PTSRaiAgent/app/db/clinical.py

"""Clinical DB schema: pseudonymised health data. SPEC §5, ADR-002, ADR-003, ADR-006.

Every row is keyed by `token` (32 hex chars of HMAC(PSEUDO_KEY, SNILS)), never by name/SNILS/phone/chat id.
Free text is stored only after `scrub()` (`*_scrubbed` columns). This module must not import
`app.db.identity` (guardrail #5, checked in tests/test_db.py); `audit_log` also lives in this DB.

Business timestamps have no server defaults: callers pass time from `app.core.clock` (ADR-005), so the
demo virtual clock is reflected consistently in data, rules and the dashboard.
"""

from datetime import date, datetime
from typing import Any

from sqlalchemy import (
    BigInteger,
    Boolean,
    Date,
    Float,
    ForeignKey,
    Index,
    Integer,
    SmallInteger,
    String,
    Text,
    UniqueConstraint,
)
from sqlalchemy.orm import DeclarativeBase, Mapped, mapped_column

from app.db.types import JSONType, TZDateTime

TOKEN_LEN = 32
# BIGSERIAL on Postgres; SQLite autoincrements only INTEGER PRIMARY KEY.
BigId = BigInteger().with_variant(Integer(), "sqlite")


class ClinicalBase(DeclarativeBase):
    """Metadata of the clinical DB (incl. audit_log); never mixed with identity metadata."""


class PatientProfile(ClinicalBase):
    """Clinical view of a patient: no name, SNILS or contacts — only what monitoring needs."""

    __tablename__ = "patient_profiles"

    token: Mapped[str] = mapped_column(String(TOKEN_LEN), primary_key=True)
    doctor_id: Mapped[str] = mapped_column(String(64), index=True)
    modules: Mapped[list[str]] = mapped_column(JSONType, default=list)  # veteran | depression | family
    therapy_start: Mapped[date | None] = mapped_column(Date)
    next_visit: Mapped[date | None] = mapped_column(Date)
    birth_year: Mapped[int | None] = mapped_column(SmallInteger)
    sex: Mapped[str | None] = mapped_column(String(1))
    # Set by rules (e.g. after an acute episode): denser check-ins and lower silence thresholds.
    enhanced_monitoring: Mapped[bool] = mapped_column(Boolean, default=False)
    # Cache for the dashboard list; the source of truth is open alerts (colour is derived, ADR-006).
    status_color: Mapped[str | None] = mapped_column(String(8))


class ItemResponse(ClinicalBase):
    """Single scale item answer (PHQ-9, C-SSRS...) from buttons, LLM extraction or clinician."""

    __tablename__ = "item_responses"
    __table_args__ = (Index("ix_item_responses_token_ts", "token", "ts"),)

    id: Mapped[int] = mapped_column(BigId, primary_key=True, autoincrement=True)
    token: Mapped[str] = mapped_column(String(TOKEN_LEN))
    ts: Mapped[datetime] = mapped_column(TZDateTime)
    scale: Mapped[str] = mapped_column(String(16))  # phq9 | gad7 | pcl5 | cssrs | auditc ...
    item_id: Mapped[str] = mapped_column(String(32))
    score: Mapped[int | None] = mapped_column(SmallInteger)
    confidence: Mapped[float | None] = mapped_column(Float)
    evidence: Mapped[str | None] = mapped_column(Text)  # scrubbed phrase supporting an LLM-extracted score
    source: Mapped[str] = mapped_column(String(16))  # llm | button | clinician


class ScaleResult(ClinicalBase):
    __tablename__ = "scale_results"
    __table_args__ = (Index("ix_scale_results_token_ts", "token", "ts"),)

    id: Mapped[int] = mapped_column(BigId, primary_key=True, autoincrement=True)
    token: Mapped[str] = mapped_column(String(TOKEN_LEN))
    ts: Mapped[datetime] = mapped_column(TZDateTime)
    scale: Mapped[str] = mapped_column(String(16))
    period_start: Mapped[date | None] = mapped_column(Date)
    period_end: Mapped[date | None] = mapped_column(Date)
    total: Mapped[int] = mapped_column(SmallInteger)
    severity: Mapped[str] = mapped_column(String(32))
    complete: Mapped[bool] = mapped_column(Boolean)
    # PHQ-9 item 9 (suicidal ideation) kept separately: any value >= 1 escalates regardless of the total.
    item9: Mapped[int | None] = mapped_column(SmallInteger)
    # False = unscheduled administration triggered by a rule (e.g. mood <= 3 for three days, ADR-002).
    scheduled: Mapped[bool] = mapped_column(Boolean, default=True)
    flags: Mapped[dict[str, Any]] = mapped_column(JSONType, default=dict)


class DailyCheckin(ClinicalBase):
    """One row per patient per (virtual) day, filled in several steps of the daily dialog (ADR-002)."""

    __tablename__ = "daily_checkins"
    __table_args__ = (UniqueConstraint("token", "day", name="uq_daily_checkins_token_day"),)

    id: Mapped[int] = mapped_column(BigId, primary_key=True, autoincrement=True)
    token: Mapped[str] = mapped_column(String(TOKEN_LEN))
    day: Mapped[date] = mapped_column(Date)
    mood: Mapped[int | None] = mapped_column(SmallInteger)  # 0..10
    med_taken: Mapped[bool | None] = mapped_column(Boolean)
    sleep_bucket: Mapped[str | None] = mapped_column(String(16))
    alcohol_bucket: Mapped[str | None] = mapped_column(String(16))
    side_effects: Mapped[list[str]] = mapped_column(JSONType, default=list)
    quit_intent: Mapped[bool | None] = mapped_column(Boolean)  # wants to stop medication — doctor flag
    nightmares: Mapped[bool | None] = mapped_column(Boolean)
    free_text_scrubbed: Mapped[str | None] = mapped_column(Text)
    updated_at: Mapped[datetime] = mapped_column(TZDateTime)


class Prescription(ClinicalBase):
    __tablename__ = "prescriptions"

    id: Mapped[int] = mapped_column(BigId, primary_key=True, autoincrement=True)
    token: Mapped[str] = mapped_column(String(TOKEN_LEN), index=True)
    drug: Mapped[str] = mapped_column(String(128))  # INN (МНН)
    dose: Mapped[str] = mapped_column(String(64))
    schedule: Mapped[dict[str, Any]] = mapped_column(JSONType)  # {"times": ["08:00", "20:00"]}
    start_date: Mapped[date | None] = mapped_column(Date)
    end_date: Mapped[date | None] = mapped_column(Date)


class Dose(ClinicalBase):
    __tablename__ = "doses"
    __table_args__ = (Index("ix_doses_token_planned", "token", "planned_at"),)

    id: Mapped[int] = mapped_column(BigId, primary_key=True, autoincrement=True)
    token: Mapped[str] = mapped_column(String(TOKEN_LEN))
    prescription_id: Mapped[int] = mapped_column(ForeignKey("prescriptions.id"))
    planned_at: Mapped[datetime] = mapped_column(TZDateTime)
    status: Mapped[str] = mapped_column(String(16), default="pending")  # taken | missed | skipped | pending
    answered_at: Mapped[datetime | None] = mapped_column(TZDateTime)
    side_effects: Mapped[str | None] = mapped_column(Text)


class Alert(ClinicalBase):
    """Output of the deterministic rules engine (ADR-007). Level is stored, UI colour is derived (ADR-006)."""

    __tablename__ = "alerts"
    __table_args__ = (Index("ix_alerts_token_ts", "token", "ts"),)

    id: Mapped[int] = mapped_column(BigId, primary_key=True, autoincrement=True)
    token: Mapped[str] = mapped_column(String(TOKEN_LEN))
    ts: Mapped[datetime] = mapped_column(TZDateTime)
    level: Mapped[str] = mapped_column(String(16))  # acute | high | moderate | info (AlertLevel name)
    code: Mapped[str] = mapped_column(String(64))  # rule id from config/rules.yaml
    reason: Mapped[str] = mapped_column(Text)
    params: Mapped[dict[str, Any]] = mapped_column(JSONType, default=dict)
    acked_by: Mapped[str | None] = mapped_column(String(64))
    acked_at: Mapped[datetime | None] = mapped_column(TZDateTime)


class Message(ClinicalBase):
    __tablename__ = "messages"
    __table_args__ = (Index("ix_messages_token_ts", "token", "ts"),)

    id: Mapped[int] = mapped_column(BigId, primary_key=True, autoincrement=True)
    token: Mapped[str] = mapped_column(String(TOKEN_LEN))
    ts: Mapped[datetime] = mapped_column(TZDateTime)
    direction: Mapped[str] = mapped_column(String(3))  # in | out
    text_scrubbed: Mapped[str] = mapped_column(Text)
    fsm_state: Mapped[str | None] = mapped_column(String(64))


class DialogState(ClinicalBase):
    """FSM state of the dialog engine, persisted instead of Redis (ADR-003)."""

    __tablename__ = "dialog_state"

    token: Mapped[str] = mapped_column(String(TOKEN_LEN), primary_key=True)
    state: Mapped[str] = mapped_column(String(64))
    data: Mapped[dict[str, Any]] = mapped_column(JSONType, default=dict)
    updated_at: Mapped[datetime] = mapped_column(TZDateTime)


class SafetyPlan(ClinicalBase):
    __tablename__ = "safety_plans"

    token: Mapped[str] = mapped_column(String(TOKEN_LEN), primary_key=True)
    steps: Mapped[list[Any]] = mapped_column(JSONType, default=list)
    updated_at: Mapped[datetime] = mapped_column(TZDateTime)


class ClockState(ClinicalBase):
    """Single row (id=1): virtual clock offset so the demo timeline survives restarts (ADR-005)."""

    __tablename__ = "clock_state"

    id: Mapped[int] = mapped_column(Integer, primary_key=True)
    offset_seconds: Mapped[float] = mapped_column(Float, default=0.0)