy",
"phq9_cssrs_discrepancy",
ctx.now,
level=AlertLevel.HIGH,
params={"record_id": row.id},
)
row.details = {**row.details, "item9_flagged": True}
async def item9_assessment(ctx, row):
"""Thoughts of death in PHQ-9 item 9 → the C-SSRS screener at once; the screener's level decides (graded)."""
await service.alert(
ctx.session,
ctx.token,
row.id + ":item9_assessment",
"phq9_item9_cssrs",
ctx.now,
level=AlertLevel.HIGH,
params={"record_id": row.id},
)
await service.finish(ctx, row, "complete", extra={"stop_reason": "phq9_item9_cssrs"})
profile = await ctx.profile()
if profile:
profile.enhanced_monitoring = True
task = await service.queue_task(ctx.session, ctx.token, "cssrs_since_contact", row.id + ":cssrs", ctx.now)
return await start(ctx, "cssrs_since_contact", task)
async def manual_review(ctx, row, code):
await service.finish(ctx, row, "review_required", extra={"stop_reason": code})
await service.alert(
@@ -135,9 +173,24 @@ async def advance(ctx, row):
a = row.answers
c = score_cssrs_recent(cssrs_answers(a))
policy = load_policy()
# PHQ-9 item 9 ≥1 — in the full scale or in the depression module of the diary — stops at once (stage 1 rule).
if a.get("phq9_9", 0) > 0 or a.get("dphq_9", 0) > 0 or c.risk_lower_bound == "high":
# Red flags (asked first): any «Да» stops the questionnaire with the help screen of its category.
for item_id, value in a.items():
if item_id.startswith("rf_") and value == 1:
category = red_flag_category(item_id)
return await urgent(ctx, row, code="red_flag_" + item_id[3:], categories=[category] if category else [])
# One crisis rule for the whole app (ADR-013): the crisis screen opens at a HIGH C-SSRS risk only. Moderate →
# stop + psychiatrist (about 24 h); low → flag, safety plan, continue.
if c.risk_lower_bound == "high":
return await urgent(ctx, row, code="suicide_signal")
if a.get("dphq_9", 0) > 0 and row.kind in DIARY_KINDS:
# Diary depression module, item 9 ≥1 → the C-SSRS right away («Этап 2»); its risk level decides.
return await item9_assessment(ctx, row)
if a.get("phq9_9", 0) > 0 and not c.complete:
# Item 9 without a completed screener (only in a scheduled PHQ-9): assess the risk right away.
return await item9_assessment(ctx, row)
if a.get("phq9_9", 0) > 0 and not row.details.get("item9_flagged"):
# Item 9 ≥1 with a negative / low C-SSRS = discrepancy (routing table): flag to the doctor, safety plan.
await item9_discrepancy(ctx, row)
if c.positive and policy.cssrs_positive_policy == "stop_any":
return await urgent(ctx, row, code="cssrs_positive")
if c.conflicts:
@@ -165,7 +218,7 @@ async def advance(ctx, row):
return await manual_review(ctx, row, "answer_conflict")
if q:
replies = [question_reply(row, q)]
if c.complete and c.risk == "low" and not row.details.get("plan_shown"):
if ((c.complete and c.risk == "low") or row.details.get("item9_flagged")) and not row.details.get("plan_shown"):
from app.dialog.actions import safety_plan_reply
replies.insert(0, await safety_plan_reply(ctx))
@@ -225,11 +278,12 @@ async def advance(ctx, row):
if row.kind in ("phq9", "pcl5"):
sid = row.kind
total = extra["totals"][sid]["total"]
priority = getattr(policy, sid + "_priority_at")
# Only PHQ-9 has a priority threshold; PCL-5 alone never makes an appointment a priority.
priority = getattr(policy, sid + "_priority_at", None)
specialist = getattr(policy, sid + "_specialist_at")
extra["route"] = (
"priority_psychiatrist"
if total >= priority
if priority is not None and total >= priority
else ("psychiatrist_or_psychotherapist" if total >= specialist else "review_with_treating_clinician")
)
earlier = [
@@ -284,7 +338,13 @@ async def advance(ctx, row):
return step
from app.dialog.flows.core import menu_reply
return Step(replies=[menu_reply(ctx, shown)], next_state="idle", data={"questionnaire_record": None})
replies = [menu_reply(ctx, shown)]
if ((c.complete and c.risk == "low") or row.details.get("item9_flagged")) and not row.details.get("plan_shown"):
# The safety plan is never skipped because the risk signal came with the last question.
from app.dialog.actions import safety_plan_reply
replies.insert(0, await safety_plan_reply(ctx))
return Step(replies=replies, next_state="idle", data={"questionnaire_record": None})
# Diary flags that bring a full scale forward («Этап 2», p.4).
app/dialog/texts.py
+3 -1
View File
@@ -7,6 +7,7 @@ import yaml
from pydantic import BaseModel, ConfigDict, Field
from app.config import get_settings
from app.core.safety import fill_phones
class _Strict(BaseModel):
@@ -91,6 +92,7 @@ class ReachOutTexts(_Strict):
silence: str
missed_doses: str
default: str
after_crisis: str
class VisitTexts(_Strict):
@@ -120,4 +122,4 @@ def dialog_texts_path() -> Path:
@lru_cache
def load_dialog_texts(path: Path | None = None) -> DialogTexts:
path = path or dialog_texts_path()
return DialogTexts.model_validate(yaml.safe_load(path.read_text(encoding="utf-8")))
return DialogTexts.model_validate(yaml.safe_load(fill_phones(path.read_text(encoding="utf-8"))))