feat(questionnaire): integrate revised intake and follow-up monitoring

Add gated TSQ, Russian C-SSRS Recent, durable responses and notifications, diaries, schedules and audited clinical review. Preserve manual assessment when the Russian follow-up source is unavailable.

Refs #52

app/core/questionnaire.py

@@ -41,9 +41,10 @@ class IntakePolicy(BaseModel):
     version: str = Field(min_length=1)
     approval: Approval | None = None
     cssrs_positive_policy: Literal["pending", "stop_any", "graded"] = "pending"
+    rus_audit_s_expand_at: int | None = Field(default=None, ge=1, le=12, strict=True)
     rus_audit_s_expand_from_zone: int | None = Field(default=None, ge=1, le=4, strict=True)
     phq2_expand_at: int = Field(ge=1, le=6, strict=True)
-    pcptsd5_expand_at: int = Field(ge=1, le=5, strict=True)
+    tsq_expand_at: int = Field(ge=1, le=10, strict=True)
     phq9_psychologist_at: int = Field(ge=0, le=27, strict=True)
     phq9_specialist_at: int = Field(ge=0, le=27, strict=True)
     phq9_priority_at: int = Field(ge=0, le=27, strict=True)
@@ -56,9 +57,11 @@ class IntakePolicy(BaseModel):
         if self.approval and (
             self.approval.policy_version != self.version
             or self.cssrs_positive_policy == "pending"
-            or self.rus_audit_s_expand_from_zone is None
+            or (self.rus_audit_s_expand_from_zone is None and self.rus_audit_s_expand_at is None)
         ):
             raise ValueError("approval requires the matching version and resolved clinical decisions")
+        if self.rus_audit_s_expand_from_zone is not None and self.rus_audit_s_expand_at is not None:
+            raise ValueError("choose a total threshold OR a zone for alcohol expansion")
         if not self.phq9_psychologist_at < self.phq9_specialist_at < self.phq9_priority_at:
             raise ValueError("PHQ-9 thresholds must be ordered")
         if self.pcl5_specialist_at >= self.pcl5_priority_at:
@@ -94,7 +97,7 @@ def score_alcohol(answers: dict[str, int], *, short: bool, sex: Sex | None) -> A
         for item in ("rus_audit_2", "rus_audit_3"):
             if values.get(item, 0) != 0:
                 raise ValueError("never drinks conflicts with positive consumption answers")
-            if item not in values:
+            if item == "rus_audit_2" and item not in values:
                 values[item] = 0
                 derived.append(item)
     result = score(scale_id, values, sex=sex)
@@ -121,6 +124,8 @@ def alcohol_expansion(result: AlcoholResult, policy: IntakePolicy) -> bool | Non
         raise ValueError("expansion requires RUS-AUDIT-S")
     if not policy.approval or not result.complete or result.zone is None:
         return None
+    if policy.rus_audit_s_expand_at is not None:
+        return result.total >= policy.rus_audit_s_expand_at
     assert policy.rus_audit_s_expand_from_zone is not None
     return result.zone >= policy.rus_audit_s_expand_from_zone
 
@@ -203,8 +208,8 @@ def _additional_flags(pcl5, alcohol, sex, traumatic_brain_injury, psychotropics,
         zone = full.zone if full.complete else short.zone
         if zone is not None and zone >= 2:
             flags.append("alcohol_zone_ii_or_higher")
-            if psychotropics:
-                flags.append("alcohol_psychotropics")
+        if psychotropics and (any(v > 0 for v in alcohol.values())):
+            flags.append("alcohol_psychotropics")
         if full.zone == 4:
             flags.append("alcohol_zone_iv")
     except ValueError:
@@ -217,7 +222,7 @@ def _additional_flags(pcl5, alcohol, sex, traumatic_brain_injury, psychotropics,
 def evaluate_intake(
     *,
     phq9: dict[str, int],
-    pcptsd5: dict[str, int],
+    tsq: dict[str, int],
     pcl5: dict[str, int],
     alcohol: dict[str, int],
     cssrs: dict[str, int],
@@ -269,12 +274,10 @@ def evaluate_intake(
         return IntakeDecision(policy.version, "clinical_review_required", None, (), tuple(flags), c.missing)
 
     phq = score("phq9", phq9)
-    pc = score("pcptsd5", pcptsd5)
+    pc = score("tsq", tsq)
     pcl = score("pcl5", pcl5)
     full_alcohol = score_alcohol(alcohol, short=False, sex=sex)
     short_values = {k: v for k, v in alcohol.items() if k in load_scale("rus_audit_s").item_ids}
-    if "rus_audit_3" in full_alcohol.derived:
-        short_values["rus_audit_3"] = 0
     short_alcohol = score_alcohol(short_values, short=True, sex=sex)
     missing = list(c.missing)
     phq2_items = ("phq9_1", "phq9_2")
@@ -285,11 +288,11 @@ def evaluate_intake(
         missing.extend(k for k in load_scale("phq9").item_ids if k not in phq9)
     if trauma_exposure is None:
         missing.append("trauma_exposure")
-    if trauma_exposure is False and any(pcptsd5.values()):
+    if trauma_exposure is False and tsq:
         flags.append("trauma_filter_conflict")
-    pc_positive = trauma_exposure is True and pc.complete and pc.total >= policy.pcptsd5_expand_at
+    pc_positive = trauma_exposure is True and pc.complete and pc.total >= policy.tsq_expand_at
     if trauma_exposure is True and not pc.complete:
-        missing.extend(k for k in load_scale("pcptsd5").item_ids if k not in pcptsd5)
+        missing.extend(k for k in load_scale("tsq").item_ids if k not in tsq)
     if pc_positive and not pcl.complete:
         missing.extend(k for k in load_scale("pcl5").item_ids if k not in pcl5)
     # Partially administered optional scales also cannot be treated as completed negatives.