PTSRaiAgent/app/api/doctor_views.py

"""Doctor dashboard read models (#12): clinical DB rows → frozen API schemas (`app/api/schemas.py`).

Everything shown to the doctor is derived from stored structured data — no LLM decides colours, trends or the
discontinuation risk (ADR-007). Time comes in as `now` (from `app.core.clock`, ADR-005).

Identity data (guardrail #5): the API is the doctor's display boundary, so it reads exactly two identity fields —
`display_name` (minimal identification for the treating doctor) and `birth_year` (age). SNILS, phone and chat
id are never selected into a response model.
"""

from collections.abc import Iterable, Sequence
from dataclasses import dataclass
from datetime import date, datetime, timedelta
from typing import Any, Literal, cast, get_args

from sqlalchemy import select
from sqlalchemy.ext.asyncio import AsyncSession

from app.api.schemas import (
    AlertOut,
    Color,
    DiscontinuationRisk,
    DoseOut,
    LevelName,
    Metric,
    Module,
    PatientCard,
    PatientListItem,
    SeriesPoint,
)
from app.core.rules import color, patient_status
from app.core.types import AlertLevel
from app.db import repo
from app.db.clinical import Alert, DailyCheckin, Dose, PatientProfile, Prescription, SafetyPlan, ScaleResult
from app.db.identity import Patient
from app.integrations.base import Prescription as PrescriptionOut

COLOR_ORDER: dict[str, int] = {"red": 0, "yellow": 1, "grey": 2, "green": 3}
_MODULES = frozenset(get_args(Module))
_METRICS = frozenset(get_args(Metric))
_SCALE_LABELS = {"phq9": "PHQ-9", "pcl5": "PCL-5", "gad7": "GAD-7", "auditc": "AUDIT-C", "dar5": "DAR-5"}

# Daily check-in buckets → numbers for charts. Sleep: bucket midpoints in hours ("<4" plotted as 3, ">8" as 9).
SLEEP_HOURS = {"<4": 3.0, "4-6": 5.0, "6-8": 7.0, ">8": 9.0}
# Alcohol: 0 = none, 1 = 1–2 drinks, 2 = more (same coding as app/llm/summary.py expects).
ALCOHOL_LEVEL = {"none": 0.0, "1-2": 1.0, "more": 2.0}

# Trend: the last two complete results of one scale. A change smaller than about half of the minimal clinically
# important difference (PHQ-9: 5 points, PCL-5: 10 points) is reported as "flat" so noise does not flip arrows.
TREND_MIN_CHANGE = {"phq9": 3, "pcl5": 5}

CARD_DAYS = 60  # how far back the card series / dose log reach


# --------------------------------------------------------------------------- discontinuation risk index
#
# Rule-based index (NOT a trained model) of the risk that the patient drops the therapy, 0–100, for sorting the
# list and for the "talk about adherence" hint. Each factor is a deterministic check over the clinical DB with a
# fixed weight; the score is the capped sum. Weights reflect the known predictors of early antidepressant
# discontinuation (non-adherence, side effects in the first weeks, expressed intent to stop, low mood, alcohol):
#
#   factor                                            weight   label for the doctor
#   missed/skipped doses on >= 3 of the last 7 days     30     "пропуски приёма N/7 дн."
#   ... on 1–2 of the last 7 days                       15     "пропуски приёма N/7 дн."
#   side effects reported >= 3 days in a row            20     "побочные эффекты N дн. подряд"
#   ... 1–2 days in a row                               10     "побочные эффекты N дн. подряд"
#   intent to stop medication voiced in last 14 days    25     "хотел бросить (день N)"
#   open, unacknowledged quit_intent alert             +15     "не разобран сигнал «хочет бросить»"
#   mood <= 3 for >= 3 days in a row                    15     "настроение ≤ 3 N дн. подряд"
#   alcohol on >= 3 of the last 7 days                  15     "алкоголь N дн. из 7"
#   ... on 1–2 of the last 7 days                        5     "алкоголь N дн. из 7"
#
# Level: >= 60 high, >= 30 medium, otherwise low. "Day" = calendar day in the clinic time zone; streaks end today
# if today's check-in exists, otherwise yesterday (same anchor as app.core.rules), and a day without a check-in
# breaks a streak — we never assume a symptom the patient did not report.

RISK_WINDOW_DAYS = 7
QUIT_WINDOW_DAYS = 14
MOOD_LOW = 3
W_MISSED_MANY, W_MISSED_SOME = 30, 15
W_SIDE_EFFECTS_LONG, W_SIDE_EFFECTS_SHORT = 20, 10
W_QUIT_INTENT, W_QUIT_ALERT_OPEN = 25, 15
W_MOOD_LOW = 15
W_ALCOHOL_MANY, W_ALCOHOL_SOME = 15, 5
STREAK_DAYS = 3
RISK_HIGH, RISK_MEDIUM = 60, 30


@dataclass
class PatientData:
    """Everything the list item and the card are computed from (one patient, loaded once)."""

    profile: PatientProfile
    checkins: Sequence[DailyCheckin]
    results: Sequence[ScaleResult]
    doses: Sequence[Dose]
    prescriptions: Sequence[Prescription]
    alerts: Sequence[Alert]  # newest first


async def load_patient_data(session: AsyncSession, profile: PatientProfile) -> PatientData:
    token = profile.token
    doses = (await session.scalars(select(Dose).where(Dose.token == token).order_by(Dose.planned_at))).all()
    rx = (
        await session.scalars(select(Prescription).where(Prescription.token == token).order_by(Prescription.id))
    ).all()
    return PatientData(
        profile=profile,
        checkins=await repo.list_checkins(session, token),
        results=await repo.list_scale_results(session, token),
        doses=doses,
        prescriptions=rx,
        alerts=await repo.list_alerts(session, token=token),
    )


def _local(ts: datetime, now: datetime) -> date:
    return ts.astimezone(now.tzinfo).date()


def _streak_days(checkins: Iterable[DailyCheckin], today: date, pred: Any) -> int:
    """Length of the run of consecutive check-in days satisfying `pred`, ending at the anchor day."""
    by_day = {c.day: c for c in checkins if c.day <= today}
    day = today if today in by_day else today - timedelta(days=1)
    n = 0
    while (c := by_day.get(day)) is not None and pred(c):
        n += 1
        day -= timedelta(days=1)
    return n


def _therapy_day(profile: PatientProfile, day: date) -> int:
    return (day - profile.therapy_start).days if profile.therapy_start else 0


def _missed_days(d: PatientData, now: datetime, first: date) -> set[date]:
    # Same sources as rule missed_doses_7d: dose records and the check-in answer "did not take".
    days = {_local(x.planned_at, now) for x in d.doses if x.status in ("missed", "skipped") and x.planned_at <= now}
    days |= {c.day for c in d.checkins if c.med_taken is False}
    return {x for x in days if first <= x <= now.date()}


def discontinuation_risk(d: PatientData, now: datetime) -> DiscontinuationRisk:
    """Deterministic discontinuation-risk index; see the weight table above."""
    today = now.date()
    first = today - timedelta(days=RISK_WINDOW_DAYS - 1)
    score = 0
    factors: list[str] = []

    missed = len(_missed_days(d, now, first))
    if missed:
        score += W_MISSED_MANY if missed >= STREAK_DAYS else W_MISSED_SOME
        factors.append(f"пропуски приёма {missed}/{RISK_WINDOW_DAYS} дн.")

    side = _streak_days(d.checkins, today, lambda c: bool(c.side_effects))
    if side:
        score += W_SIDE_EFFECTS_LONG if side >= STREAK_DAYS else W_SIDE_EFFECTS_SHORT
        factors.append(f"побочные эффекты {side} дн. подряд")

    quit_since = today - timedelta(days=QUIT_WINDOW_DAYS - 1)
    quit_days = [c.day for c in d.checkins if c.quit_intent and quit_since <= c.day <= today]
    if quit_days:
        score += W_QUIT_INTENT
        factors.append(f"хотел бросить (день {_therapy_day(d.profile, max(quit_days))})")
    if any(a.code == "quit_intent" and a.acked_at is None for a in d.alerts):
        score += W_QUIT_ALERT_OPEN
        factors.append("не разобран сигнал «хочет бросить»")

    low = _streak_days(d.checkins, today, lambda c: c.mood is not None and c.mood <= MOOD_LOW)
    if low >= STREAK_DAYS:
        score += W_MOOD_LOW
        factors.append(f"настроение ≤ {MOOD_LOW} {low} дн. подряд")

    drinking = sum(1 for c in d.checkins if first <= c.day <= today and c.alcohol_bucket not in (None, "none"))
    if drinking:
        score += W_ALCOHOL_MANY if drinking >= STREAK_DAYS else W_ALCOHOL_SOME
        factors.append(f"алкоголь {drinking} дн. из {RISK_WINDOW_DAYS}")

    score = min(score, 100)
    level: Literal["low", "medium", "high"] = (
        "high" if score >= RISK_HIGH else "medium" if score >= RISK_MEDIUM else "low"
    )
    return DiscontinuationRisk(score=score, level=level, factors=factors)


# --------------------------------------------------------------------------- list item


def _complete(d: PatientData, scale: str) -> list[ScaleResult]:
    return [r for r in d.results if r.scale == scale and r.complete]  # repo returns them oldest first


def trend(d: PatientData) -> Literal["up", "down", "flat", "unknown"]:
    """Direction of symptom scores (up = worse) from the scale with the most recent pair of results."""
    pairs = [(s, rs[-2:]) for s in TREND_MIN_CHANGE if len(rs := _complete(d, s)) >= 2]
    if not pairs:
        return "unknown"
    scale, (prev, last) = max(pairs, key=lambda p: p[1][-1].ts)
    delta = last.total - prev.total
    if abs(delta) < TREND_MIN_CHANGE[scale]:
        return "flat"
    return "up" if delta > 0 else "down"


def adherence_7d(d: PatientData, now: datetime) -> float | None:
    """Taken / planned doses of the last 7 days; doses still `pending` (not resolved yet) are not counted."""
    since = now - timedelta(days=RISK_WINDOW_DAYS)
    resolved = [x for x in d.doses if since < x.planned_at <= now and x.status != "pending"]
    if not resolved:
        return None
    return round(sum(1 for x in resolved if x.status == "taken") / len(resolved), 2)


def _drug_label(rx: Prescription) -> str:
    return f"{rx.drug} {rx.dose}".strip()


def _active_rx(d: PatientData, today: date) -> Prescription | None:
    active = [
        r
        for r in d.prescriptions
        if (r.start_date is None or r.start_date <= today) and (r.end_date is None or r.end_date >= today)
    ]
    return (active or list(d.prescriptions) or [None])[-1]


def _last_event(d: PatientData, now: datetime) -> str:
    alert = d.alerts[0] if d.alerts else None
    scales = [r for r in d.results if r.complete and r.scale in _SCALE_LABELS]
    scale = scales[-1] if scales else None
    if scale is not None and (alert is None or scale.ts > alert.ts):
        day = _therapy_day(d.profile, _local(scale.ts, now))
        return f"{_SCALE_LABELS[scale.scale]} = {scale.total} (день {day})"
    return alert.reason if alert is not None else ""


def _age(patient: Patient | None, profile: PatientProfile, today: date) -> int:
    birth_year = (patient.birth_year if patient else None) or profile.birth_year
    return today.year - birth_year if birth_year else 0


def list_item(d: PatientData, patient: Patient | None, now: datetime) -> PatientListItem:
    p = d.profile
    today = now.date()
    open_alerts = [a for a in d.alerts if a.acked_at is None]
    # ADR-006: the colour is derived from open alert levels (the source of truth), not from the cached column.
    status = patient_status(AlertLevel[a.level.upper()] for a in open_alerts)
    phq9, pcl5 = _complete(d, "phq9"), _complete(d, "pcl5")
    rx = _active_rx(d, today)
    return PatientListItem(
        token=p.token,
        display_name=patient.display_name if patient else "Пациент",
        age=_age(patient, p, today),
        modules=[cast(Module, m) for m in p.modules or [] if m in _MODULES],
        drug=_drug_label(rx) if rx else None,
        therapy_day=_therapy_day(p, today),
        next_visit=p.next_visit,
        status_color=status.color,
        top_alert_level=cast(LevelName, status.top_level.name.lower()) if status.top_level is not None else None,
        open_alerts=len(open_alerts),
        phq9_last=phq9[-1].total if phq9 else None,
        pcl5_last=pcl5[-1].total if pcl5 else None,
        trend=trend(d),
        adherence_7d=adherence_7d(d, now),
        discontinuation_risk=discontinuation_risk(d, now),
        last_event=_last_event(d, now),
    )


def sort_key(item: PatientListItem) -> tuple[int, int, str]:
    """red → yellow → grey → green, then discontinuation risk (desc), then name for a stable order."""
    return (COLOR_ORDER[item.status_color], -item.discontinuation_risk.score, item.display_name)


# --------------------------------------------------------------------------- card


def alert_out(a: Alert, patient_name: str) -> AlertOut:
    level = cast(LevelName, a.level)
    return AlertOut(
        id=a.id,
        token=a.token,
        patient_name=patient_name,
        ts=a.ts,
        level=level,
        color=cast(Color, color([AlertLevel[a.level.upper()]])),
        code=a.code,
        reason=a.reason,
        acked_by=a.acked_by,
        acked_at=a.acked_at,
    )


def series(d: PatientData, now: datetime) -> list[SeriesPoint]:
    since = now.date() - timedelta(days=CARD_DAYS)
    out: list[SeriesPoint] = []
    for c in d.checkins:
        if not since <= c.day <= now.date():
            continue
        if c.mood is not None:
            out.append(SeriesPoint(day=c.day, metric="mood", value=float(c.mood)))
        if c.sleep_bucket in SLEEP_HOURS:
            out.append(SeriesPoint(day=c.day, metric="sleep_hours", value=SLEEP_HOURS[c.sleep_bucket]))
        if c.alcohol_bucket in ALCOHOL_LEVEL:
            out.append(SeriesPoint(day=c.day, metric="alcohol", value=ALCOHOL_LEVEL[c.alcohol_bucket]))
    for r in d.results:
        day = _local(r.ts, now)
        if r.complete and r.scale in _METRICS and since <= day and r.ts <= now:
            out.append(SeriesPoint(day=day, metric=cast(Metric, r.scale), value=float(r.total), scheduled=r.scheduled))
    return sorted(out, key=lambda p: (p.day, p.metric))


def doses(d: PatientData, now: datetime) -> list[DoseOut]:
    labels = {r.id: _drug_label(r) for r in d.prescriptions}
    since = now - timedelta(days=CARD_DAYS)
    return [
        DoseOut(planned_at=x.planned_at, drug=labels.get(x.prescription_id, ""), status=x.status)  # type: ignore[arg-type]
        for x in d.doses
        if since <= x.planned_at <= now + timedelta(days=1)
    ]


def prescriptions(d: PatientData) -> list[PrescriptionOut]:
    out = []
    for r in d.prescriptions:
        schedule = dict(r.schedule or {})
        out.append(
            PrescriptionOut(
                drug=r.drug,
                dose=r.dose,
                schedule={"times": [str(t) for t in schedule.get("times", [])]},
                instructions=" ".join(str(t) for t in _as_list(schedule.get("instructions"))),
                start_date=r.start_date,
                end_date=r.end_date,
            )
        )
    return out


def _as_list(value: Any) -> list[Any]:
    if value is None:
        return []
    return list(value) if isinstance(value, list) else [value]


def _plan_line(step: Any) -> str:
    # Same rendering as the dialog's safety-plan reply (app/dialog/actions.py).
    if isinstance(step, dict):
        return ": ".join(str(v) for v in step.values() if v)
    return str(step)


async def safety_plan(session: AsyncSession, token: str) -> list[str] | None:
    row = await session.get(SafetyPlan, token)
    return [_plan_line(s) for s in row.steps] if row is not None and row.steps else None


async def build_card(session: AsyncSession, d: PatientData, patient: Patient | None, now: datetime) -> PatientCard:
    """Card without the summary (the caller adds it: the LLM call must not hold the DB session)."""
    item = list_item(d, patient, now)
    return PatientCard(
        patient=item,
        prescriptions=prescriptions(d),
        series=series(d, now),
        doses=doses(d, now),
        alerts=[alert_out(a, item.display_name) for a in d.alerts],
        safety_plan=await safety_plan(session, d.profile.token),
    )