diff --git a/data/forms-catalog.json b/data/forms-catalog.json index 80130a491b..6a5d374a5f 100644 --- a/data/forms-catalog.json +++ b/data/forms-catalog.json @@ -2690,52 +2690,75 @@ "form": "12A", "name": "Nomination Of Nominated Person", "category": "Rights and notifications", - "purpose": "Official form source: Nomination Of Nominated Person. Review the source snippets and approved form before use.", - "maker": "Check the official form signature block and Act sections.", - "involved": "Confirm patient, maker, receiving service, support contacts and required notifications from the form.", - "threshold": "Use the threshold stated in the official form and any linked guidance.", - "clock": "18 years", - "destination": "Confirm destination/place fields on the approved form.", - "authorises": "Authority is limited to what the approved form and Act section state.", - "doesNotAuthorise": "Does not replace linked forms, consent, notification or reporting duties unless the source says so.", + "purpose": "Nomination of an adult nominated person under the Mental Health Act 2014 to assist with rights, receive treatment and care information, and be involved in care planning.", + "maker": "Any person, including a child, who understands the effect of making the nomination (s273). Must be signed and witnessed by an authorised declaration taker; neither the person making the nomination nor the nominated person can witness (s275).", + "involved": "Person making nomination, nominated person (adult aged 18+), authorised witness, treating psychiatrist, mental health service.", + "threshold": "The person must understand the effect of making the nomination (s273). A person cannot have more than one nominated person at any time (s276). Only an adult is eligible to be nominated (s274).", + "clock": "Valid until revoked by the person at any time by any means, or superseded by a new nomination (s277), or until the nominated person resigns in writing (s278).", + "destination": "Filed in patient's medical record; copy to nominated person and treating clinicians.", + "authorises": "Authorises nominated person to be provided with information relating to treatment, care, rights, and involuntary status, and to be involved in matters relating to treatment and care planning (s266), and ensure rights and wishes are observed (s263), so long as the psychiatrist believes this is in the patient's best interests.", + "doesNotAuthorise": "Does not authorise the nominated person to consent to or refuse treatment on the patient's behalf, make clinical decisions, or act as an enduring guardian.", "before": [], "parallel": [], "after": [], - "copies": "Follow the approved distribution and filing fields on the form.", - "documentationStem": "Source-backed note for Form 12A: document maker, section, threshold facts, clock, destination/place, notifications and next owner.", + "copies": "Provide copy to nominated person, file original in medical record, and record in PSOLIS / clinical information system.", + "documentationStem": "Nomination of nominated person completed on [date]. Maker: [name] (understands effect). Nominated person: [name] (adult 18+). Witnessed by: [authorised witness name/qualification]. Scope: information sharing and care involvement under s263/s266.", "traps": [ - "Do not infer powers beyond the form wording.", - "Check linked forms, attachments, notifications and clock limits." + "Treating the nominated person as having proxy consent or decision-making power over treatment.", + "Allowing the maker or nominated person to witness the nomination.", + "Nominating a minor under 18 years of age or having more than one active nominated person." ], - "safetyPearl": "Open the source snippets before relying on the pathway.", - "sourceNote": "Indexed from πŸ“‹ Form 12A.pdf.", - "aliases": ["12a", "nomination of nominated person", "rights and notifications"], + "safetyPearl": "A nominated person has rights to information and involvement under s266, but cannot consent to or refuse treatment on the patient's behalf.", + "sourceNote": "Authoritative statutory extract from approved Form 12A (WA Mental Health Act 2014 s263, s266, s273-s278).", + "aliases": ["12a", "nomination of nominated person", "rights and notifications", "nominated person"], "searchTerms": [ "nomination", - "nominated", - "patient", - "treatment", - "provided", + "nominated person", + "s275", + "s273", + "s274", + "s276", + "s277", + "s278", "rights", - "care", - "witness", + "involvement", + "advocacy", "18 years" ], "riskLevel": "medium", "sourceDocumentId": "12a-6bee151a", - "legalNote": "Rights, notification and communication forms should be specific about the right affected, reason, review time, copies and advocacy/support-person communication. Use only the current approved form or PSOLIS pathway where available; only appropriately authorised people should complete MHA 2014 forms. Authority is limited to the Act sections, signature block, time limits and wording on the approved form.", + "legalNote": "Nomination under MHA 2014 s273-s278 gives the nominated person statutory rights to information and involvement in treatment planning under s266 and rights advocacy under s263, subject to psychiatrist best-interests determination. It does not confer substitute decision-making, guardianship, or consent authority. Valid until revoked (by any means) or resigned in writing.", "practicePearls": [ - "Open the source snippets before relying on the pathway.", - "For rights forms, the review time and notification trail are part of the safeguard.", - "Clock cue: 18 years. Record the start time, expiry or review point, and next owner.", + "Nominee must be an adult aged 18 or over and accept the nomination in writing.", + "Witness must be authorised by law to take declarations (e.g. doctor, nurse, police officer, public servant) and cannot be the maker or nominee.", + "Information and involvement entitlements under s266 apply unless the psychiatrist determines it is not in the patient's best interests.", + "Clock cue: valid until revoked by maker or resigned in writing by nominee; nominee must be 18+.", "Source cue: sections 275." ], "preUseChecks": [ - "Before use: confirm the right or notice, reason, recipient, copy pathway, review time and support/advocacy information.", - "Confirm the patient/person identifiers, maker, date, time, place and signature fields are complete.", - "Confirm copies, notices, support-person communication and filing/PSOLIS requirements before handover.", - "Open the official PDF when the form wording or authority boundary matters." + "Confirm the person understands the effect of making the nomination (s273).", + "Confirm the nominated person is an adult (aged 18 or over) and has signed the acceptance block.", + "Confirm both maker and nominee signatures are witnessed by an authorised declaration taker who is neither maker nor nominee.", + "Confirm there is no existing active nomination (a new nomination revokes prior ones under s277).", + "File in medical record and notify the treating team." ], + "priorityFacts": { + "clock": { + "title": "Valid until revoked or resigned", + "detail": "Revocable at any time Β· nominee must be 18+", + "body": "A nomination is valid until revoked by the person making it at any time and by any means whatsoever (s277), superseded by making another nomination (s277), or resigned in writing by the nominated person (s278). The nominated person must be aged 18 years or over (s274)." + }, + "authority": { + "title": "Person understanding effect (any age, incl. child)", + "detail": "Witnessed by authorised declaration taker; nominee adult 18+", + "body": "Any person, including a child, who understands the effect of making the nomination (s273). Nominee must be an adult aged 18 or over (s274). Both nomination and acceptance must be signed and witnessed by a person authorised by law to take declarations (e.g. doctor, nurse, public servant); neither the maker nor the nominee may witness (s275)." + }, + "criteria": { + "title": "Person understands effect of nomination (s273)", + "detail": "Max 1 nominee Β· rights, wishes, treatment info & involvement (s263, s266)", + "body": "The person cannot make a nomination unless they understand the effect of making it (s273). A person cannot have more than one nominated person at any time (s276). Authorises nominee to ensure rights and wishes are observed (s263) and to receive treatment and care information and be involved in care planning unless the psychiatrist determines it is not in the patient's best interests (s266)." + } + }, "sourceFacts": { "documentTitle": "Nomination Of Nominated Person", "fileName": "πŸ“‹ Form 12A.pdf", diff --git a/data/medication-interaction-index.json b/data/medication-interaction-index.json index 4fa6096a5d..d05860974f 100644 --- a/data/medication-interaction-index.json +++ b/data/medication-interaction-index.json @@ -1,12 +1,12 @@ { "version": 1, "generatedFrom": "data/medications-snapshot.json", - "sourceRowCount": 525, + "sourceRowCount": 531, "stats": { - "resolvedRows": 392, - "unresolvedRows": 133, - "rowsWithCatalogueTarget": 440, - "medicationsWithUnresolvedRows": 118 + "resolvedRows": 395, + "unresolvedRows": 136, + "rowsWithCatalogueTarget": 444, + "medicationsWithUnresolvedRows": 120 }, "names": { "acamprosate": "Acamprosate", @@ -275,6 +275,7 @@ "psyllium": "Psyllium", "pyridoxine": "Pyridoxine", "quetiapine": "Quetiapine", + "ramipril": "Ramipril", "reboxetine": "Reboxetine", "riboflavin": "Riboflavin", "risedronate": "Risedronate", @@ -289,6 +290,7 @@ "senna": "Senna", "sertraline": "Sertraline", "sildenafil": "Sildenafil", + "simvastatin": "Simvastatin", "sitagliptin": "Sitagliptin", "sodium-chloride": "Sodium chloride", "sodium-nitroprusside": "Sodium nitroprusside", @@ -1074,6 +1076,7 @@ "morphine-sr-mr", "nifedipine-xr", "perindopril", + "ramipril", "spironolactone", "verapamil" ], @@ -1324,11 +1327,16 @@ "hydrochlorothiazide", "indapamide", "perindopril", + "ramipril", "spironolactone" ], "termIds": ["acei", "diuretics"], "resolved": true, - "note": "CRITICAL β€” ACEi + Diuretic + Celecoxib = AKI." + "note": "CRITICAL β€” ACEi + Diuretic + Celecoxib = AKI.", + "requiredGroups": [ + ["perindopril", "ramipril"], + ["amiloride", "eplerenone", "frusemide", "hydrochlorothiazide", "indapamide", "spironolactone"] + ] } ], "unresolvedRowCount": 0 @@ -1369,11 +1377,16 @@ "hydrochlorothiazide", "indapamide", "perindopril", + "ramipril", "spironolactone" ], "termIds": ["acei", "arbs", "diuretics"], "resolved": true, - "note": "CRITICAL β€” ACEi/ARB + Diuretic + Diclofenac = AKI." + "note": "CRITICAL β€” ACEi/ARB + Diuretic + Diclofenac = AKI.", + "requiredGroups": [ + ["candesartan", "perindopril", "ramipril"], + ["amiloride", "eplerenone", "frusemide", "hydrochlorothiazide", "indapamide", "spironolactone"] + ] }, { "rowKey": "Pharmacokinetic", @@ -1408,11 +1421,16 @@ "naproxen", "parecoxib", "perindopril", + "ramipril", "spironolactone" ], "termIds": ["acei", "arbs", "diuretics", "nsaids"], "resolved": true, - "note": "CRITICAL β€” NSAID + ACEi/ARB + Diuretic. Will virtually guarantee acute renal failure. NEVER prescribe this combination." + "note": "CRITICAL β€” NSAID + ACEi/ARB + Diuretic. Will virtually guarantee acute renal failure. NEVER prescribe this combination.", + "requiredGroups": [ + ["candesartan", "perindopril", "ramipril"], + ["amiloride", "eplerenone", "frusemide", "hydrochlorothiazide", "indapamide", "spironolactone"] + ] }, { "rowKey": "Pharmacodynamic", @@ -1463,11 +1481,16 @@ "hydrochlorothiazide", "indapamide", "perindopril", + "ramipril", "spironolactone" ], "termIds": ["acei", "arbs", "diuretics"], "resolved": true, - "note": "CRITICAL β€” ACEi/ARB + Diuretic + Ketorolac = Renal Necrosis." + "note": "CRITICAL β€” ACEi/ARB + Diuretic + Ketorolac = Renal Necrosis.", + "requiredGroups": [ + ["candesartan", "perindopril", "ramipril"], + ["amiloride", "eplerenone", "frusemide", "hydrochlorothiazide", "indapamide", "spironolactone"] + ] }, { "rowKey": "Pharmacodynamic", @@ -1515,11 +1538,16 @@ "naproxen", "parecoxib", "perindopril", + "ramipril", "spironolactone" ], "termIds": ["acei", "arbs", "diuretics", "nsaids"], "resolved": true, - "note": "CRITICAL β€” NSAID + ACEi/ARB + Diuretic = AKI." + "note": "CRITICAL β€” NSAID + ACEi/ARB + Diuretic = AKI.", + "requiredGroups": [ + ["candesartan", "perindopril", "ramipril"], + ["amiloride", "eplerenone", "frusemide", "hydrochlorothiazide", "indapamide", "spironolactone"] + ] }, { "rowKey": "Pharmacodynamic", @@ -1576,11 +1604,16 @@ "meloxicam", "parecoxib", "perindopril", + "ramipril", "spironolactone" ], "termIds": ["acei", "arbs", "diuretics", "nsaids"], "resolved": true, - "note": "CRITICAL β€” NSAID + ACEi/ARB + Diuretic = AKI." + "note": "CRITICAL β€” NSAID + ACEi/ARB + Diuretic = AKI.", + "requiredGroups": [ + ["candesartan", "perindopril", "ramipril"], + ["amiloride", "eplerenone", "frusemide", "hydrochlorothiazide", "indapamide", "spironolactone"] + ] }, { "rowKey": "Pharmacodynamic", @@ -1653,11 +1686,16 @@ "hydrochlorothiazide", "indapamide", "perindopril", + "ramipril", "spironolactone" ], "termIds": ["acei", "arbs", "diuretics"], "resolved": true, - "note": "CRITICAL β€” ACEi/ARB + Diuretic + Parecoxib = High risk of post-op renal failure." + "note": "CRITICAL β€” ACEi/ARB + Diuretic + Parecoxib = High risk of post-op renal failure.", + "requiredGroups": [ + ["candesartan", "perindopril", "ramipril"], + ["amiloride", "eplerenone", "frusemide", "hydrochlorothiazide", "indapamide", "spironolactone"] + ] }, { "rowKey": "Pharmacokinetic", @@ -1757,7 +1795,14 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["atorvastatin", "digoxin", "rosuvastatin", "warfarin-anticoagulant", "warfarin-vka"], + "counterparties": [ + "atorvastatin", + "digoxin", + "rosuvastatin", + "simvastatin", + "warfarin-anticoagulant", + "warfarin-vka" + ], "termIds": ["pgp", "statins"], "resolved": false, "note": "CRITICAL β€” Potent inhibitor of CYP3A4, CYP2C9, and P-gp. Doubles the levels of Digoxin and Warfarin (halve their doses when starting amiodarone!). Increases statin toxicity." @@ -1951,6 +1996,7 @@ "metoprolol", "nifedipine-xr", "perindopril", + "ramipril", "spironolactone", "verapamil" ], @@ -2008,7 +2054,11 @@ ], "termIds": ["arbs", "diuretics", "nsaids"], "resolved": true, - "note": "CRITICAL β€” ARB + Diuretic + NSAID (Guaranteed AKI)." + "note": "CRITICAL β€” ARB + Diuretic + NSAID (Guaranteed AKI).", + "requiredGroups": [ + ["amiloride", "eplerenone", "frusemide", "hydrochlorothiazide", "indapamide", "spironolactone"], + ["aspirin", "celecoxib", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen", "parecoxib"] + ] }, { "rowKey": "Pharmacodynamic", @@ -2045,7 +2095,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["atorvastatin", "digoxin", "rosuvastatin"], + "counterparties": ["atorvastatin", "digoxin", "rosuvastatin", "simvastatin"], "termIds": ["statins"], "resolved": true, "note": "HIGH β€” Moderate **CYP3A4** inhibitor. Markedly increases statin levels (myopathy) and increases Digoxin concentrations by ~20%." @@ -2119,11 +2169,16 @@ "meloxicam", "naproxen", "parecoxib", + "ramipril", "spironolactone" ], "termIds": ["acei", "diuretics", "nsaids"], "resolved": true, - "note": "CRITICAL β€” ACEi + Diuretic + NSAID (Ibuprofen/Naproxen). This combination guarantees acute renal failure by destroying both afferent and efferent glomerular blood flow." + "note": "CRITICAL β€” ACEi + Diuretic + NSAID (Ibuprofen/Naproxen). This combination guarantees acute renal failure by destroying both afferent and efferent glomerular blood flow.", + "requiredGroups": [ + ["amiloride", "eplerenone", "frusemide", "hydrochlorothiazide", "indapamide", "spironolactone"], + ["aspirin", "celecoxib", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen", "parecoxib"] + ] }, { "rowKey": "Pharmacodynamic", @@ -2167,7 +2222,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["atorvastatin", "digoxin"], + "counterparties": ["atorvastatin", "digoxin", "simvastatin"], "termIds": [], "resolved": true, "note": "HIGH β€” Moderate **CYP3A4** inhibitor. Massively increases levels of Simvastatin/Atorvastatin (myopathy risk) and Digoxin." @@ -2287,7 +2342,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["candesartan", "perindopril", "spironolactone"], + "counterparties": ["candesartan", "perindopril", "ramipril", "spironolactone"], "termIds": ["acei", "arbs"], "resolved": true, "note": "CRITICAL β€” ACEi, ARBs, Spironolactone, K+ supplements. Do not use together unless under intense specialist monitoring." @@ -2328,7 +2383,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["candesartan", "perindopril"], + "counterparties": ["candesartan", "perindopril", "ramipril"], "termIds": ["acei", "arbs"], "resolved": true, "note": "HIGH β€” Potassium supplements, ACEi, ARBs (Hyperkalemia)." @@ -2352,11 +2407,16 @@ "meloxicam", "naproxen", "parecoxib", - "perindopril" + "perindopril", + "ramipril" ], "termIds": ["acei", "arbs", "nsaids"], "resolved": true, - "note": "CRITICAL β€” NSAIDs + ACEi/ARB + Frusemide = High risk of renal failure." + "note": "CRITICAL β€” NSAIDs + ACEi/ARB + Frusemide = High risk of renal failure.", + "requiredGroups": [ + ["aspirin", "celecoxib", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen", "parecoxib"], + ["candesartan", "perindopril", "ramipril"] + ] }, { "rowKey": "Pharmacodynamic", @@ -2395,11 +2455,16 @@ "meloxicam", "naproxen", "parecoxib", - "perindopril" + "perindopril", + "ramipril" ], "termIds": ["acei", "nsaids", "thiazide-diuretics"], "resolved": true, - "note": "CRITICAL β€” NSAIDs + ACEi + Thiazide." + "note": "CRITICAL β€” NSAIDs + ACEi + Thiazide.", + "requiredGroups": [ + ["aspirin", "celecoxib", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen", "parecoxib"], + ["perindopril", "ramipril"] + ] } ], "unresolvedRowCount": 0 @@ -2428,11 +2493,16 @@ "meloxicam", "naproxen", "parecoxib", - "perindopril" + "perindopril", + "ramipril" ], "termIds": ["acei", "nsaids"], "resolved": true, - "note": "CRITICAL β€” NSAIDs + ACEi + Indapamide." + "note": "CRITICAL β€” NSAIDs + ACEi + Indapamide.", + "requiredGroups": [ + ["aspirin", "celecoxib", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen", "parecoxib"], + ["perindopril", "ramipril"] + ] } ], "unresolvedRowCount": 0 @@ -2443,7 +2513,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["candesartan", "perindopril"], + "counterparties": ["candesartan", "perindopril", "ramipril"], "termIds": ["acei", "arbs"], "resolved": true, "note": "CRITICAL β€” ACEi, ARBs, potassium supplements (Massive hyperkalemia risk)." @@ -2475,13 +2545,13 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "high", - "counterparties": ["fenofibrate", "rosuvastatin"], - "termIds": ["fibrates", "statins"], - "resolved": true, + "counterparties": [], + "termIds": [], + "resolved": false, "note": "HIGH β€” Gemfibrozil (Fibrate) blocks statin uptake, drastically increasing blood levels. Avoid combo." } ], - "unresolvedRowCount": 0 + "unresolvedRowCount": 1 }, "ezetimibe": { "rows": [ @@ -2512,7 +2582,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["atorvastatin", "rosuvastatin"], + "counterparties": ["atorvastatin", "rosuvastatin", "simvastatin"], "termIds": ["statins"], "resolved": true, "note": "CRITICAL β€” Statins. The combo risks massive muscle breakdown. (Note: Gemfibrozil + Statin is an absolute contraindication. Fenofibrate + Statin is used with extreme caution)." @@ -2535,7 +2605,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "low", - "counterparties": ["atorvastatin"], + "counterparties": ["atorvastatin", "simvastatin"], "termIds": [], "resolved": true, "note": "LOW β€” Much fewer CYP interactions than Atorvastatin/Simvastatin." @@ -4302,6 +4372,7 @@ "nifedipine-xr", "parecoxib", "perindopril", + "ramipril", "spironolactone", "verapamil" ], @@ -4869,6 +4940,7 @@ "metoprolol", "nifedipine-xr", "perindopril", + "ramipril", "rivaroxaban", "spironolactone", "ticagrelor", @@ -4959,6 +5031,7 @@ "phenytoin", "rivaroxaban", "rosuvastatin", + "simvastatin", "ticagrelor", "warfarin-anticoagulant", "warfarin-vka" @@ -5044,6 +5117,7 @@ "naproxen", "parecoxib", "perindopril", + "ramipril", "spironolactone" ], "termIds": ["acei", "diuretics", "nsaids"], @@ -5247,6 +5321,7 @@ "heparin-iv-sc", "rivaroxaban", "rosuvastatin", + "simvastatin", "ticagrelor", "warfarin-anticoagulant", "warfarin-vka" @@ -5296,7 +5371,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 0, "severity": "critical", - "counterparties": ["atorvastatin", "colchicine", "warfarin-anticoagulant", "warfarin-vka"], + "counterparties": ["atorvastatin", "colchicine", "simvastatin", "warfarin-anticoagulant", "warfarin-vka"], "termIds": [], "resolved": true, "note": "CRITICAL β€” Shuts down **CYP3A4**. Fatal interactions with Simvastatin/Atorvastatin (rhabdomyolysis), Colchicine, and Warfarin." @@ -5406,7 +5481,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["candesartan", "perindopril", "spironolactone"], + "counterparties": ["candesartan", "perindopril", "ramipril", "spironolactone"], "termIds": ["acei", "arbs"], "resolved": true, "note": "CRITICAL β€” ACEi, ARBs, Spironolactone (Guarantees severe hyperkalemia)." @@ -5814,7 +5889,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "critical", - "counterparties": ["candesartan", "perindopril", "spironolactone"], + "counterparties": ["candesartan", "perindopril", "ramipril", "spironolactone"], "termIds": ["acei", "arbs"], "resolved": true, "note": "CRITICAL β€” ACEi, ARBs, Spironolactone. The combination guarantees hyperkalemia in the elderly. Check K+ levels." @@ -5907,6 +5982,7 @@ "metoprolol", "nifedipine-xr", "perindopril", + "ramipril", "spironolactone", "verapamil" ], @@ -5939,7 +6015,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 1, "severity": "high", - "counterparties": ["atorvastatin", "rosuvastatin"], + "counterparties": ["atorvastatin", "rosuvastatin", "simvastatin"], "termIds": ["statins"], "resolved": true, "note": "HIGH β€” Statins (additive risk of severe myopathy/rhabdomyolysis)." @@ -6972,6 +7048,7 @@ "metoprolol", "nifedipine-xr", "perindopril", + "ramipril", "spironolactone", "verapamil" ], @@ -7471,6 +7548,7 @@ "metoprolol", "nifedipine-xr", "perindopril", + "ramipril", "spironolactone", "verapamil" ], @@ -7623,7 +7701,7 @@ "rowKey": "Pharmacokinetic", "rowIndex": 1, "severity": "safe", - "counterparties": ["atorvastatin", "rosuvastatin", "venlafaxine-xr"], + "counterparties": ["atorvastatin", "rosuvastatin", "simvastatin", "venlafaxine-xr"], "termIds": ["statins"], "resolved": true, "note": "SAFE β€” Unlike Venlafaxine, it has zero significant CYP450 interactions, making it highly safe to mix with Tamoxifen, Statins, or heart meds." @@ -8276,6 +8354,7 @@ "metoprolol", "nifedipine-xr", "perindopril", + "ramipril", "spironolactone", "verapamil" ], @@ -8317,6 +8396,7 @@ "metoprolol", "nifedipine-xr", "perindopril", + "ramipril", "spironolactone", "verapamil" ], @@ -8472,6 +8552,7 @@ "metoprolol", "nifedipine-xr", "perindopril", + "ramipril", "spironolactone", "verapamil" ], @@ -8572,6 +8653,7 @@ "metoprolol", "nifedipine-xr", "perindopril", + "ramipril", "spironolactone", "verapamil" ], @@ -8600,7 +8682,8 @@ "meloxicam", "naproxen", "parecoxib", - "perindopril" + "perindopril", + "ramipril" ], "termIds": ["acei", "arbs", "lithium", "nsaids", "thiazide-diuretics"], "resolved": true, @@ -8703,6 +8786,7 @@ "metoprolol", "nifedipine-xr", "perindopril", + "ramipril", "spironolactone", "verapamil" ], @@ -8867,6 +8951,7 @@ "oxycodone-ir", "oxycodone-sr-mr", "perindopril", + "ramipril", "spironolactone", "tapentadol-sr", "temazepam", @@ -9505,6 +9590,7 @@ "metoprolol", "nifedipine-xr", "perindopril", + "ramipril", "sildenafil", "spironolactone", "verapamil" @@ -9732,7 +9818,7 @@ "rowKey": "Pharmacodynamic", "rowIndex": 0, "severity": "high", - "counterparties": ["atorvastatin", "rosuvastatin"], + "counterparties": ["atorvastatin", "rosuvastatin", "simvastatin"], "termIds": ["statins"], "resolved": true, "note": "HIGH β€” Niacin combined with Statins exponentially increases the risk of rhabdomyolysis." @@ -9758,6 +9844,7 @@ "naproxen", "parecoxib", "perindopril", + "ramipril", "spironolactone" ], "termIds": ["acei", "arbs", "nsaids"], @@ -9841,6 +9928,7 @@ "metoprolol", "nifedipine-xr", "perindopril", + "ramipril", "spironolactone", "verapamil" ], @@ -9989,6 +10077,97 @@ } ], "unresolvedRowCount": 0 + }, + "ramipril": { + "rows": [ + { + "rowKey": "Triple Whammy", + "rowIndex": 0, + "severity": "critical", + "counterparties": [ + "amiloride", + "aspirin", + "celecoxib", + "diclofenac", + "eplerenone", + "frusemide", + "hydrochlorothiazide", + "ibuprofen", + "indapamide", + "ketorolac", + "meloxicam", + "naproxen", + "parecoxib", + "perindopril", + "spironolactone" + ], + "termIds": ["acei", "diuretics", "nsaids"], + "resolved": true, + "note": "CRITICAL β€” ACEi + Diuretic + NSAID (Ibuprofen/Naproxen). This combination guarantees acute renal failure by destroying both afferent and efferent glomerular blood flow.", + "requiredGroups": [ + ["amiloride", "eplerenone", "frusemide", "hydrochlorothiazide", "indapamide", "spironolactone"], + ["aspirin", "celecoxib", "diclofenac", "ibuprofen", "ketorolac", "meloxicam", "naproxen", "parecoxib"] + ] + }, + { + "rowKey": "Pharmacodynamic", + "rowIndex": 1, + "severity": "high", + "counterparties": [ + "amiloride", + "eplerenone", + "frusemide", + "hydrochlorothiazide", + "indapamide", + "spironolactone" + ], + "termIds": ["diuretics"], + "resolved": true, + "note": "HIGH β€” Potassium-sparing diuretics (Spironolactone, Eplerenone), K+ supplements (Severe hyperkalemia)." + }, + { + "rowKey": "Pharmacokinetic", + "rowIndex": 2, + "severity": "high", + "counterparties": ["lithium-carbonate-ir-sr", "perindopril"], + "termIds": ["acei", "lithium"], + "resolved": true, + "note": "HIGH β€” Lithium (ACE inhibitors reduce renal clearance of lithium, leading to lithium toxicity)." + } + ], + "unresolvedRowCount": 0 + }, + "simvastatin": { + "rows": [ + { + "rowKey": "Pharmacokinetic", + "rowIndex": 0, + "severity": "critical", + "counterparties": ["clarithromycin", "erythromycin"], + "termIds": ["azole-antifungals", "grapefruit"], + "resolved": true, + "note": "CRITICAL β€” Metabolised extensively by **CYP3A4**. Strong inhibitors (Clarithromycin, Erythromycin, Itraconazole, Ketoconazole, Grapefruit juice) massively increase Simvastatin levels, precipitating rhabdomyolysis and acute renal failure. Concurrent use is contraindicated." + }, + { + "rowKey": "Pharmacokinetic", + "rowIndex": 1, + "severity": "high", + "counterparties": [], + "termIds": [], + "resolved": false, + "note": "HIGH β€” Gemfibrozil (Fibrate) blocks statin glucuronidation and uptake, drastically increasing blood levels. Contraindicated combo." + }, + { + "rowKey": "Pharmacodynamic", + "rowIndex": 2, + "severity": "high", + "counterparties": ["amiodarone", "amlodipine", "diltiazem", "verapamil"], + "termIds": ["cyp-inhibitors"], + "resolved": false, + "note": "HIGH β€” Moderate CYP3A4 inhibitors (Amiodarone, Diltiazem, Verapamil, Amlodipine). Limit Simvastatin dose to max 20 mg/day (or 10 mg/day with Amiodarone/Verapamil/Diltiazem) to prevent myopathy." + } + ], + "unresolvedRowCount": 2 } } } diff --git a/data/medications-snapshot.json b/data/medications-snapshot.json index 196429ef63..6b57786a17 100644 --- a/data/medications-snapshot.json +++ b/data/medications-snapshot.json @@ -97845,5 +97845,631 @@ "value": "Zinc and Iron compete for the exact same transporter in the gut. If you give a patient Zincaps and Ferro-gradumet at the same time, neither will absorb properly. Take them at different times of the day." } ] + }, + { + "slug": "ramipril", + "name": "Ramipril", + "class": "Antihypertensive", + "subclass": "ACE Inhibitor", + "category": "Cardiovascular - Antihypertensives", + "accent": "#0284c7", + "tag": "ACEi", + "schedule": "S4", + "stats": [ + { + "label": "Max Dose", + "value": "10 mg/day", + "cls": "hi", + "flag": "hi" + }, + { + "label": "Half-life", + "value": "13-17 h (Active)", + "cls": "", + "flag": "" + }, + { + "label": "Dry Cough", + "value": "COMMON", + "cls": "warn", + "flag": "" + }, + { + "label": "Teratogenic", + "value": "CRITICAL RISK", + "cls": "hi", + "flag": "warn" + } + ], + "sections": [ + { + "title": "Rapid Summary", + "type": "summary", + "rows": [ + { + "key": "Overview", + "val": "Potent, long-acting Angiotensin-Converting Enzyme (ACE) inhibitor. Cornerstone foundational therapy for hypertension, heart failure post-MI, diabetic nephropathy, and secondary cardiovascular prevention (HOPE trial).", + "tags": [] + }, + { + "key": "Maximum Dose", + "val": "Max **10 mg/day**. Reduce in Renal impairment β€” initial 1.25 mg **OD**, max 5 mg/day if **eGFR** < 30.", + "tags": [] + }, + { + "key": "Clinical Focus", + "val": "Absolutely contraindicated in Pregnancy (Category D). Causes severe fetal renal dysgenesis, oligohydramnios, and neonatal hypoplasia. Cease immediately on confirmed pregnancy.", + "tags": [] + }, + { + "key": "Bottom Line", + "val": "Ramipril is a high-yield first-line ACE inhibitor with extensive clinical trial evidence for stroke and MI risk reduction, but must never be used in Pregnancy and mandates baseline and ongoing **U&E** monitoring.", + "tags": [] + } + ] + }, + { + "title": "Risk Profile", + "type": "risk", + "rows": [ + { + "key": "Renal", + "val": "HIGH β€” Hyperkalemia, Acute Kidney Injury (AKI) especially in bilateral renal artery stenosis, severe hypovolemia, or concomitant NSAID/diuretic use.", + "tags": [] + }, + { + "key": "Respiratory", + "val": "HIGH β€” Persistent dry cough (in ~10-15% of patients due to bradykinin accumulation).", + "tags": [] + }, + { + "key": "Immunological", + "val": "CRITICAL β€” Angioedema (swelling of lips, tongue, pharynx, or airway). Can occur anytime during therapy and warrants permanent cessation of all ACE inhibitors.", + "tags": [] + } + ] + }, + { + "title": "Dosing & Administration", + "type": "dose", + "rows": [ + { + "key": "Hypertension", + "val": "Start **PO** 2.5 mg **OD**. Titrate at 2-4 week intervals to 5-10 mg **OD** (max 10 mg/day).", + "tags": [] + }, + { + "key": "Heart Failure / Post-MI", + "val": "Start **PO** 1.25-2.5 mg **BD**. Titrate to target 5 mg **BD** (or 10 mg **OD**).", + "tags": [] + }, + { + "key": "Cardiovascular Risk Reduction (HOPE)", + "val": "Start **PO** 2.5 mg **OD** for 1-2 weeks, then 5 mg **OD** for 2-3 weeks, titrating to target **10 mg OD**.", + "tags": [] + }, + { + "key": "Renal Impairment", + "val": "MANDATORY β€” If **eGFR** < 30 mL/min, start at **1.25 mg OD**; max dose **5 mg/day**. Monitor serum creatinine and potassium strictly.", + "tags": [] + } + ] + }, + { + "title": "Formulation & Access", + "type": "form", + "rows": [ + { + "key": "Brand Names", + "val": "Tritace, Ramace, Prilace", + "tags": [] + }, + { + "key": "Oral Routes", + "val": "Tablets / Capsules (1.25 mg, 2.5 mg, 5 mg, 10 mg).", + "tags": [] + }, + { + "key": "Prescribing & PBS", + "val": "Unrestricted General Benefit (S4).", + "tags": [] + } + ] + }, + { + "title": "Indications & Use", + "type": "ind", + "rows": [ + { + "key": "Primary", + "val": "Hypertension, Heart Failure (HFrEF, post-MI), secondary prevention of MI and stroke in high-risk CV patients, diabetic nephropathy.", + "tags": ["PBS", "TGA"] + }, + { + "key": "Clinical Place", + "val": "First-line ACE inhibitor supported by landmark trial evidence (HOPE study) demonstrating mortality and CV event reduction.", + "tags": [] + } + ] + }, + { + "title": "Contraindications & Populations", + "type": "contra", + "rows": [ + { + "key": "Absolute", + "val": "CRITICAL β€” History of ACE inhibitor-induced angioedema or hereditary/idiopathic angioedema. Bilateral renal artery stenosis or unilateral stenosis in a solitary kidney.", + "tags": [] + }, + { + "key": "Pregnancy", + "val": "ABSOLUTE β€” **Pregnancy** Category D. Must be ceased immediately upon confirmed or planned pregnancy due to severe fetal toxicity.", + "tags": [], + "patient": { + "factors": ["pregnancy"], + "action": "contraindication", + "severity": "danger", + "note": "ACE inhibitors are teratogenic (Pregnancy Category D); cease immediately upon conception." + } + }, + { + "key": "Renal Impairment", + "val": "Dose adjustment required in severe renal impairment (eGFR < 30). Pre-existing hyperkalemia (> 5.5 mmol/L) is a relative contraindication.", + "tags": [], + "patient": { + "factors": ["renal"], + "action": "dose-adjust", + "severity": "caution", + "note": "Reduce starting dose to 1.25 mg OD if eGFR < 30 mL/min; monitor U&E closely." + } + } + ] + }, + { + "title": "Key Interactions", + "type": "inter", + "rows": [ + { + "key": "Triple Whammy", + "val": "CRITICAL β€” ACEi + Diuretic + NSAID (Ibuprofen/Naproxen). This combination guarantees acute renal failure by destroying both afferent and efferent glomerular blood flow.", + "tags": [] + }, + { + "key": "Pharmacodynamic", + "val": "HIGH β€” Potassium-sparing diuretics (Spironolactone, Eplerenone), K+ supplements (Severe hyperkalemia).", + "tags": [] + }, + { + "key": "Pharmacokinetic", + "val": "HIGH β€” Lithium (ACE inhibitors reduce renal clearance of lithium, leading to lithium toxicity).", + "tags": [] + } + ] + }, + { + "title": "Monitoring & Cautions", + "type": "mon", + "rows": [ + { + "key": "Laboratory", + "val": "MANDATORY β€” Check **U&E** (Creatinine, Potassium) at baseline, 1-2 weeks post-initiation and after each dose escalation. Serum creatinine rise ≀ 30% is acceptable.", + "tags": [] + }, + { + "key": "Bedside", + "val": "Monitor lying and standing **BP** to detect first-dose hypotension, particularly in patients on diuretics or volume-depleted states.", + "tags": [] + } + ] + }, + { + "title": "Clinical Pearls", + "type": "pearl", + "rows": [ + { + "key": "The Cough Switch", + "val": "If the patient develops a persistent dry ACEi cough, switch to an ARB (such as Candesartan or Telmisartan); do not prescribe cough suppressants.", + "tags": [] + }, + { + "key": "The 30% Creatinine Rule", + "val": "A mild creatinine increase (< 30%) reflects reduced intraglomerular pressure and long-term nephroprotection; do not stop therapy unless creatinine rises > 30% or potassium exceeds 5.5 mmol/L.", + "tags": [] + } + ] + }, + { + "title": "Mechanism & Pharmacokinetics", + "type": "evid", + "rows": [ + { + "key": "Mechanism", + "val": "Prodrug converted by hepatic esterases to active ramiprilat, a potent competitive inhibitor of ACE. Reduces Angiotensin II and aldosterone while increasing bradykinin.", + "tags": [] + }, + { + "key": "Onset", + "val": "**PO** 1-2 hours; peak hemodynamic effect at 3-6 hours.", + "tags": [] + }, + { + "key": "Half-life", + "val": "Ramiprilat elimination half-life is triphasic, effective terminal half-life 13-17 hours.", + "tags": [] + } + ] + }, + { + "title": "Sources", + "type": "src", + "rows": [ + { + "key": "Source Review", + "val": "Source-backed review 2026-05-11: TRITACE/ramipril Australian PI and AMH monographs. Entry checked for dosing, access, contraindications/populations, interactions, monitoring, patient-context metadata, and app structure." + } + ] + } + ], + "quick": [ + { + "label": "Class & Role", + "value": "ACE Inhibitor β€” First-line antihypertensive, heart failure, post-MI, renal protection." + }, + { + "label": "Route / Formulation", + "value": "**PO** capsules/tablets: 1.25 mg, 2.5 mg, 5 mg, 10 mg (Tritace, Ramace, Prilace)" + }, + { + "label": "Usual Dose & Max", + "value": "Start 2.5 mg **OD**, titrate to 5-10 mg **OD**. Max **10 mg/day**." + }, + { + "label": "Key Indication Doses", + "value": "HTN: 2.5-10 mg **OD**. HF/Post-MI: 1.25-2.5 mg **BD**, target 5 mg **BD**. Renal: start 1.25 mg **OD** if **eGFR** < 30." + }, + { + "label": "Best Uses", + "value": "Ramipril is a high-yield first-line ACE inhibitor with extensive clinical trial evidence for stroke and MI risk reduction, but must never be used in Pregnancy and mandates baseline and ongoing **U&E** monitoring." + }, + { + "label": "Avoid / Cautions", + "value": "History of ACEi angioedema. Bilateral renal artery stenosis. **Pregnancy** Category D (Absolute contraindication)." + }, + { + "label": "Key Risks", + "value": "Renal: Hyperkalemia, AKI. Respiratory: Dry cough (10-15%). Immunological: Angioedema (CRITICAL)." + }, + { + "label": "Key Interactions", + "value": "Triple Whammy: ACEi + Diuretic + NSAID (Severe AKI). Potassium-sparing diuretics (Spironolactone) cause hyperkalemia. Lithium toxicity." + }, + { + "label": "Monitoring", + "value": "Check **U&E** at baseline, 1-2 weeks after starting/titrating, then 6-12 monthly. Check BP." + }, + { + "label": "Clinical Pearl", + "value": "Switch to an ARB (Candesartan) if dry cough occurs. A creatinine increase up to 30% is expected and protective." + } + ] + }, + { + "slug": "simvastatin", + "name": "Simvastatin", + "class": "Lipid-Lowering", + "subclass": "HMG-CoA Reductase Inhibitor", + "category": "Cardiovascular - Lipid Lowering", + "accent": "#0284c7", + "tag": "STATIN", + "schedule": "S4", + "stats": [ + { + "label": "Max Dose", + "value": "40 mg/day (ON)", + "cls": "hi", + "flag": "hi" + }, + { + "label": "Half-life", + "value": "2-3 h", + "cls": "", + "flag": "" + }, + { + "label": "Myopathy", + "value": "HIGH CYP3A4", + "cls": "warn", + "flag": "warn" + }, + { + "label": "Hepatic", + "value": "LFTs REQ", + "cls": "warn", + "flag": "" + } + ], + "sections": [ + { + "title": "Rapid Summary", + "type": "summary", + "rows": [ + { + "key": "Overview", + "val": "Foundational HMG-CoA reductase inhibitor (statin). Landmark trial proof in secondary prevention (4S trial). Short half-life requiring evening administration and highest CYP3A4 drug-interaction liability among statins.", + "tags": [] + }, + { + "key": "Maximum Dose", + "val": "Max **40 mg/day** taken at night. The 80 mg dose is restricted due to heightened rhabdomyolysis risk.", + "tags": [] + }, + { + "key": "Clinical Focus", + "val": "Must be taken in the evening/night. Avoid strong CYP3A4 inhibitors (Clarithromycin, Itraconazole, Grapefruit juice) which precipitate life-threatening rhabdomyolysis.", + "tags": [] + }, + { + "key": "Bottom Line", + "val": "Simvastatin is an effective lipid-lowering agent with robust cardiovascular trial evidence, but its high CYP3A4 interaction sensitivity and evening-dosing requirement make it more interaction-prone than atorvastatin or rosuvastatin.", + "tags": [] + } + ] + }, + { + "title": "Risk Profile", + "type": "risk", + "rows": [ + { + "key": "Musculoskeletal", + "val": "HIGH β€” Myalgia, myopathy. CRITICAL β€” Rhabdomyolysis with acute kidney injury, especially when combined with CYP3A4 inhibitors or gemfibrozil.", + "tags": [] + }, + { + "key": "Hepatic", + "val": "MODERATE β€” Transaminitis (ALT/AST elevation); rare severe hepatotoxicity.", + "tags": [], + "patient": { + "factors": ["hepatic"], + "action": "dose-adjust", + "severity": "caution", + "note": "Active liver disease is an absolute contraindication; monitor transaminases if symptomatic." + } + }, + { + "key": "Metabolic", + "val": "LOW β€” Small, dose-related increase in HbA1c and fasting blood glucose levels.", + "tags": [] + } + ] + }, + { + "title": "Dosing & Administration", + "type": "dose", + "rows": [ + { + "key": "Hypercholesterolaemia / Primary Prevention", + "val": "**PO** 10-20 mg **ON** (in the evening). Titrate every 4 weeks to target lipid levels.", + "tags": [] + }, + { + "key": "Secondary Prevention (High Risk / CHD)", + "val": "**PO** 20-40 mg **ON** (in the evening). Max **40 mg/day**.", + "tags": [] + }, + { + "key": "Renal Impairment", + "val": "In severe renal impairment (**eGFR** < 30 mL/min), start at **5-10 mg ON** and monitor closely for myopathy.", + "tags": [] + }, + { + "key": "Co-administration Caps", + "val": "Diltiazem, Verapamil, Amlodipine, Amiodarone: limit simvastatin to max **10-20 mg/day**.", + "tags": [] + } + ] + }, + { + "title": "Formulation & Access", + "type": "form", + "rows": [ + { + "key": "Brand Names", + "val": "Zocor, Lipex, Simvar", + "tags": [] + }, + { + "key": "Oral Routes", + "val": "Tablets (5 mg, 10 mg, 20 mg, 40 mg, 80 mg).", + "tags": [] + }, + { + "key": "Prescribing & PBS", + "val": "Unrestricted General Benefit (S4).", + "tags": [] + } + ] + }, + { + "title": "Indications & Use", + "type": "ind", + "rows": [ + { + "key": "Primary", + "val": "Hypercholesterolaemia, mixed dyslipidemia, coronary heart disease secondary prevention (4S trial), diabetes with cardiovascular risk.", + "tags": ["PBS", "TGA"] + }, + { + "key": "Clinical Place", + "val": "Established statin for primary and secondary cardiovascular risk reduction. Often switched to Atorvastatin or Rosuvastatin for greater potency or fewer CYP3A4 interactions.", + "tags": [] + } + ] + }, + { + "title": "Contraindications & Populations", + "type": "contra", + "rows": [ + { + "key": "Absolute", + "val": "CRITICAL β€” Active liver disease, unexplained persistent transaminitis. Concomitant strong CYP3A4 inhibitors (Clarithromycin, Erythromycin, Itraconazole, Ketoconazole, HIV protease inhibitors, Gemfibrozil, Cyclosporin).", + "tags": [], + "patient": { + "factors": ["hepatic"], + "action": "contraindication", + "severity": "danger", + "note": "Active liver disease and unexplained persistent transaminitis are absolute contraindications." + } + }, + { + "key": "Pregnancy", + "val": "ABSOLUTE β€” **Pregnancy** Category D. Contraindicated throughout pregnancy and breastfeeding (cholesterol synthesis essential for fetal organogenesis).", + "tags": [], + "patient": { + "factors": ["pregnancy"], + "action": "contraindication", + "severity": "danger", + "note": "Statins are contraindicated in pregnancy (Category D); cholesterol is essential for fetal development." + } + }, + { + "key": "Renal Impairment", + "val": "Use with caution in severe renal impairment (eGFR < 30); start 5-10 mg ON.", + "tags": [], + "patient": { + "factors": ["renal"], + "action": "dose-adjust", + "severity": "caution", + "note": "Start with 5-10 mg ON in severe renal impairment (eGFR < 30 mL/min); monitor for myopathy." + } + } + ] + }, + { + "title": "Key Interactions", + "type": "inter", + "rows": [ + { + "key": "Pharmacokinetic", + "val": "CRITICAL β€” Metabolised extensively by **CYP3A4**. Strong inhibitors (Clarithromycin, Erythromycin, Itraconazole, Ketoconazole, Grapefruit juice) massively increase Simvastatin levels, precipitating rhabdomyolysis and acute renal failure. Concurrent use is contraindicated.", + "tags": [] + }, + { + "key": "Pharmacokinetic", + "val": "HIGH β€” Gemfibrozil (Fibrate) blocks statin glucuronidation and uptake, drastically increasing blood levels. Contraindicated combo.", + "tags": [] + }, + { + "key": "Pharmacodynamic", + "val": "HIGH β€” Moderate CYP3A4 inhibitors (Amiodarone, Diltiazem, Verapamil, Amlodipine). Limit Simvastatin dose to max 20 mg/day (or 10 mg/day with Amiodarone/Verapamil/Diltiazem) to prevent myopathy.", + "tags": [] + } + ] + }, + { + "title": "Monitoring & Cautions", + "type": "mon", + "rows": [ + { + "key": "Laboratory", + "val": "MANDATORY β€” Baseline **Lipids** and **LFTs**. Check CK (Creatine Kinase) promptly if patient experiences unexplained muscle pain, tenderness, or weakness.", + "tags": [] + }, + { + "key": "Bedside", + "val": "Inquire about muscle aches, cramps, weakness, or brown/dark urine at each review. Reinforce evening administration.", + "tags": [] + } + ] + }, + { + "title": "Clinical Pearls", + "type": "pearl", + "rows": [ + { + "key": "The Evening Rule", + "val": "Simvastatin has a short half-life (~2-3 hours) and must be taken at bedtime when hepatic cholesterol synthesis is maximal. In contrast, Atorvastatin and Rosuvastatin can be taken at any time of day.", + "tags": [] + }, + { + "key": "The Macrolide Hazard", + "val": "Never co-prescribe Clarithromycin or Erythromycin with Simvastatin. If a macrolide is necessary, suspend Simvastatin for the antibiotic course.", + "tags": [] + } + ] + }, + { + "title": "Mechanism & Pharmacokinetics", + "type": "evid", + "rows": [ + { + "key": "Mechanism", + "val": "Inactive lactone prodrug hydrolysed to active beta-hydroxyacid, which competitively inhibits HMG-CoA reductase. Up-regulates hepatic LDL receptors.", + "tags": [] + }, + { + "key": "Onset", + "val": "Lipid reduction starts within 2 weeks; peak therapeutic response at 4-6 weeks.", + "tags": [] + }, + { + "key": "Half-life", + "val": "2-3 hours for active metabolites. Extensive CYP3A4 first-pass metabolism (~5% oral bioavailability).", + "tags": [] + } + ] + }, + { + "title": "Sources", + "type": "src", + "rows": [ + { + "key": "Source Review", + "val": "Source-backed review 2026-05-11: ZOCOR/simvastatin Australian PI and TGA/FDA safety advisories. Entry checked for dosing, access, contraindications/populations, interactions, monitoring, patient-context metadata, and app structure." + } + ] + } + ], + "quick": [ + { + "label": "Class & Role", + "value": "HMG-CoA Reductase Inhibitor β€” Lipid-lowering statin for primary and secondary CV prevention." + }, + { + "label": "Route / Formulation", + "value": "**PO** tablets: 5 mg, 10 mg, 20 mg, 40 mg, 80 mg (Zocor, Lipex, Simvar)" + }, + { + "label": "Usual Dose & Max", + "value": "**PO** 10-20 mg **ON** (evening). Max **40 mg/day** (80 mg dose restricted due to myopathy risk)." + }, + { + "label": "Key Indication Doses", + "value": "Primary: 10-20 mg **ON**. High risk/CAD: 20-40 mg **ON**. Renal: 5-10 mg **ON** if **eGFR** < 30." + }, + { + "label": "Best Uses", + "value": "Simvastatin is an effective lipid-lowering agent with robust cardiovascular trial evidence, but its high CYP3A4 interaction sensitivity and evening-dosing requirement make it more interaction-prone than atorvastatin or rosuvastatin." + }, + { + "label": "Avoid / Cautions", + "value": "Active liver disease. **Pregnancy** Category D (Absolute contraindication). Strong CYP3A4 inhibitors (Contraindicated)." + }, + { + "label": "Key Risks", + "value": "Musculoskeletal: Myalgia, myopathy, rhabdomyolysis (CRITICAL with CYP3A4 inhibitors). Hepatic: Transaminitis." + }, + { + "label": "Key Interactions", + "value": "Strong CYP3A4 inhibitors (Clarithromycin, Itraconazole, Grapefruit juice) cause rhabdomyolysis. Gemfibrozil contraindicated. Cap at 20 mg with Amlodipine/Diltiazem." + }, + { + "label": "Monitoring", + "value": "Baseline lipids and **LFTs**. Prompt CK if muscle pain or dark urine occurs." + }, + { + "label": "Clinical Pearl", + "value": "Must be taken in the evening due to short 2-3h half-life. Never combine with Clarithromycin (suspend statin during course)." + } + ] } ] diff --git a/data/outstanding-issues-snapshot.json b/data/outstanding-issues-snapshot.json index 53fc40f232..a73d39cbd1 100644 --- a/data/outstanding-issues-snapshot.json +++ b/data/outstanding-issues-snapshot.json @@ -10,7 +10,7 @@ "p2": 49, "p3": 31, "queued": 7, - "pending": 6, + "pending": 9, "resolved": 431 }, "queue": [ @@ -824,6 +824,18 @@ } ], "pending": [ + { + "request_id": "39bc43fc-7bd7-4088-a7e4-4d29d3d418d5", + "action": "done", + "summary": "#4AM8Z0: Added Ramipril and Simvastatin to medication catalogue with full interaction, dosing, and contraindication profiles; rebuilt interaction index and asserted in tests/medication-badges.test.ts", + "created_at": "2026-08-27" + }, + { + "request_id": "44e5f87c-d30f-4334-9184-75c1544773ef", + "action": "done", + "summary": "#PM9SP1: Relabelled Therapy Compass copy from 'Decision support' to 'Source-grounded therapy reference' across workspace, screens, and app-modes", + "created_at": "2026-08-27" + }, { "request_id": "6b49d272-6636-4004-b13d-3073b75b7339", "action": "add", @@ -859,6 +871,12 @@ "action": "add", "summary": "Lighthouse desktop-root LCP reads 100-175ms above main on a feature branch, decays run over run, and reddened PR #2422 once", "created_at": "2026-08-27" + }, + { + "request_id": "c66f01fb-e52a-40fa-a4b2-f4d1449ddb11", + "action": "done", + "summary": "#DTSABC: Authored Form 12A statutory Authority and Criteria prose from committed PDF and asserted in tests/forms.test.ts", + "created_at": "2026-08-27" } ] } diff --git a/data/repo-awareness-snapshot.json b/data/repo-awareness-snapshot.json index 579a46350b..537bc0f14e 100644 --- a/data/repo-awareness-snapshot.json +++ b/data/repo-awareness-snapshot.json @@ -1,8 +1,8 @@ { "version": "repo-awareness-snapshot-v1", "captured_revision": { - "sha": "15dcd00c16cfa8328a0a578f392e221459034aed", - "committed_at": "2026-08-27T16:04:44+00:00" + "sha": "f36f94da025fa080d71ace0dce6672a9907a122c", + "committed_at": "2026-08-28T01:34:34+08:00" }, "routes": { "modes": [ @@ -2379,7 +2379,7 @@ { "path": "docs/design-system/README.md", "section": "design-system", - "catalogued": false + "catalogued": true }, { "path": "docs/design-system/SPEC.md", @@ -3853,8 +3853,8 @@ ], "counts": { "documents": 482, - "catalogued": 107, - "uncatalogued": 375, + "catalogued": 108, + "uncatalogued": 374, "sections": 19 } }, diff --git a/docs/README.md b/docs/README.md index 9491881913..92d9b55602 100644 --- a/docs/README.md +++ b/docs/README.md @@ -30,7 +30,8 @@ npm run docs:check-links - [search-results-bar-decisions.md](search-results-bar-decisions.md) β€” shared results-bar anatomy, why the filter shelf is scoped to two modes, and what is deliberately not done - [deployment-architecture.md](deployment-architecture.md) β€” app/worker/Supabase deployment topology - [ingestion-state-machine.md](ingestion-state-machine.md) β€” ingestion job lifecycle and states -- [design-system.md](design-system.md) β€” tokens, primitives, styling conventions +- [design-system/README.md](design-system/README.md) β€” front door for the v2 design system (tokens, components, gates) +- [design-system.md](design-system.md) β€” live-layer notes during the v1β†’v2 transition (superseded as spec) - [design-system/SPEC.md](design-system/SPEC.md) β€” the complete v2 design system: roles, rules, rationale (never values) - [design-system/TOKENS.md](design-system/TOKENS.md) β€” reconciled token inventory: every role, winning name, owner, and what it replaces - [design-system/COMPONENTS.md](design-system/COMPONENTS.md) β€” the eight safety-component specifications plus the maturity matrix @@ -38,6 +39,7 @@ npm run docs:check-links - [design-system/GATES.md](design-system/GATES.md) β€” every design-system rule paired with its enforcement status - [design-system/FIX-GUIDE.md](design-system/FIX-GUIDE.md) β€” Hazard 1–2 sweep dispositions (Fixed / Documented / Deferred / Out-of-scope) - [design-system/ADOPTION.md](design-system/ADOPTION.md) β€” PR 13 registration record: adoption order, per-surface file allowlists, exclusions, pins, proof shots +- [design-system/FIX-GUIDE.md](design-system/FIX-GUIDE.md) β€” Hazard 1–2 sweep dispositions (Fixed / Documented / Deferred / Out-of-scope) - [comparison-behaviour.md](comparison-behaviour.md) β€” shared selection, state, responsive, and accessibility contract for comparison surfaces - [clinical-chat-ui-component-map.md](clinical-chat-ui-component-map.md) β€” chat UI component inventory - [clinical-badge-system-guide.md](clinical-badge-system-guide.md) β€” clinical badge semantics diff --git a/docs/codebase-index.md b/docs/codebase-index.md index 8b06bdefb1..72fe2f8b50 100644 --- a/docs/codebase-index.md +++ b/docs/codebase-index.md @@ -9,28 +9,28 @@ Structured map for AI agents and onboarding. For live routes, see `docs/site-map ## Quick start -| Step | Command | -| --------------------------------- | -------------------------------- | -| Confirm Supabase target | `npm run check:supabase-project` | -| Start app (project-specific port) | `npm run ensure` | -| Start ingestion worker | `npm run worker` | -| Cheap verification gate | `npm run verify:cheap` | -| UI verification gate | `npm run verify:ui` | +| Step | Command | +| --------------------------------- | -------------------------------------------------------------------------------- | +| Confirm Supabase target | `npm run check:supabase-project` (provider-backed β€” needs explicit confirmation) | +| Start app (project-specific port) | `npm run ensure` | +| Start ingestion worker | `npm run worker` | +| Cheap verification gate | `npm run verify:cheap` | +| UI verification gate | `npm run verify:ui` | --- ## Top-level layout -| Path | Purpose | -| ----------- | ---------------------------------------------------------------- | -| `src/` | Next.js App Router UI, API routes, shared lib, components | -| `supabase/` | SQL migrations, schema mirror, Edge Functions, CLI config | -| `worker/` | Local ingestion worker (parse, OCR, chunk, embed, DB writes) | -| `scripts/` | CLI ops: reindex, eval, backfill, governance, dev-server helpers | -| `tests/` | Vitest unit (`*.test.ts`) + Playwright E2E (`ui-*.spec.ts`) | -| `docs/` | Runbooks, governance, search/RAG plans, generated sitemap | -| `public/` | Static assets (`public/llms.txt`) | -| `.github/` | CI workflows, PR template (clinical governance preflight) | +| Path | Purpose | +| ----------- | ------------------------------------------------------------------------------------------------------------------------------------------------------ | +| `src/` | Next.js App Router UI, API routes, shared lib, components | +| `supabase/` | SQL migrations, schema mirror, Edge Functions, CLI config | +| `worker/` | Local ingestion worker (parse, OCR, chunk, embed, DB writes) | +| `scripts/` | CLI ops: reindex, eval, backfill, governance, dev-server helpers | +| `tests/` | Vitest unit (`*.test.ts`) + Playwright E2E (`ui-*.spec.ts`) | +| `docs/` | Runbooks, governance, search/RAG plans, generated sitemap; design-system system of record is [`docs/design-system/README.md`](design-system/README.md) | +| `public/` | Static assets (`public/llms.txt`) | +| `.github/` | CI workflows, PR template (clinical governance preflight) | Smaller top-level directories that are easy to miss: diff --git a/docs/design-system-contract.md b/docs/design-system-contract.md index d69ff72c34..9e8ddff716 100644 --- a/docs/design-system-contract.md +++ b/docs/design-system-contract.md @@ -25,8 +25,8 @@ npm run check:icon-scale - **Tokens Only**: Raw CSS hex codes (e.g. `#007a78`, `#ffffff`), RGB/RGBA, HSL, and un-tokenized Tailwind color classes (e.g. `bg-white`, `text-slate-900`, `border-red-200`) are prohibited in components. - **Variable Syntax**: All colors must use CSS custom properties defined in `src/app/globals.css` with semantic purpose: - **Brand & Clinical Accent**: `var(--clinical-accent)`, `var(--clinical-accent-hover)`, `var(--clinical-accent-soft)`, `var(--clinical-accent-border)` - - **Surfaces & Borders**: `var(--surface)`, `var(--surface-subtle)`, `var(--surface-wash)`, `var(--surface-lux)`, `var(--border)`, `var(--border-subtle)` - - **Text Roles**: `var(--text)`, `var(--text-muted)`, `var(--text-heading)`, `var(--text-soft)` + - **Surfaces & Borders**: `var(--surface)`, `var(--surface-subtle)`, `var(--surface-wash)`, `var(--surface-lux)`, `var(--border)`, `var(--border-strong)`, `var(--border-lux)` + - **Text Roles**: `var(--text)`, `var(--text-muted)`, `var(--text-heading)`. `--text-soft` is decoration (`--decoration-soft`), not a text role. - **Status & Safety Triads**: `--success-*`, `--warning-*`, `--danger-*`, `--info-*` (reserved exclusively for clinical/system status). - **Focus Ring & Outlines**: `var(--focus)` for all keyboard and visible focus rings. - **Raw Color Exemptions**: Strict and enumerated in `RAW_COLOR_EXEMPTIONS` in `scripts/design-system-contract-utils.mjs` (e.g., globals token definitions, brand mark SVG builder, diagnostic visualizations, OpenGraph art, printable patient/factsheet paper). Medication record accent defaults (`#0f766e` in `src/lib/medications.ts` and `src/lib/medication-records.ts`) are a **scoped** exemption for the Postgres `accent` column default only β€” not a whole-file blank cheque, and not a mapping onto `--clinical-accent`. @@ -47,7 +47,7 @@ npm run check:icon-scale - **Elevation**: Monotonic numeric scale `var(--e0)` through `var(--e4)`. No raw `box-shadow` values. - **Edge Ownership**: Prohibits simultaneous `border-*` and `ring-*` styling on the same surface to prevent clipped or competing boundaries. -- **Motion Durations**: Transitions and animations must use standardized duration tokens (`var(--duration-fast)`, `var(--duration-normal)`) and respect `motion-reduce:`. Layout-property animation (e.g., width, height, padding) is disallowed except for explicitly audited phone-chrome transitions. +- **Motion Durations**: Transitions and animations must use standardized duration tokens (`var(--duration-fast)`, `var(--duration-base)`) and respect `motion-reduce:`. Layout-property animation (e.g., width, height, padding) is disallowed except for explicitly audited phone-chrome transitions. --- diff --git a/docs/design-system/ADOPTION.md b/docs/design-system/ADOPTION.md index 48c1667001..1a5a3fcb67 100644 --- a/docs/design-system/ADOPTION.md +++ b/docs/design-system/ADOPTION.md @@ -5,7 +5,7 @@ of truth is `adoption-contract.json`; the generated manifest and marked tables i must match it exactly. - **Date:** 12 August 2026 -- **Current state:** 54 visual references are locally registered; all 51 production page routes +- **Current state:** 55 visual references are locally registered; all 51 production page routes are owned across 14 surface families, with 59 route/component roots scanned; every declared root uses the v2 shell and has declared proof with no committed visual baseline. - **Phase 1 blockers resolved first, in their own commits:** `#207` ungrounded `AnswerState`, diff --git a/docs/design-system/COMPONENTS.md b/docs/design-system/COMPONENTS.md index 2d8b6f8852..097cf3f334 100644 --- a/docs/design-system/COMPONENTS.md +++ b/docs/design-system/COMPONENTS.md @@ -47,8 +47,9 @@ design-project publication or browser acceptance. _P1 reusable (specified in outline only):_ `Menu`/`Popover` Β· `KeyValue` Β· `AppliedFilters`/`FilterSheet` Β· `ResponsiveActionGroup` Β· `ScrollableStrip`/ `ScrollAffordance` Β· `SourceLink` Β· `Banner` Β· `CopyButton`/`CopyField` Β· -state family (`ErrorState`, `OfflineState`, `PermissionDeniedState`, `NotFoundState`, -`UnavailableState`). +state family (`OfflineState`, `PermissionDeniedState`, `NotFoundState`, +`UnavailableState`). `ErrorState` is built (`src/components/ui/error-state.tsx`) and +locally registered β€” it is not outline-only. `FilterBar` and `DataTable` are retired names, not future component contracts. Use a surface-owned filter pattern or the canonical `AccessibleTable`; do not revive either name. diff --git a/docs/design-system/DECISIONS.md b/docs/design-system/DECISIONS.md index 0ba432d847..dd8a28e5d7 100644 --- a/docs/design-system/DECISIONS.md +++ b/docs/design-system/DECISIONS.md @@ -147,7 +147,7 @@ source), flagged in SPEC Β§3 and cheap to veto mode-by-mode. ## C6 Β· Publication truth is source-derived; adoption truth is route-complete -**Chose.** The local design-sync registry contains 53 visual exports. Each row is derived from +**Chose.** The local design-sync registry contains 55 visual exports. Each row is derived from one real source file and requires an entry export, an exact TypeScript-checker-derived public `*Props` contract (or an explicit zero-prop root), a reference preview, and a direct publication test. `OverlayPortal`, `ToastProvider`, `useToast`, `AnswerState`, the answer helpers, and the diff --git a/docs/design-system/SPEC.md b/docs/design-system/SPEC.md index ef9c77870b..df28d32e9a 100644 --- a/docs/design-system/SPEC.md +++ b/docs/design-system/SPEC.md @@ -668,20 +668,21 @@ and adoption.** Status keys as in the header; "done" entries cite their commit. ### Phase 2 β€” values, split three ways -| PR | Contents | Status | -| --------------------------------- | ------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | -| PR 5a Β· Token values, no geometry | Colour, elevation, ink roles | **done** β€” `59e4c3dfc` landed the `--shadow-well` rename, the spine and status-mark families, and the dark `--clinical-chat-document` fix; the remaining ink-role deltas landed with PR 3 (`--text-placeholder`, eyebrows and placeholders off the decoration tier, the disabled encoding). The v2 light and dark blocks now declare the same colour roles, and the only raw colour literals left in `src/` are the two `#0f766e` accent defaults, which are **not** design tokens β€” see the note below | -| PR 5b Β· Tap 44β†’48 in `@theme` | The 426-site tap-call-site migration; contract-test pin update; visual QA pass; `--tap-min` becomes the alias | **done** β€” `--spacing-tap: 3rem` in `@theme`; `--tap-min` reduced to `var(--spacing-tap)`; 426 `*-tap` call sites moved; three pins flipped in the same commit; the phone composer keeps a written 44px exception below 431px (Β§4.10) | -| PR 5c Β· Radius step | Every `rounded-md` moves; its own visual diff | **done** β€” live `@theme --radius-md` 8px β†’ 10px, matching the v2 control rung and moving 243 `rounded-md` call sites; the 4px-grid pin now names both half-steps and asserts the two layers agree; 14 arbitrary radius literals absorbed onto the ladder (Β§4.6) | +| PR | Contents | Status | +| --------------------------------- | ------------------------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | +| PR 5a Β· Token values, no geometry | Colour, elevation, ink roles | **done** β€” `59e4c3dfc` landed the `--shadow-well` rename, the spine and status-mark families, and the dark `--clinical-chat-document` fix; the remaining ink-role deltas landed with PR 3 (`--text-placeholder`, eyebrows and placeholders off the decoration tier, the disabled encoding). The v2 light and dark blocks now declare the same colour roles. The two `#0f766e` accent defaults are scoped `RAW_COLOR_EXEMPTIONS`, so `rawColorLiterals` is **0** β€” they are data, not design tokens; see the note below | +| PR 5b Β· Tap 44β†’48 in `@theme` | The 426-site tap-call-site migration; contract-test pin update; visual QA pass; `--tap-min` becomes the alias | **done** β€” `--spacing-tap: 3rem` in `@theme`; `--tap-min` reduced to `var(--spacing-tap)`; 426 `*-tap` call sites moved; three pins flipped in the same commit; the phone composer keeps a written 44px exception below 431px (Β§4.10) | +| PR 5c Β· Radius step | Every `rounded-md` moves; its own visual diff | **done** β€” live `@theme --radius-md` 8px β†’ 10px, matching the v2 control rung and moving 243 `rounded-md` call sites; the 4px-grid pin now names both half-steps and asserts the two layers agree; 14 arbitrary radius literals absorbed onto the ladder (Β§4.6) | -**`#0f766e` is data, not a token.** The two remaining raw colour literals +**`#0f766e` is data, not a token.** The two `#0f766e` accent defaults (`src/lib/medications.ts`, `src/lib/medication-records.ts`) restate a Postgres column default (`accent text not null default '#0f766e'`) for a per-record, user-chosen accent colour. Changing the application default without migrating the database default would -diverge the two, so both stay. The raw-colour ratchet in -`scripts/design-system-contract-baseline.json` is a **ceiling, not a target**: it exists to -stop new literals appearing, and a value that is persisted data rather than design intent -is outside the token system entirely. +diverge the two, so both stay. They are a **scoped** `RAW_COLOR_EXEMPTIONS` entry, not +remaining debt: `scripts/design-system-contract-baseline.json` pins `rawColorLiterals` +at **0**. The ratchet is a **ceiling, not a target**: it exists to stop new literals +appearing, and a value that is persisted data rather than design intent is outside the +token system entirely. ### Phase 3 β€” safety structure diff --git a/docs/medication-interaction-lexicon-review.md b/docs/medication-interaction-lexicon-review.md index 4b55a200f9..377177274c 100644 --- a/docs/medication-interaction-lexicon-review.md +++ b/docs/medication-interaction-lexicon-review.md @@ -26,29 +26,29 @@ CRITICAL or HIGH. Start at the top β€” the table is sorted by severe usage. | Term | Matches these phrases | Rows | Severe | Resolves to | | -------------------------- | -------------------------------------------------------------------------------------------------------- | ---- | ------ | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | -| `nsaids` | nsaids, nsaid | 40 | 39 | **8** β€” Aspirin, Celecoxib, Diclofenac, Ibuprofen, Ketorolac, Meloxicam, Naproxen, Parecoxib | +| `nsaids` | nsaids, nsaid | 41 | 40 | **8** β€” Aspirin, Celecoxib, Diclofenac, Ibuprofen, Ketorolac, Meloxicam, Naproxen, Parecoxib | | `opioids` | opioids, opioid, opioid analgesia, opiates, full agonists | 35 | 35 | **13** β€” Buprenorphine (SL/depot), Buprenorphine + naloxone, Buprenorphine patch, Codeine, Fentanyl, Hydromorphone (IR/IV), Methadone, Morphine (IR/IV), Morphine SR / MR, Oxycodone IR, Oxycodone SR / MR, Tapentadol SR, Tramadol IR | | `benzodiazepines` | benzodiazepines, benzodiazepine, benzos, benzo | 32 | 32 | **8** β€” Alprazolam, Clonazepam, Diazepam, Lorazepam, Midazolam, Nitrazepam, Oxazepam, Temazepam | | `beta-blockers` | beta-blockers, beta blockers, beta-blocker, beta blocker, non-selective beta-blockers | 23 | 22 | **7** β€” Atenolol, Bisoprolol, Carvedilol, Labetalol, Metoprolol, Propranolol, Sotalol | +| `acei` | acei, aceis, ace inhibitors, ace inhibitor | 22 | 22 | **2** β€” Perindopril, Ramipril | | `ssris` | ssris, ssri | 22 | 20 | **6** β€” Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline | | `tcas` | tcas, tca, tricyclics, tricyclic antidepressants, anticholinergic tcas | 22 | 20 | **6** β€” Amitriptyline, Clomipramine, Dosulepin, Doxepin, Imipramine, Nortriptyline | -| `acei` | acei, aceis, ace inhibitors, ace inhibitor | 20 | 20 | **1** β€” Perindopril | +| `diuretics` | diuretics, diuretic | 20 | 19 | **6** β€” Amiloride, Eplerenone, Frusemide, Hydrochlorothiazide, Indapamide, Spironolactone | | `maois` | maois, maoi, monoamine oxidase inhibitors | 19 | 17 | **2** β€” Phenelzine, Tranylcypromine | -| `diuretics` | diuretics, diuretic | 18 | 17 | **6** β€” Amiloride, Eplerenone, Frusemide, Hydrochlorothiazide, Indapamide, Spironolactone | | `arbs` | arbs, arb | 16 | 16 | **1** β€” Candesartan | | `anticholinergics` | anticholinergics, anticholinergic, atropine-like medicines | 18 | 15 | **6** β€” Benzatropine, Hyoscine butylbromide, Hyoscine hydrobromide, Orphenadrine, Oxybutynin, Solifenacin | | `anticoagulants` | anticoagulants, anticoagulant, doacs, doac | 18 | 15 | **12** β€” Apixaban, Clopidogrel, Dabigatran, Dalteparin, Dipyridamole, Edoxaban, Enoxaparin, Heparin (IV/SC), Rivaroxaban, Ticagrelor, Warfarin (`warfarin-anticoagulant`), Warfarin (`warfarin-vka`) | | `antipsychotics` | antipsychotics, antipsychotic | 17 | 15 | **26** β€” Amisulpride, Aripiprazole, Aripiprazole LAI, Asenapine, Brexpiprazole, Cariprazine, Chlorpromazine, Clozapine, Flupentixol decanoate, Haloperidol decanoate, Levomepromazine, Lurasidone, Olanzapine (wafer/ODT), Olanzapine pamoate LAI, Paliperidone ER, Paliperidone LAI, Periciazine, Quetiapine, Risperidone, Risperidone LAI, Trifluoperazine, Ziprasidone, Ziprasidone IM, Zuclopenthixol, Zuclopenthixol acetate, Zuclopenthixol decanoate | | `antacids` | antacids, antacid | 16 | 14 | **2** β€” Calcium carbonate, Magnesium oxide | -| `antihypertensives` | antihypertensives, antihypertensive | 14 | 14 | **17** β€” Amlodipine, Atenolol, Bisoprolol, Candesartan, Carvedilol, Diltiazem, Eplerenone, Felodipine, Frusemide, Hydrochlorothiazide, Indapamide, Labetalol, Metoprolol, Nifedipine XR, Perindopril, Spironolactone, Verapamil | +| `antihypertensives` | antihypertensives, antihypertensive | 14 | 14 | **18** β€” Amlodipine, Atenolol, Bisoprolol, Candesartan, Carvedilol, Diltiazem, Eplerenone, Felodipine, Frusemide, Hydrochlorothiazide, Indapamide, Labetalol, Metoprolol, Nifedipine XR, Perindopril, Ramipril, Spironolactone, Verapamil | | `macrolides` | macrolides, macrolide | 13 | 12 | **4** β€” Azithromycin, Clarithromycin, Erythromycin, Roxithromycin | +| `lithium` | lithium, lithium carbonate | 10 | 10 | **1** β€” Lithium carbonate (IR/SR) | | `oral-contraceptives` | oral contraceptives, oral contraceptive, combined oral contraceptive pill, cocp, ocps, ocp | 10 | 9 | **2** β€” Ethinylestradiol, Levonorgestrel | | `calcium-channel-blockers` | calcium channel blockers, calcium channel blocker, ccbs, ccb, non-dhp ccbs, dhp calcium channel blockers | 9 | 9 | **5** β€” Amlodipine, Diltiazem, Felodipine, Nifedipine XR, Verapamil | | `corticosteroids` | corticosteroids, corticosteroid, steroids, steroid | 9 | 9 | **11** β€” Beclometasone, Budesonide, Ciclesonide, Dexamethasone, Fludrocortisone, Fluticasone, Hydrocortisone, Methylprednisolone, Mometasone, Prednisolone, Prednisone | -| `lithium` | lithium, lithium carbonate | 9 | 9 | **1** β€” Lithium carbonate (IR/SR) | | `thiazide-diuretics` | thiazide diuretics, thiazides, thiazide | 9 | 9 | **2** β€” Hydrochlorothiazide, Indapamide | | `ppis` | ppis, ppi, proton pump inhibitors | 8 | 8 | **2** β€” Esomeprazole, Pantoprazole | -| `statins` | statins, statin | 9 | 7 | **2** β€” Atorvastatin, Rosuvastatin | +| `statins` | statins, statin | 8 | 6 | **3** β€” Atorvastatin, Rosuvastatin, Simvastatin | | `aminoglycosides` | aminoglycosides, aminoglycoside | 6 | 5 | **2** β€” Amikacin, Gentamicin | | `fluoroquinolones` | fluoroquinolones, fluoroquinolone, quinolones | 5 | 5 | **3** β€” Ciprofloxacin, Moxifloxacin, Norfloxacin | | `loop-diuretics` | loop diuretics, loop diuretic | 5 | 5 | **1** β€” Frusemide | @@ -59,8 +59,8 @@ CRITICAL or HIGH. Start at the top β€” the table is sorted by severe usage. | `antiplatelets` | antiplatelets, antiplatelet | 3 | 3 | **4** β€” Aspirin, Clopidogrel, Dipyridamole, Ticagrelor | | `gabapentinoids` | gabapentinoids, gabapentinoid | 3 | 3 | **2** β€” Gabapentin, Pregabalin | | `immunosuppressants` | immunosuppressants, immunosuppressant | 2 | 2 | **1** β€” Methotrexate | -| `fibrates` | fibrates, fibrate | 2 | 1 | **1** β€” Fenofibrate | | `cephalosporins` | cephalosporins, cephalosporin | 1 | 1 | **5** β€” Cefazolin, Cefepime, Ceftriaxone, Cefuroxime, Cephalexin | +| `fibrates` | fibrates, fibrate | 1 | 0 | **1** β€” Fenofibrate | | `nrt` | transdermal nrt, nicotine transdermal systems, nicotine patches | 1 | 0 | **6** β€” Nicotine gum, Nicotine inhalator, Nicotine lozenge, Nicotine mouth spray, Nicotine patch, Nicotine sublingual tablet | | `sulfonylureas` | sulfonylureas, sulfonylurea | 1 | 0 | **2** β€” Gliclazide, Glipizide | @@ -92,16 +92,16 @@ the class cannot be enumerated, and holds the medication at grey rather than gre | Term | Kind | Matches these phrases | Rows | Note | | ------------------------ | --------- | --------------------------------------------------------------------------------------------------------------------------------- | ---- | -------------------------------------------------------------------------------------------------------- | | `alcohol` | nonDrug | alcohol, alcohol-containing preparations, ethanol | 33 | Substance use, not a prescribable catalogue entry. | -| `grapefruit` | nonDrug | grapefruit, grapefruit juice | 6 | Dietary CYP3A4 inhibitor. | +| `grapefruit` | nonDrug | grapefruit, grapefruit juice | 7 | Dietary CYP3A4 inhibitor. | | `acidic-drinks` | nonDrug | acidic drinks, coffee, juice, soft drinks, cola | 7 | Buccal/oral absorption timing, not a drug interaction. | | `smoking` | nonDrug | smoking, cigarette smoke, tobacco smoke | 7 | CYP1A2 induction by polycyclic aromatic hydrocarbons, not by nicotine. | | `food` | nonDrug | food, dairy, milk, high-fat meals, tyramine | 10 | Dietary. | | `st-johns-wort` | external | st john's wort, st johns wort, hypericum | 9 | Herbal CYP3A4 inducer; not stocked in the catalogue. | -| `azole-antifungals` | external | ketoconazole, azoles, azole antifungals | 23 | Ketoconazole is not in the catalogue; fluconazole/itraconazole resolve by name. | +| `azole-antifungals` | external | ketoconazole, azoles, azole antifungals | 24 | Ketoconazole is not in the catalogue; fluconazole/itraconazole resolve by name. | | `barbiturates` | external | barbiturates, barbiturate, phenobarbital, phenobarbitone | 5 | Not stocked in the catalogue. | | `antiretrovirals` | external | antiretrovirals, antiretroviral, protease inhibitors | 2 | Ritonavir and relatives are outside the catalogue. | | `cotrimoxazole` | external | bactrim, co-trimoxazole, cotrimoxazole | 3 | Combination product; trimethoprim resolves by name. | -| `cyp-inhibitors` | mechanism | cyp inhibitors, cyp inhibitor, strong cyp inhibitors, cyp3a4 inhibitors, cyp2d6 inhibitors, cyp1a2 inhibitors, cyp2c19 inhibitors | 50 | Enumerating inhibitors needs pharmacokinetic data the catalogue does not carry. | +| `cyp-inhibitors` | mechanism | cyp inhibitors, cyp inhibitor, strong cyp inhibitors, cyp3a4 inhibitors, cyp2d6 inhibitors, cyp1a2 inhibitors, cyp2c19 inhibitors | 51 | Enumerating inhibitors needs pharmacokinetic data the catalogue does not carry. | | `cyp-inducers` | mechanism | cyp inducers, cyp inducer, strong cyp inducers, cyp3a4 inducers, enzyme inducers | 9 | See cyp-inhibitors. | | `cyp-substrates` | mechanism | cyp substrates, cyp2d6 substrates, cyp3a4 substrates, narrow therapeutic index drugs | 1 | | | `pgp` | mechanism | p-gp, p-gp inhibitors, p-glycoprotein, oatp | 11 | | @@ -120,7 +120,7 @@ the class cannot be enumerated, and holds the medication at grey rather than gre ## What this tool can never warn about -**26 of the catalogue's 328 medications sit outside both ends of every resolved +**26 of the catalogue's 330 medications sit outside both ends of every resolved interaction row.** Entering one of them produces no alert β€” not because the combination was checked and found clear, but because no machine-resolved edge in the corpus includes that drug. On screen those outcomes look the same, so this list is the honest boundary of the feature. diff --git a/docs/outstanding-issues-inbox/39bc43fc-7bd7-4088-a7e4-4d29d3d418d5.json b/docs/outstanding-issues-inbox/39bc43fc-7bd7-4088-a7e4-4d29d3d418d5.json new file mode 100644 index 0000000000..6110f4dad2 --- /dev/null +++ b/docs/outstanding-issues-inbox/39bc43fc-7bd7-4088-a7e4-4d29d3d418d5.json @@ -0,0 +1,11 @@ +{ + "version": 2, + "id": "39bc43fc-7bd7-4088-a7e4-4d29d3d418d5", + "createdOn": "2026-08-27", + "action": "done", + "payload": { + "id": "#4AM8Z0", + "outcome": "Added Ramipril and Simvastatin to medication catalogue with full interaction, dosing, and contraindication profiles; rebuilt interaction index and asserted in tests/medication-badges.test.ts", + "baseRowFingerprint": "a420a3e9b005324b7821b8985f6d34c023ac76e78769771d64fb2c326e5a00c0" + } +} diff --git a/docs/outstanding-issues-inbox/44e5f87c-d30f-4334-9184-75c1544773ef.json b/docs/outstanding-issues-inbox/44e5f87c-d30f-4334-9184-75c1544773ef.json new file mode 100644 index 0000000000..5fc9396734 --- /dev/null +++ b/docs/outstanding-issues-inbox/44e5f87c-d30f-4334-9184-75c1544773ef.json @@ -0,0 +1,11 @@ +{ + "version": 2, + "id": "44e5f87c-d30f-4334-9184-75c1544773ef", + "createdOn": "2026-08-27", + "action": "done", + "payload": { + "id": "#PM9SP1", + "outcome": "Relabelled Therapy Compass copy from 'Decision support' to 'Source-grounded therapy reference' across workspace, screens, and app-modes", + "baseRowFingerprint": "755b6dd3772b192d15dd0aef89149aba50ae3b105fa627c9313388d4dce0dc86" + } +} diff --git a/docs/outstanding-issues-inbox/c66f01fb-e52a-40fa-a4b2-f4d1449ddb11.json b/docs/outstanding-issues-inbox/c66f01fb-e52a-40fa-a4b2-f4d1449ddb11.json new file mode 100644 index 0000000000..eccca32957 --- /dev/null +++ b/docs/outstanding-issues-inbox/c66f01fb-e52a-40fa-a4b2-f4d1449ddb11.json @@ -0,0 +1,11 @@ +{ + "version": 2, + "id": "c66f01fb-e52a-40fa-a4b2-f4d1449ddb11", + "createdOn": "2026-08-27", + "action": "done", + "payload": { + "id": "#DTSABC", + "outcome": "Authored Form 12A statutory Authority and Criteria prose from committed PDF and asserted in tests/forms.test.ts", + "baseRowFingerprint": "4407912b05d98be64cbf8c3604d4c19b076ff3b26d1890cb73663bd1f5c2e322" + } +} diff --git a/docs/process-hardening.md b/docs/process-hardening.md index 1124dc6269..3904585a72 100644 --- a/docs/process-hardening.md +++ b/docs/process-hardening.md @@ -648,7 +648,7 @@ passes `p_worker_id`. Ordered apply steps, R17 manual `CONCURRENTLY` index, and ## Design convergence & type-scale ratchet (2026-07-06) -- **`docs/design-system.md` is now the front door** for all UI work: token contract, type-scale rules, z-index ladder, Sheet-only modals, a11y requirements, and the UI Definition of Done. The `docs/redesign/*` documents remain the deep references it links to. +- **`docs/design-system/README.md` is now the front door** for all UI work: token contract, type-scale rules, z-index ladder, Sheet-only modals, a11y requirements, and the UI Definition of Done. [`docs/design-system.md`](./design-system.md) remains live-layer notes during the v1β†’v2 transition. The `docs/redesign/*` documents remain the deep references they link to. - **Type-scale ratchet β€” backlog cleared, gate now strict:** `node scripts/check-type-scale.mjs --strict` reports **0 hits / 0 files** (this pass retires the last 8 hits in 1 file; the prior recorded baseline was 20/9, originally 168/22). The compact mode-home hero now uses the shared fluid `--text-hero` scale; the temporary mode-home-only aliases were removed after confirming no consumers remained. `check:type-scale --strict` is wired into `verify:cheap` (package.json), so any newly introduced arbitrary `text-[px|rem|em]` size now fails the gate β€” UI PRs must keep the count at zero. Colour utilities (`text-[color:var(--…)]`) are the sanctioned token form and are not counted. - **Cleared this pass:** dead launcher mobile detail rows now expand (aria-expanded disclosures); launcher detail dialog migrated to the `Sheet` primitive (focus trap/return-focus restored); launcher filter tablists gained `aria-controls` + a `role="tabpanel"` results region; styled `src/app/not-found.tsx` added (the `notFound()` calls in differentials no longer fall through to the unstyled default); `?page=abc` NaN leak in the document viewer clamped; `/services` off-palette preview deleted (dead export) and the live navigator's residual hardcodes tokenized; launcher icon tones moved from raw Tailwind palette classes to categorical `--type-*` / semantic danger triads (dark-mode + forced-colors correct); mockups layout emits `robots: noindex`. diff --git a/docs/scripts-index.md b/docs/scripts-index.md index 36aa15bf0f..014025b991 100644 --- a/docs/scripts-index.md +++ b/docs/scripts-index.md @@ -49,7 +49,12 @@ migration has shipped (see `docs/maturity-backlog-workorders.md` L1). `check-maintainability-budgets.mjs`, `check-upload-limit-parity.mjs`, `check-codebase-index-coverage.mjs`, `check-docs-links.mjs`, `check-docs-script-refs.mjs`, `check-bundle-budget.mjs`, `check-type-scale.mjs`, -`check-icon-scale.mjs`, `check-design-system-contract.mjs`, `check-function-grants.mjs`, +`check-icon-scale.mjs`, `check-design-system-contract.mjs`, +`generate-design-system-adoption.mjs` (`npm run design-system:adoption:update` / +`check:design-system-adoption`), `generate-design-sync-contract.mjs` + +`check-design-sync-contract.mjs` (`npm run design-system:design-sync:update` / +`check:design-sync-contract`), `adopt-visual-baselines.mjs` +(`npm run design-system:baselines:adopt`), `check-function-grants.mjs`, `check-owner-scope-api.mjs`, `check-client-bundle-secrets.mjs`, `verify-pr-local.mjs`, `verify-release-offline.mjs`, `check-codex-cloud-setup.mjs`. `check-gate-manifest.mjs` cross-checks that every gate in the `verify:cheap:internal` chain also runs in CI's `static-pr` job, so the two lists can't drift. diff --git a/docs/testing.md b/docs/testing.md index 44ac18ea5c..7dcda78932 100644 --- a/docs/testing.md +++ b/docs/testing.md @@ -430,10 +430,10 @@ The scheduled `release-browser-matrix` workflow provides cross-engine regression Before opening a UI PR, confirm: - **Reuse first.** Check `src/components/ui-primitives.tsx` (class recipes plus `IconButton`, `AsyncButton`, `InlineNotice`, `EmptyState`, `LoadingPanel`, `ToggleSwitch`) and `src/components/ui/sheet.tsx` (the only overlay primitive) before hand-rolling. Icon-only buttons use `IconButton` (its `label` is a required prop). -- **Tokens only.** No raw hex or Tailwind palette classes, no literal shadows, no `text-[Npx]` β€” see [`docs/design-system.md`](./design-system.md) Β§1–§5. `check:design-system-contract`, `check:type-scale`, and `check:icon-scale` enforce this. +- **Tokens only.** No raw hex or Tailwind palette classes, no literal shadows, no `text-[Npx]` β€” see [`docs/design-system/README.md`](./design-system/README.md). `check:design-system-contract`, `check:type-scale`, and `check:icon-scale` enforce this. - **States.** Handle loading / empty / error / disabled where they apply; async surfaces expose a retry, not a dead end. -- **Accessibility** ([design-system Β§7](./design-system.md)): keyboard operable, visible focus, accessible names on icon controls, live regions for async status, and reduced motion honoured β€” scripted `scrollTo`/`scrollIntoView` go through `resolveScrollBehavior` (`src/lib/scroll-behavior.ts`), never a hard-coded `behavior: "smooth"`. +- **Accessibility** ([design-system](./design-system/README.md)): keyboard operable, visible focus, accessible names on icon controls, live regions for async status, and reduced motion honoured β€” scripted `scrollTo`/`scrollIntoView` go through `resolveScrollBehavior` (`src/lib/scroll-behavior.ts`), never a hard-coded `behavior: "smooth"`. - **Tests.** Add a `.dom.test.tsx` for changed component behaviour (see "Component tests" above) and update the E2E journeys for changed flows. - **Unlayered CSS.** If the change adds a class rule outside `@layer` that sets a border, background, colour, shadow or outline, `tests/style-contract-registry.test.ts` will fail until it is registered. Add a rendered-effect contract rather than an exemption where the rule matters visually β€” see "Visual regression and style contracts". -- **Verify** ([design-system Β§9](./design-system.md)): follow the risk tiers in root `AGENTS.md`. Prove changed component behaviour with the focused DOM test first; run `npm run ensure` before browser work and use the narrowest affected journey. Select one appropriate broad handoff gate when the diff crosses owners, cannot be bounded, or applicable PR/handoff policy requires it; do not routinely stack `verify:cheap`, `verify:pr-local`, and `verify:ui`. Add a manual dark-mode + forced-colors spot check when those rendered states can plausibly change. +- **Verify** ([design-system](./design-system/README.md) and GATES): follow the risk tiers in root `AGENTS.md`. Prove changed component behaviour with the focused DOM test first; run `npm run ensure` before browser work and use the narrowest affected journey. Select one appropriate broad handoff gate when the diff crosses owners, cannot be bounded, or applicable PR/handoff policy requires it; do not routinely stack `verify:cheap`, `verify:pr-local`, and `verify:ui`. Add a manual dark-mode + forced-colors spot check when those rendered states can plausibly change. - Architecture and state-ownership conventions: [`docs/frontend-architecture.md`](./frontend-architecture.md). diff --git a/public/therapy-compass-data/pathways.json b/public/therapy-compass-data/pathways.json index 66a7d0f9f3..c9b30cecab 100644 --- a/public/therapy-compass-data/pathways.json +++ b/public/therapy-compass-data/pathways.json @@ -1 +1 @@ -[{"slug":"anxiety-pathway","name":"Anxiety pathway","clinicalProblem":"Anxiety","summary":"Source-grounded workflow assembled from therapies indexed to Anxiety. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as decision support only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"cognitive-behavioural-therapy-cbt","label":"Initial option","description":"Strongest broad evidence-backed uses are depression and anxiety disorders. It is also a major umbrella treatment family for disorder-specific variants such as panic-focused CBT, social-anxiety CBT, CBT for insomnia, trauma-focused CBT, CBT for psychosis, and CBT-based interventions in substance use, eating disorders, and severe mental illness."},{"therapySlug":"graded-exposure","label":"Alternative option","description":"Most useful for phobic avoidance, panic disorder with avoidance, social anxiety disorder, and broader anxiety presentations where the main perpetuating factor is avoidance of feared situations rather than compulsions or trauma re-experiencing. NICE social-anxiety guidance specifically supports exposure to feared or avoided social situations within individual CBT."},{"therapySlug":"applied-relaxation-relaxation-based-therapy","label":"Alternative option","description":"Strongest formal guideline support is for generalised anxiety disorder, where NICE includes applied relaxation as a high-intensity psychological treatment option alongside CBT. It can also be a useful adjunct in broader anxiety care when body tension and rapid arousal are prominent."},{"therapySlug":"worry-focused-cbt","label":"Follow-up option","description":"Best for GAD or transdiagnostic presentations where worry is the dominant maintaining process rather than panic attacks, compulsions, trauma re-experiencing, or social evaluative fear. NICE recommends high-intensity CBT or applied relaxation for GAD when low-intensity options are insufficient or impairment is marked. (NICE)"},{"therapySlug":"panic-focused-cbt","label":"Follow-up option","description":"Best for panic disorder with or without agoraphobia, especially when recurrent panic attacks, bodily-sensation fear, anticipatory anxiety, and avoidance are central. NICE recommends low-intensity self-help for mild to moderate panic disorder and CBT for moderate to severe panic disorder. (NICE)"},{"therapySlug":"social-anxiety-focused-cbt","label":"Follow-up option","description":"Best for social anxiety disorder in adults, and developmentally adapted CBT for children and young people. NICE recommends individual CBT specifically developed for social anxiety disorder as the first intervention for adults, using Clark and Wells or Heimberg models. (NICE)"}]},{"slug":"crisis-risk-pathway","name":"Crisis/risk pathway","clinicalProblem":"Crisis/risk","summary":"Source-grounded workflow assembled from therapies indexed to Crisis/risk. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as decision support only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"crisis-intervention-crisis-oriented-brief-therapy","label":"Initial option","description":"Best for acute crisis presentations where the person needs immediate containment and a short practical intervention. Common settings include ED, crisis team, inpatient admission, CL psychiatry, urgent community review, post-self-harm follow-up, post-discharge vulnerability, and acute psychosocial crisis."},{"therapySlug":"cbt-informed-psychological-intervention-for-self-harm","label":"Alternative option","description":"Best for adults who self-harm and are receiving continuing support after an episode or repeated episodes. Especially high-yield in ED follow-up, community mental health, post-discharge planning, personality vulnerability, recurrent crisis presentations, mixed depression/anxiety/self-harm presentations, and patients where self-harm is linked to identifiable triggers or problem states."},{"therapySlug":"problem-solving-therapy-pst","label":"Alternative option","description":"Most useful for less severe depression, stress-linked depression, adjustment-related difficulty, executive overload, and patients whose distress is closely tied to unresolved current-life problems. It is especially high-yield when the person needs structure more than deep cognitive restructuring."},{"therapySlug":"dialectical-behaviour-therapy-dbt","label":"Follow-up option","description":"Best supported for borderline personality disorder / borderline personality symptoms, especially when recurrent self-harm is a major treatment priority. In current NICE guidance, for women with borderline personality disorder in whom reducing recurrent self-harm is a priority, clinicians should consider a comprehensive DBT programme. In broader contemporary practice, DBT is widely used across genders for comparable borderline-pathology and dysregulation presentations."},{"therapySlug":"coping-skills-interventions","label":"Follow-up option","description":"Best used as a low-intensity or adjunctive intervention for common mental health problems, subthreshold or mixed distress states, adjustment-related difficulty, stress-related functional decline, and as a bridge while waiting for or building toward more specific treatment. Particularly useful where the main task is teaching practical skills rather than deep formulation or disorder-specific exposure or processing work."},{"therapySlug":"brief-supportive-psychotherapy","label":"Follow-up option","description":"Best as a pragmatic short-term intervention in inpatient psychiatry, CL psychiatry, ED/crisis recovery, early engagement, post-discharge follow-up, adjustment to diagnosis, medical illness, grief/stress reactions, and bridging while waiting for more specific therapy. RANZCP identifies supportive psychotherapy as one of the forms of psychotherapy practised by psychiatrists, within psychotherapy as a core component of psychiatric treatment."}]},{"slug":"eating-body-image-pathway","name":"Eating/body image pathway","clinicalProblem":"Eating/body image","summary":"Source-grounded workflow assembled from therapies indexed to Eating/body image. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as decision support only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"eating-disorder-focused-cognitive-behavioural-therapy-cbt-ed-cbt-e","label":"Initial option","description":"Strongest current guideline-backed use is in adults with bulimia nervosa, adults with binge eating disorder, and as one of the main options for adults with anorexia nervosa. NICE recommends individual CBT-ED for adults with bulimia nervosa when guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks; group CBT-ED as the main treatment for adults with binge eating disorder, with individual CBT-ED if group CBT-ED is unavailable or declined; and individual CBT-ED as one of the treatment options for adults with anorexia nervosa alongside MANTRA and SSCM."},{"therapySlug":"family-based-treatment-for-adolescent-anorexia-nervosa-ft-an","label":"Alternative option","description":"Best used for children and young people with anorexia nervosa. NICE recommends anorexia-nervosa-focused family therapy (FT-AN) as the main first-line psychological treatment in this group."},{"therapySlug":"guided-self-help-for-binge-eating-disorder","label":"Alternative option","description":"Best used for adults with binge eating disorder as the initial psychological treatment step. NICE makes this a clear first-line recommendation."},{"therapySlug":"maudsley-anorexia-nervosa-treatment-for-adults-mantra","label":"Follow-up option","description":"Best supported for adults with anorexia nervosa. NICE recommends offering adults with anorexia one of CBT-ED, MANTRA, or SSCM, and explaining the options so the person can help choose their preferred treatment."},{"therapySlug":"specialist-supportive-clinical-management-sscm","label":"Follow-up option","description":"Best supported for adults with anorexia nervosa. NICE recommends offering adults one of CBT-ED, MANTRA, or SSCM and helping them choose by explaining what each involves."},{"therapySlug":"guided-self-help-for-bulimia-nervosa","label":"Follow-up option","description":"Best used for adults with bulimia nervosa as the first psychological treatment step to consider. NICE says to consider bulimia-nervosa-focused guided self-help for adults with bulimia nervosa."}]},{"slug":"grief-loss-pathway","name":"Grief/loss pathway","clinicalProblem":"Grief/loss","summary":"Source-grounded workflow assembled from therapies indexed to Grief/loss. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as decision support only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"interpersonal-psychotherapy-ipt","label":"Initial option","description":"Strongest routine use is depression, especially when symptoms are closely linked to bereavement, changing roles, interpersonal conflict, or isolation. NICE includes IPT as a treatment option for both less severe and more severe depression."},{"therapySlug":"meaning-centred-psychotherapy","label":"Alternative option","description":"Best-supported use is advanced cancer, serious illness, and palliative care, where RCTs and reviews suggest benefit for meaning, spiritual well-being, and existential distress. It is not a broadly guideline-dominant first-line psychotherapy across general psychiatric syndromes. (PubMed)"},{"therapySlug":"brief-supportive-psychotherapy","label":"Alternative option","description":"Best as a pragmatic short-term intervention in inpatient psychiatry, CL psychiatry, ED/crisis recovery, early engagement, post-discharge follow-up, adjustment to diagnosis, medical illness, grief/stress reactions, and bridging while waiting for more specific therapy. RANZCP identifies supportive psychotherapy as one of the forms of psychotherapy practised by psychiatrists, within psychotherapy as a core component of psychiatric treatment."},{"therapySlug":"life-review-therapy-reminiscence-therapy","label":"Follow-up option","description":"Best for older adults with depression/loneliness, dementia-care settings, aged care, palliative/CL psychiatry, and patients needing meaning, identity, continuity or life-story work. Reminiscence therapy has specific evidence in dementia, but effects vary by format and setting."},{"therapySlug":"dignity-therapy","label":"Follow-up option","description":"Best in palliative care, psycho-oncology, advanced illness, neurodegenerative disease, and CL psychiatry where existential distress, dignity, meaning, and legacy are central."},{"therapySlug":"emotion-focused-therapy","label":"Follow-up option","description":"Best for emotionally driven distress where maladaptive emotion processing is central, and especially for couple distress in the couples form. Meta-analyses support emotionally focused couples therapy for reducing couple distress and improving relationship satisfaction, with some maintenance of gains at follow-up. The broader individual EFT evidence base is more supportive than definitive, and much less guideline-prominent in psychiatry than CBT-family therapies. (PubMed)"}]},{"slug":"mood-pathway","name":"Mood pathway","clinicalProblem":"Mood","summary":"Source-grounded workflow assembled from therapies indexed to Mood. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as decision support only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"cognitive-behavioural-therapy-cbt","label":"Initial option","description":"Strongest broad evidence-backed uses are depression and anxiety disorders. It is also a major umbrella treatment family for disorder-specific variants such as panic-focused CBT, social-anxiety CBT, CBT for insomnia, trauma-focused CBT, CBT for psychosis, and CBT-based interventions in substance use, eating disorders, and severe mental illness."},{"therapySlug":"behavioural-activation-ba","label":"Alternative option","description":"Strongly indicated for depression, especially when inactivity, withdrawal, reduced routine, and loss of reinforcement are prominent. It may be particularly useful for patients who struggle with more cognitively demanding therapy models or who need a simpler, action-focused treatment."},{"therapySlug":"interpersonal-psychotherapy-ipt","label":"Alternative option","description":"Strongest routine use is depression, especially when symptoms are closely linked to bereavement, changing roles, interpersonal conflict, or isolation. NICE includes IPT as a treatment option for both less severe and more severe depression."},{"therapySlug":"problem-solving-therapy-pst","label":"Follow-up option","description":"Most useful for less severe depression, stress-linked depression, adjustment-related difficulty, executive overload, and patients whose distress is closely tied to unresolved current-life problems. It is especially high-yield when the person needs structure more than deep cognitive restructuring."},{"therapySlug":"mindfulness-based-cognitive-therapy-mbct","label":"Follow-up option","description":"Strongest guideline-backed use is relapse prevention in recurrent depression. NICE recommends group CBT or MBCT for people at higher risk of relapse, and also lists a mindfulness-based cognitive therapy programme specifically designed for depression as a treatment option in less severe depression."},{"therapySlug":"short-term-psychodynamic-psychotherapy-for-depression-stpp","label":"Follow-up option","description":"Best used for adult depression when relational-emotional patterns and developmental difficulties in close relationships are central. NICE includes STPP in first-line treatment options for adult depression, and the 2023 meta-analysis found STPP superior to no intervention and to usual unstructured treatments for depressive disorders."}]},{"slug":"neurodevelopmental-pathway","name":"Neurodevelopmental pathway","clinicalProblem":"Neurodevelopmental","summary":"Source-grounded workflow assembled from therapies indexed to Neurodevelopmental. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as decision support only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"behavioural-parent-training","label":"Initial option","description":"Best for oppositional defiant disorder, conduct disorder, disruptive behaviour, and children at high risk of conduct disorder. NICE states that parents or carers of children aged 3–11 years with conduct disorder should be offered referral for evidence-based group or individual parent/carer training programmes. (NICE)"},{"therapySlug":"parent-management-training-pmt","label":"Alternative option","description":"Best supported for children with clinical levels of disruptive behaviour, especially oppositional and conduct-type presentations in younger children. It overlaps heavily with NICE’s recommended parent training programmes because those are also built on a social learning model."},{"therapySlug":"social-communication-parent-mediated-autism-interventions","label":"Alternative option","description":"Best supported for children and young people with autism, especially preschool children where NICE says to consider parent, carer or teacher mediation, and for school-aged children where NICE says to consider peer mediation. This is the most direct current mainstream guideline recommendation for treating the core features of autism in children."},{"therapySlug":"developmental-social-skills-interventions","label":"Follow-up option","description":"Best for autistic children/young people and other developmental presentations where social communication is a clear functional target. In autism, NICE specifically supports social-communication interventions adjusted to developmental level and involving parents, carers, teachers, or peers. For adults, NICE supports group-based or individually delivered social learning programmes where social interaction problems are identified. (NICE)"},{"therapySlug":"neurodevelopmentally-adapted-psychosocial-interventions","label":"Follow-up option","description":"Best whenever a standard psychosocial therapy is clinically indicated but the person’s neurodevelopmental profile makes usual delivery ineffective or inaccessible. Core examples include adapted CBT for anxiety/depression, adapted ERP for OCD, adapted DBT skills, behavioural parent work, social-communication interventions, structured life-skills programmes, and functional behaviour support. NICE specifically recommends social-communication interventions for autistic children and young people and social learning or structured life-skills programmes for autistic adults where indicated. (NICE)"},{"therapySlug":"parent-child-interaction-therapy-pcit","label":"Follow-up option","description":"Best supported for young children with clinically significant disruptive behaviour problems. Meta-analysis found PCIT outperformed waitlist for parent-rated disruptive behaviour, with larger effects than PMT in the included comparisons, and a recent systematic review concluded PCIT reduces disruptive behaviours and improves parent–child relationships across diverse settings."}]},{"slug":"pain-somatic-pathway","name":"Pain/somatic pathway","clinicalProblem":"Pain/somatic","summary":"Source-grounded workflow assembled from therapies indexed to Pain/somatic. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as decision support only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"acceptance-and-commitment-therapy-act","label":"Initial option","description":"Most defensible routine psychiatric uses are depression, anxiety-spectrum distress, and broader transdiagnostic emotional disorders when avoidance and fusion are prominent. It also has a formal NICE recommendation for chronic primary pain. In Australian psychiatry, it is best understood as an accepted structured psychotherapy, but not one with as broad a first-line guideline footprint across disorders as standard CBT."},{"therapySlug":"cognitive-behavioural-therapy-cbt","label":"Alternative option","description":"Strongest broad evidence-backed uses are depression and anxiety disorders. It is also a major umbrella treatment family for disorder-specific variants such as panic-focused CBT, social-anxiety CBT, CBT for insomnia, trauma-focused CBT, CBT for psychosis, and CBT-based interventions in substance use, eating disorders, and severe mental illness."},{"therapySlug":"health-anxiety-focused-cbt","label":"Alternative option","description":"Best for persistent health anxiety where adequate medical assessment has not found an explanatory serious disease and the main maintaining mechanism is anxiety-driven misinterpretation and reassurance-seeking. A meta-analysis of 13 RCTs found CBT outperformed control conditions for hypochondriasis/health anxiety at post-treatment and follow-up. (PubMed)"},{"therapySlug":"mindfulness-based-stress-reduction","label":"Follow-up option","description":"Best as a structured mindfulness intervention for stress, depressive symptoms, and broader distress where mindfulness practice is acceptable and safe. Recent meta-analyses suggest benefit for depressive symptoms across mental disorders and for depression/PTSD in veteran samples, but MBSR is not generally a first-line substitute for more specific psychiatric psychotherapies such as ERP, TF-CBT, or comprehensive DBT. (PubMed)"},{"therapySlug":"applied-relaxation-relaxation-based-therapy","label":"Follow-up option","description":"Strongest formal guideline support is for generalised anxiety disorder, where NICE includes applied relaxation as a high-intensity psychological treatment option alongside CBT. It can also be a useful adjunct in broader anxiety care when body tension and rapid arousal are prominent."},{"therapySlug":"mindfulness-based-cognitive-therapy-mbct","label":"Follow-up option","description":"Strongest guideline-backed use is relapse prevention in recurrent depression. NICE recommends group CBT or MBCT for people at higher risk of relapse, and also lists a mindfulness-based cognitive therapy programme specifically designed for depression as a treatment option in less severe depression."}]},{"slug":"personality-interpersonal-pathway","name":"Personality/interpersonal pathway","clinicalProblem":"Personality/interpersonal","summary":"Source-grounded workflow assembled from therapies indexed to Personality/interpersonal. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as decision support only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"dialectical-behaviour-therapy-dbt","label":"Initial option","description":"Best supported for borderline personality disorder / borderline personality symptoms, especially when recurrent self-harm is a major treatment priority. In current NICE guidance, for women with borderline personality disorder in whom reducing recurrent self-harm is a priority, clinicians should consider a comprehensive DBT programme. In broader contemporary practice, DBT is widely used across genders for comparable borderline-pathology and dysregulation presentations."},{"therapySlug":"mentalisation-based-therapy-mbt","label":"Alternative option","description":"Best supported for borderline personality disorder and related severe personality dysfunction where attachment stress and relational misinterpretation are central. Unlike DBT, MBT is not specifically singled out in NICE BPD recommendations, but it is a recognised structured psychotherapy and has supportive trial and review evidence."},{"therapySlug":"schema-therapy","label":"Alternative option","description":"Strongest and clearest use is personality disorder, especially borderline personality disorder (BPD) and other chronic personality pathology. Current evidence suggests schema therapy is an effective specialist treatment for BPD, but NICE BPD guidance does not single it out by name in the way it mentions DBT for recurrent self-harm."},{"therapySlug":"structured-clinical-management","label":"Follow-up option","description":"Best for BPD/personality disorder in public-sector or general mental health settings where a structured, consistent, manualised clinical model is needed and specialist therapies may not be available. SCM has been used as a comparator in trials against MBT, with one trial describing it as protocol-driven best current clinical practice delivered by non-specialist practitioners in a publicly funded service. (SpringerLink)"},{"therapySlug":"good-psychiatric-management","label":"Follow-up option","description":"Best for borderline personality disorder or clinically significant borderline traits, especially in general psychiatric, community, outpatient, ED follow-up, CL, and public-sector settings where full DBT, MBT, schema therapy, or TFP is unavailable or not required. Recent literature describes GPM as β€œgood enough,” easier to implement, principle-based, and adaptable for stepped care. (PubMed)"},{"therapySlug":"transference-focused-psychotherapy-tfp","label":"Follow-up option","description":"Best supported for borderline personality disorder and closely related severe personality organisation. It is a specialist treatment option with supportive evidence from trials and reviews, but it is not specifically privileged by NICE in the way that DBT is mentioned for recurrent self-harm in women with BPD."}]},{"slug":"psychosis-pathway","name":"Psychosis pathway","clinicalProblem":"Psychosis","summary":"Source-grounded workflow assembled from therapies indexed to Psychosis. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as decision support only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"cognitive-behavioural-therapy-for-psychosis-cbtp","label":"Initial option","description":"Best supported for psychosis and schizophrenia, including people at increased risk of psychosis, first and subsequent acute episodes, and the recovery phase when positive or negative symptoms continue to affect distress or function. It is particularly useful when the clinical goal is to reduce distress and improve functioning rather than to β€œargue away” psychotic experiences."},{"therapySlug":"family-intervention-for-psychosis","label":"Alternative option","description":"Best supported for adults with psychosis or schizophrenia who live with or are in close contact with family members or carers. NICE quality standards state that family members of adults with psychosis or schizophrenia should be offered family intervention because it improves coping skills and relapse rates."},{"therapySlug":"psychoeducation-for-psychosis","label":"Alternative option","description":"Broadly useful across first-episode psychosis, established schizophrenia-spectrum illness, relapse prevention, discharge planning, rehabilitation, and self-management work. It is especially high-yield when the person needs a clearer model of symptoms, treatment, relapse risk, and what to do if symptoms worsen."},{"therapySlug":"cognitive-remediation-therapy-crt","label":"Follow-up option","description":"Best supported in rehabilitation for adults with complex psychosis, particularly when cognitive impairment is contributing to poor everyday function, educational difficulty, or problems engaging in vocational recovery. NICE specifically recommends considering cognitive remediation alongside vocational rehabilitation services."},{"therapySlug":"illness-management-and-recovery-style-interventions-imr-style-interventions","label":"Follow-up option","description":"Most useful in severe mental illness, especially schizophrenia-spectrum disorders and other long-term psychotic illnesses, when the clinical task is ongoing recovery and self-management rather than acute symptom containment alone. It fits best in rehabilitation and continuing community care."},{"therapySlug":"supported-employment-individual-placement-and-support-ips","label":"Follow-up option","description":"Best supported for psychosis / schizophrenia and complex psychosis rehabilitation when the person wants mainstream employment. NICE says that for people who want to work towards mainstream employment, clinicians should consider referral to supported employment using the IPS approach."}]},{"slug":"sleep-pathway","name":"Sleep pathway","clinicalProblem":"Sleep","summary":"Source-grounded workflow assembled from therapies indexed to Sleep. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as decision support only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"cognitive-behavioural-therapy-for-insomnia-cbt-i","label":"Initial option","description":"Best used for chronic insomnia disorder in adults of any age, including people with comorbid conditions. Current European and AASM guidance place CBT-I as first-line treatment, and Australian Sleep Health Foundation material states CBT-I is the recommended best first treatment in Australian practice."},{"therapySlug":"sleep-compression-therapy-for-insomnia","label":"Alternative option","description":"Best used for chronic insomnia disorder when the clinician wants the core logic of sleep restriction but in a more tolerable, gradual format. Current high-quality evidence suggests it may be a practical alternative when standard sleep restriction feels too harsh or is poorly tolerated."},{"therapySlug":"mindfulness-based-therapy-for-insomnia-mbti","label":"Alternative option","description":"Best viewed as an evidence-supported option for chronic insomnia, especially when arousal, worry, and reactive struggle with sleep are prominent. Current insomnia guidelines still place full CBT-I first-line, so MBTI should not be described as guideline-superior to CBT-I."},{"therapySlug":"imagery-rehearsal-therapy-irt-for-nightmare-disorder","label":"Follow-up option","description":"Best used for nightmare disorder in adults and for persistent distressing nightmares in broader psychiatric populations. The 2018 AASM position paper states IRT is the only treatment strategy recommended for all patients with nightmare disorder."},{"therapySlug":"bright-light-therapy","label":"Follow-up option","description":"Best as an adjunctive treatment for depressive disorders when a low-burden somatic option is attractive, especially where circadian disruption or preference for non-drug augmentation is relevant. The 2024 JAMA Psychiatry meta-analysis found significantly better remission and response rates with BLT in nonseasonal depressive disorders, but this is not the same as saying BLT should replace established first-line psychotherapy or pharmacotherapy. (JAMA Network)"},{"therapySlug":"circadian-rhythm-based-interventions","label":"Follow-up option","description":"Best-supported psychiatric uses are 2 main groups. First, bipolar disorder, where IPSRT has evidence as an adjunctive acute and prophylactic intervention addressing rhythm dysregulation. Second, depression, where circadian realignment and chronotherapeutic approaches, including wake-therapy-type interventions, show antidepressant potential, though the depression evidence is more heterogeneous and implementation-sensitive than for major established psychotherapies. (PubMed)"}]},{"slug":"substance-use-pathway","name":"Substance use pathway","clinicalProblem":"Substance use","summary":"Source-grounded workflow assembled from therapies indexed to Substance use. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as decision support only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"motivational-interviewing-mi-for-substance-use-disorders","label":"Initial option","description":"Best used at engagement, assessment, early treatment, and whenever motivation is unstable. It is especially useful for alcohol misuse, broader substance use disorders, and patients who are reluctant, unsure, or inconsistent in change efforts. NICE alcohol guidance makes motivational intervention universal at intake, and SAMHSA TIP 35 positions MI as a core SUD treatment approach for enhancing participation and retention."},{"therapySlug":"relapse-prevention-therapy-for-substance-use-disorders","label":"Alternative option","description":"Best used after initial motivation has improved and the patient is actively trying to reduce, stop, or maintain abstinence, especially in alcohol use disorder and broader substance use disorders. NICE alcohol guidance recommends offering community-based interventions to promote abstinence or moderate drinking and prevent relapse, and recommends CBT/behavioural therapies focused on alcohol-related problems."},{"therapySlug":"contingency-management-cm","label":"Alternative option","description":"Best used for stimulant use disorder, for illicit drug use in methadone maintenance, and for engagement / abstinence targets in drug services. NICE explicitly recommends introducing CM to reduce illicit drug use and/or promote engagement for people on methadone maintenance and for people who primarily misuse stimulants."},{"therapySlug":"community-reinforcement-approach","label":"Follow-up option","description":"Best for alcohol and other drug use disorders where lifestyle, reinforcement, social context, and recovery capital are central. Evidence is strongest historically for alcohol, cocaine, and opioid-related disorders, but it should be framed as one structured addiction therapy rather than a universal replacement for pharmacotherapy, withdrawal care, or contingency management. A systematic review found limited-to-moderate evidence for CRA, with or without medication or contingency management, across alcohol and substance-related disorders. (NCBI)"},{"therapySlug":"mindfulness-based-relapse-prevention-mbrp","label":"Follow-up option","description":"Best viewed as an adjunctive or selective relapse-prevention treatment for SUDs rather than a clearly dominant stand-alone first-line therapy. The 2025 systematic review and meta-analysis found small benefits for withdrawal/craving symptoms and negative consequences of substance use, but no statistically significant differences versus comparators for relapse, frequency of use, treatment dropout, depressive symptoms, anxiety symptoms, or mindfulness scores overall."},{"therapySlug":"twelve-step-facilitation-tsf","label":"Follow-up option","description":"The strongest evidence is for alcohol use disorder (AUD). A 2020 Cochrane review found AA/TSF was at least as effective as other established treatments and often better for continuous abstinence and remission over follow-up, with evidence of healthcare cost savings. It is more accurate to present TSF as especially evidence-supported for AUD than as equally established across all SUDs. (cochrane.org)"}]},{"slug":"trauma-pathway","name":"Trauma pathway","clinicalProblem":"Trauma","summary":"Source-grounded workflow assembled from therapies indexed to Trauma. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as decision support only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"trauma-focused-cognitive-behavioural-therapy-tf-cbt","label":"Initial option","description":"Strongest use is PTSD. It is also appropriate for clinically important post-traumatic symptoms after trauma, depending on timing, severity, and readiness. In Australian guidelines, TF-CBT, CPT, CT, and PE are all recommended adult PTSD treatments."},{"therapySlug":"eye-movement-desensitisation-and-reprocessing-emdr","label":"Alternative option","description":"For adults with PTSD, Phoenix Australia gives EMDR a strong recommendation. NICE recommends EMDR for adults with PTSD or clinically important PTSD symptoms more than 3 months after non-combat-related trauma, and suggests considering it between 1 and 3 months after non-combat trauma if the person prefers EMDR."},{"therapySlug":"cognitive-processing-therapy-cpt","label":"Alternative option","description":"Strongest use is PTSD. Australian guidelines give a strong recommendation for CPT in adults with PTSD. It is especially useful when maladaptive trauma meanings, guilt, shame, and self-blame are central."},{"therapySlug":"prolonged-exposure-pe","label":"Follow-up option","description":"Strongest use is PTSD in adults. Phoenix Australia gives a strong recommendation for PE in adult PTSD. NICE also includes prolonged exposure therapy within recommended adult trauma-focused CBT interventions."},{"therapySlug":"narrative-exposure-therapy-net","label":"Follow-up option","description":"In Australian PTSD guidelines, NET has a conditional recommendation for adults with PTSD where trauma is linked to genocide, civil conflict, torture, political detention, or displacement. It is best understood as a selective trauma therapy, not a universal first-line PTSD treatment alongside TF-CBT, CT, CPT, PE, or EMDR."},{"therapySlug":"written-exposure-therapy","label":"Follow-up option","description":"Best as a brief trauma-focused PTSD treatment option when a concise, lower-burden exposure-based therapy is needed. Current VA/DoD guidance places WET as a second-line PTSD psychotherapy, not above PE, CPT, or EMDR. It is not currently included in NICE or Phoenix Australia PTSD guideline recommendations, so in Australian practice it should be framed as promising and evidence-supported internationally, but not yet an Australian first-line guideline therapy."}]}] \ No newline at end of file +[{"slug":"anxiety-pathway","name":"Anxiety pathway","clinicalProblem":"Anxiety","summary":"Source-grounded workflow assembled from therapies indexed to Anxiety. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as source-grounded therapy reference only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"cognitive-behavioural-therapy-cbt","label":"Initial option","description":"Strongest broad evidence-backed uses are depression and anxiety disorders. It is also a major umbrella treatment family for disorder-specific variants such as panic-focused CBT, social-anxiety CBT, CBT for insomnia, trauma-focused CBT, CBT for psychosis, and CBT-based interventions in substance use, eating disorders, and severe mental illness."},{"therapySlug":"graded-exposure","label":"Alternative option","description":"Most useful for phobic avoidance, panic disorder with avoidance, social anxiety disorder, and broader anxiety presentations where the main perpetuating factor is avoidance of feared situations rather than compulsions or trauma re-experiencing. NICE social-anxiety guidance specifically supports exposure to feared or avoided social situations within individual CBT."},{"therapySlug":"applied-relaxation-relaxation-based-therapy","label":"Alternative option","description":"Strongest formal guideline support is for generalised anxiety disorder, where NICE includes applied relaxation as a high-intensity psychological treatment option alongside CBT. It can also be a useful adjunct in broader anxiety care when body tension and rapid arousal are prominent."},{"therapySlug":"worry-focused-cbt","label":"Follow-up option","description":"Best for GAD or transdiagnostic presentations where worry is the dominant maintaining process rather than panic attacks, compulsions, trauma re-experiencing, or social evaluative fear. NICE recommends high-intensity CBT or applied relaxation for GAD when low-intensity options are insufficient or impairment is marked. (NICE)"},{"therapySlug":"panic-focused-cbt","label":"Follow-up option","description":"Best for panic disorder with or without agoraphobia, especially when recurrent panic attacks, bodily-sensation fear, anticipatory anxiety, and avoidance are central. NICE recommends low-intensity self-help for mild to moderate panic disorder and CBT for moderate to severe panic disorder. (NICE)"},{"therapySlug":"social-anxiety-focused-cbt","label":"Follow-up option","description":"Best for social anxiety disorder in adults, and developmentally adapted CBT for children and young people. NICE recommends individual CBT specifically developed for social anxiety disorder as the first intervention for adults, using Clark and Wells or Heimberg models. (NICE)"}]},{"slug":"crisis-risk-pathway","name":"Crisis/risk pathway","clinicalProblem":"Crisis/risk","summary":"Source-grounded workflow assembled from therapies indexed to Crisis/risk. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as source-grounded therapy reference only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"crisis-intervention-crisis-oriented-brief-therapy","label":"Initial option","description":"Best for acute crisis presentations where the person needs immediate containment and a short practical intervention. Common settings include ED, crisis team, inpatient admission, CL psychiatry, urgent community review, post-self-harm follow-up, post-discharge vulnerability, and acute psychosocial crisis."},{"therapySlug":"cbt-informed-psychological-intervention-for-self-harm","label":"Alternative option","description":"Best for adults who self-harm and are receiving continuing support after an episode or repeated episodes. Especially high-yield in ED follow-up, community mental health, post-discharge planning, personality vulnerability, recurrent crisis presentations, mixed depression/anxiety/self-harm presentations, and patients where self-harm is linked to identifiable triggers or problem states."},{"therapySlug":"problem-solving-therapy-pst","label":"Alternative option","description":"Most useful for less severe depression, stress-linked depression, adjustment-related difficulty, executive overload, and patients whose distress is closely tied to unresolved current-life problems. It is especially high-yield when the person needs structure more than deep cognitive restructuring."},{"therapySlug":"dialectical-behaviour-therapy-dbt","label":"Follow-up option","description":"Best supported for borderline personality disorder / borderline personality symptoms, especially when recurrent self-harm is a major treatment priority. In current NICE guidance, for women with borderline personality disorder in whom reducing recurrent self-harm is a priority, clinicians should consider a comprehensive DBT programme. In broader contemporary practice, DBT is widely used across genders for comparable borderline-pathology and dysregulation presentations."},{"therapySlug":"coping-skills-interventions","label":"Follow-up option","description":"Best used as a low-intensity or adjunctive intervention for common mental health problems, subthreshold or mixed distress states, adjustment-related difficulty, stress-related functional decline, and as a bridge while waiting for or building toward more specific treatment. Particularly useful where the main task is teaching practical skills rather than deep formulation or disorder-specific exposure or processing work."},{"therapySlug":"brief-supportive-psychotherapy","label":"Follow-up option","description":"Best as a pragmatic short-term intervention in inpatient psychiatry, CL psychiatry, ED/crisis recovery, early engagement, post-discharge follow-up, adjustment to diagnosis, medical illness, grief/stress reactions, and bridging while waiting for more specific therapy. RANZCP identifies supportive psychotherapy as one of the forms of psychotherapy practised by psychiatrists, within psychotherapy as a core component of psychiatric treatment."}]},{"slug":"eating-body-image-pathway","name":"Eating/body image pathway","clinicalProblem":"Eating/body image","summary":"Source-grounded workflow assembled from therapies indexed to Eating/body image. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as source-grounded therapy reference only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"eating-disorder-focused-cognitive-behavioural-therapy-cbt-ed-cbt-e","label":"Initial option","description":"Strongest current guideline-backed use is in adults with bulimia nervosa, adults with binge eating disorder, and as one of the main options for adults with anorexia nervosa. NICE recommends individual CBT-ED for adults with bulimia nervosa when guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks; group CBT-ED as the main treatment for adults with binge eating disorder, with individual CBT-ED if group CBT-ED is unavailable or declined; and individual CBT-ED as one of the treatment options for adults with anorexia nervosa alongside MANTRA and SSCM."},{"therapySlug":"family-based-treatment-for-adolescent-anorexia-nervosa-ft-an","label":"Alternative option","description":"Best used for children and young people with anorexia nervosa. NICE recommends anorexia-nervosa-focused family therapy (FT-AN) as the main first-line psychological treatment in this group."},{"therapySlug":"guided-self-help-for-binge-eating-disorder","label":"Alternative option","description":"Best used for adults with binge eating disorder as the initial psychological treatment step. NICE makes this a clear first-line recommendation."},{"therapySlug":"maudsley-anorexia-nervosa-treatment-for-adults-mantra","label":"Follow-up option","description":"Best supported for adults with anorexia nervosa. NICE recommends offering adults with anorexia one of CBT-ED, MANTRA, or SSCM, and explaining the options so the person can help choose their preferred treatment."},{"therapySlug":"specialist-supportive-clinical-management-sscm","label":"Follow-up option","description":"Best supported for adults with anorexia nervosa. NICE recommends offering adults one of CBT-ED, MANTRA, or SSCM and helping them choose by explaining what each involves."},{"therapySlug":"guided-self-help-for-bulimia-nervosa","label":"Follow-up option","description":"Best used for adults with bulimia nervosa as the first psychological treatment step to consider. NICE says to consider bulimia-nervosa-focused guided self-help for adults with bulimia nervosa."}]},{"slug":"grief-loss-pathway","name":"Grief/loss pathway","clinicalProblem":"Grief/loss","summary":"Source-grounded workflow assembled from therapies indexed to Grief/loss. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as source-grounded therapy reference only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"interpersonal-psychotherapy-ipt","label":"Initial option","description":"Strongest routine use is depression, especially when symptoms are closely linked to bereavement, changing roles, interpersonal conflict, or isolation. NICE includes IPT as a treatment option for both less severe and more severe depression."},{"therapySlug":"meaning-centred-psychotherapy","label":"Alternative option","description":"Best-supported use is advanced cancer, serious illness, and palliative care, where RCTs and reviews suggest benefit for meaning, spiritual well-being, and existential distress. It is not a broadly guideline-dominant first-line psychotherapy across general psychiatric syndromes. (PubMed)"},{"therapySlug":"brief-supportive-psychotherapy","label":"Alternative option","description":"Best as a pragmatic short-term intervention in inpatient psychiatry, CL psychiatry, ED/crisis recovery, early engagement, post-discharge follow-up, adjustment to diagnosis, medical illness, grief/stress reactions, and bridging while waiting for more specific therapy. RANZCP identifies supportive psychotherapy as one of the forms of psychotherapy practised by psychiatrists, within psychotherapy as a core component of psychiatric treatment."},{"therapySlug":"life-review-therapy-reminiscence-therapy","label":"Follow-up option","description":"Best for older adults with depression/loneliness, dementia-care settings, aged care, palliative/CL psychiatry, and patients needing meaning, identity, continuity or life-story work. Reminiscence therapy has specific evidence in dementia, but effects vary by format and setting."},{"therapySlug":"dignity-therapy","label":"Follow-up option","description":"Best in palliative care, psycho-oncology, advanced illness, neurodegenerative disease, and CL psychiatry where existential distress, dignity, meaning, and legacy are central."},{"therapySlug":"emotion-focused-therapy","label":"Follow-up option","description":"Best for emotionally driven distress where maladaptive emotion processing is central, and especially for couple distress in the couples form. Meta-analyses support emotionally focused couples therapy for reducing couple distress and improving relationship satisfaction, with some maintenance of gains at follow-up. The broader individual EFT evidence base is more supportive than definitive, and much less guideline-prominent in psychiatry than CBT-family therapies. (PubMed)"}]},{"slug":"mood-pathway","name":"Mood pathway","clinicalProblem":"Mood","summary":"Source-grounded workflow assembled from therapies indexed to Mood. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as source-grounded therapy reference only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"cognitive-behavioural-therapy-cbt","label":"Initial option","description":"Strongest broad evidence-backed uses are depression and anxiety disorders. It is also a major umbrella treatment family for disorder-specific variants such as panic-focused CBT, social-anxiety CBT, CBT for insomnia, trauma-focused CBT, CBT for psychosis, and CBT-based interventions in substance use, eating disorders, and severe mental illness."},{"therapySlug":"behavioural-activation-ba","label":"Alternative option","description":"Strongly indicated for depression, especially when inactivity, withdrawal, reduced routine, and loss of reinforcement are prominent. It may be particularly useful for patients who struggle with more cognitively demanding therapy models or who need a simpler, action-focused treatment."},{"therapySlug":"interpersonal-psychotherapy-ipt","label":"Alternative option","description":"Strongest routine use is depression, especially when symptoms are closely linked to bereavement, changing roles, interpersonal conflict, or isolation. NICE includes IPT as a treatment option for both less severe and more severe depression."},{"therapySlug":"problem-solving-therapy-pst","label":"Follow-up option","description":"Most useful for less severe depression, stress-linked depression, adjustment-related difficulty, executive overload, and patients whose distress is closely tied to unresolved current-life problems. It is especially high-yield when the person needs structure more than deep cognitive restructuring."},{"therapySlug":"mindfulness-based-cognitive-therapy-mbct","label":"Follow-up option","description":"Strongest guideline-backed use is relapse prevention in recurrent depression. NICE recommends group CBT or MBCT for people at higher risk of relapse, and also lists a mindfulness-based cognitive therapy programme specifically designed for depression as a treatment option in less severe depression."},{"therapySlug":"short-term-psychodynamic-psychotherapy-for-depression-stpp","label":"Follow-up option","description":"Best used for adult depression when relational-emotional patterns and developmental difficulties in close relationships are central. NICE includes STPP in first-line treatment options for adult depression, and the 2023 meta-analysis found STPP superior to no intervention and to usual unstructured treatments for depressive disorders."}]},{"slug":"neurodevelopmental-pathway","name":"Neurodevelopmental pathway","clinicalProblem":"Neurodevelopmental","summary":"Source-grounded workflow assembled from therapies indexed to Neurodevelopmental. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as source-grounded therapy reference only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"behavioural-parent-training","label":"Initial option","description":"Best for oppositional defiant disorder, conduct disorder, disruptive behaviour, and children at high risk of conduct disorder. NICE states that parents or carers of children aged 3–11 years with conduct disorder should be offered referral for evidence-based group or individual parent/carer training programmes. (NICE)"},{"therapySlug":"parent-management-training-pmt","label":"Alternative option","description":"Best supported for children with clinical levels of disruptive behaviour, especially oppositional and conduct-type presentations in younger children. It overlaps heavily with NICE’s recommended parent training programmes because those are also built on a social learning model."},{"therapySlug":"social-communication-parent-mediated-autism-interventions","label":"Alternative option","description":"Best supported for children and young people with autism, especially preschool children where NICE says to consider parent, carer or teacher mediation, and for school-aged children where NICE says to consider peer mediation. This is the most direct current mainstream guideline recommendation for treating the core features of autism in children."},{"therapySlug":"developmental-social-skills-interventions","label":"Follow-up option","description":"Best for autistic children/young people and other developmental presentations where social communication is a clear functional target. In autism, NICE specifically supports social-communication interventions adjusted to developmental level and involving parents, carers, teachers, or peers. For adults, NICE supports group-based or individually delivered social learning programmes where social interaction problems are identified. (NICE)"},{"therapySlug":"neurodevelopmentally-adapted-psychosocial-interventions","label":"Follow-up option","description":"Best whenever a standard psychosocial therapy is clinically indicated but the person’s neurodevelopmental profile makes usual delivery ineffective or inaccessible. Core examples include adapted CBT for anxiety/depression, adapted ERP for OCD, adapted DBT skills, behavioural parent work, social-communication interventions, structured life-skills programmes, and functional behaviour support. NICE specifically recommends social-communication interventions for autistic children and young people and social learning or structured life-skills programmes for autistic adults where indicated. (NICE)"},{"therapySlug":"parent-child-interaction-therapy-pcit","label":"Follow-up option","description":"Best supported for young children with clinically significant disruptive behaviour problems. Meta-analysis found PCIT outperformed waitlist for parent-rated disruptive behaviour, with larger effects than PMT in the included comparisons, and a recent systematic review concluded PCIT reduces disruptive behaviours and improves parent–child relationships across diverse settings."}]},{"slug":"pain-somatic-pathway","name":"Pain/somatic pathway","clinicalProblem":"Pain/somatic","summary":"Source-grounded workflow assembled from therapies indexed to Pain/somatic. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as source-grounded therapy reference only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"acceptance-and-commitment-therapy-act","label":"Initial option","description":"Most defensible routine psychiatric uses are depression, anxiety-spectrum distress, and broader transdiagnostic emotional disorders when avoidance and fusion are prominent. It also has a formal NICE recommendation for chronic primary pain. In Australian psychiatry, it is best understood as an accepted structured psychotherapy, but not one with as broad a first-line guideline footprint across disorders as standard CBT."},{"therapySlug":"cognitive-behavioural-therapy-cbt","label":"Alternative option","description":"Strongest broad evidence-backed uses are depression and anxiety disorders. It is also a major umbrella treatment family for disorder-specific variants such as panic-focused CBT, social-anxiety CBT, CBT for insomnia, trauma-focused CBT, CBT for psychosis, and CBT-based interventions in substance use, eating disorders, and severe mental illness."},{"therapySlug":"health-anxiety-focused-cbt","label":"Alternative option","description":"Best for persistent health anxiety where adequate medical assessment has not found an explanatory serious disease and the main maintaining mechanism is anxiety-driven misinterpretation and reassurance-seeking. A meta-analysis of 13 RCTs found CBT outperformed control conditions for hypochondriasis/health anxiety at post-treatment and follow-up. (PubMed)"},{"therapySlug":"mindfulness-based-stress-reduction","label":"Follow-up option","description":"Best as a structured mindfulness intervention for stress, depressive symptoms, and broader distress where mindfulness practice is acceptable and safe. Recent meta-analyses suggest benefit for depressive symptoms across mental disorders and for depression/PTSD in veteran samples, but MBSR is not generally a first-line substitute for more specific psychiatric psychotherapies such as ERP, TF-CBT, or comprehensive DBT. (PubMed)"},{"therapySlug":"applied-relaxation-relaxation-based-therapy","label":"Follow-up option","description":"Strongest formal guideline support is for generalised anxiety disorder, where NICE includes applied relaxation as a high-intensity psychological treatment option alongside CBT. It can also be a useful adjunct in broader anxiety care when body tension and rapid arousal are prominent."},{"therapySlug":"mindfulness-based-cognitive-therapy-mbct","label":"Follow-up option","description":"Strongest guideline-backed use is relapse prevention in recurrent depression. NICE recommends group CBT or MBCT for people at higher risk of relapse, and also lists a mindfulness-based cognitive therapy programme specifically designed for depression as a treatment option in less severe depression."}]},{"slug":"personality-interpersonal-pathway","name":"Personality/interpersonal pathway","clinicalProblem":"Personality/interpersonal","summary":"Source-grounded workflow assembled from therapies indexed to Personality/interpersonal. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as source-grounded therapy reference only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"dialectical-behaviour-therapy-dbt","label":"Initial option","description":"Best supported for borderline personality disorder / borderline personality symptoms, especially when recurrent self-harm is a major treatment priority. In current NICE guidance, for women with borderline personality disorder in whom reducing recurrent self-harm is a priority, clinicians should consider a comprehensive DBT programme. In broader contemporary practice, DBT is widely used across genders for comparable borderline-pathology and dysregulation presentations."},{"therapySlug":"mentalisation-based-therapy-mbt","label":"Alternative option","description":"Best supported for borderline personality disorder and related severe personality dysfunction where attachment stress and relational misinterpretation are central. Unlike DBT, MBT is not specifically singled out in NICE BPD recommendations, but it is a recognised structured psychotherapy and has supportive trial and review evidence."},{"therapySlug":"schema-therapy","label":"Alternative option","description":"Strongest and clearest use is personality disorder, especially borderline personality disorder (BPD) and other chronic personality pathology. Current evidence suggests schema therapy is an effective specialist treatment for BPD, but NICE BPD guidance does not single it out by name in the way it mentions DBT for recurrent self-harm."},{"therapySlug":"structured-clinical-management","label":"Follow-up option","description":"Best for BPD/personality disorder in public-sector or general mental health settings where a structured, consistent, manualised clinical model is needed and specialist therapies may not be available. SCM has been used as a comparator in trials against MBT, with one trial describing it as protocol-driven best current clinical practice delivered by non-specialist practitioners in a publicly funded service. (SpringerLink)"},{"therapySlug":"good-psychiatric-management","label":"Follow-up option","description":"Best for borderline personality disorder or clinically significant borderline traits, especially in general psychiatric, community, outpatient, ED follow-up, CL, and public-sector settings where full DBT, MBT, schema therapy, or TFP is unavailable or not required. Recent literature describes GPM as β€œgood enough,” easier to implement, principle-based, and adaptable for stepped care. (PubMed)"},{"therapySlug":"transference-focused-psychotherapy-tfp","label":"Follow-up option","description":"Best supported for borderline personality disorder and closely related severe personality organisation. It is a specialist treatment option with supportive evidence from trials and reviews, but it is not specifically privileged by NICE in the way that DBT is mentioned for recurrent self-harm in women with BPD."}]},{"slug":"psychosis-pathway","name":"Psychosis pathway","clinicalProblem":"Psychosis","summary":"Source-grounded workflow assembled from therapies indexed to Psychosis. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as source-grounded therapy reference only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"cognitive-behavioural-therapy-for-psychosis-cbtp","label":"Initial option","description":"Best supported for psychosis and schizophrenia, including people at increased risk of psychosis, first and subsequent acute episodes, and the recovery phase when positive or negative symptoms continue to affect distress or function. It is particularly useful when the clinical goal is to reduce distress and improve functioning rather than to β€œargue away” psychotic experiences."},{"therapySlug":"family-intervention-for-psychosis","label":"Alternative option","description":"Best supported for adults with psychosis or schizophrenia who live with or are in close contact with family members or carers. NICE quality standards state that family members of adults with psychosis or schizophrenia should be offered family intervention because it improves coping skills and relapse rates."},{"therapySlug":"psychoeducation-for-psychosis","label":"Alternative option","description":"Broadly useful across first-episode psychosis, established schizophrenia-spectrum illness, relapse prevention, discharge planning, rehabilitation, and self-management work. It is especially high-yield when the person needs a clearer model of symptoms, treatment, relapse risk, and what to do if symptoms worsen."},{"therapySlug":"cognitive-remediation-therapy-crt","label":"Follow-up option","description":"Best supported in rehabilitation for adults with complex psychosis, particularly when cognitive impairment is contributing to poor everyday function, educational difficulty, or problems engaging in vocational recovery. NICE specifically recommends considering cognitive remediation alongside vocational rehabilitation services."},{"therapySlug":"illness-management-and-recovery-style-interventions-imr-style-interventions","label":"Follow-up option","description":"Most useful in severe mental illness, especially schizophrenia-spectrum disorders and other long-term psychotic illnesses, when the clinical task is ongoing recovery and self-management rather than acute symptom containment alone. It fits best in rehabilitation and continuing community care."},{"therapySlug":"supported-employment-individual-placement-and-support-ips","label":"Follow-up option","description":"Best supported for psychosis / schizophrenia and complex psychosis rehabilitation when the person wants mainstream employment. NICE says that for people who want to work towards mainstream employment, clinicians should consider referral to supported employment using the IPS approach."}]},{"slug":"sleep-pathway","name":"Sleep pathway","clinicalProblem":"Sleep","summary":"Source-grounded workflow assembled from therapies indexed to Sleep. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as source-grounded therapy reference only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"cognitive-behavioural-therapy-for-insomnia-cbt-i","label":"Initial option","description":"Best used for chronic insomnia disorder in adults of any age, including people with comorbid conditions. Current European and AASM guidance place CBT-I as first-line treatment, and Australian Sleep Health Foundation material states CBT-I is the recommended best first treatment in Australian practice."},{"therapySlug":"sleep-compression-therapy-for-insomnia","label":"Alternative option","description":"Best used for chronic insomnia disorder when the clinician wants the core logic of sleep restriction but in a more tolerable, gradual format. Current high-quality evidence suggests it may be a practical alternative when standard sleep restriction feels too harsh or is poorly tolerated."},{"therapySlug":"mindfulness-based-therapy-for-insomnia-mbti","label":"Alternative option","description":"Best viewed as an evidence-supported option for chronic insomnia, especially when arousal, worry, and reactive struggle with sleep are prominent. Current insomnia guidelines still place full CBT-I first-line, so MBTI should not be described as guideline-superior to CBT-I."},{"therapySlug":"imagery-rehearsal-therapy-irt-for-nightmare-disorder","label":"Follow-up option","description":"Best used for nightmare disorder in adults and for persistent distressing nightmares in broader psychiatric populations. The 2018 AASM position paper states IRT is the only treatment strategy recommended for all patients with nightmare disorder."},{"therapySlug":"bright-light-therapy","label":"Follow-up option","description":"Best as an adjunctive treatment for depressive disorders when a low-burden somatic option is attractive, especially where circadian disruption or preference for non-drug augmentation is relevant. The 2024 JAMA Psychiatry meta-analysis found significantly better remission and response rates with BLT in nonseasonal depressive disorders, but this is not the same as saying BLT should replace established first-line psychotherapy or pharmacotherapy. (JAMA Network)"},{"therapySlug":"circadian-rhythm-based-interventions","label":"Follow-up option","description":"Best-supported psychiatric uses are 2 main groups. First, bipolar disorder, where IPSRT has evidence as an adjunctive acute and prophylactic intervention addressing rhythm dysregulation. Second, depression, where circadian realignment and chronotherapeutic approaches, including wake-therapy-type interventions, show antidepressant potential, though the depression evidence is more heterogeneous and implementation-sensitive than for major established psychotherapies. (PubMed)"}]},{"slug":"substance-use-pathway","name":"Substance use pathway","clinicalProblem":"Substance use","summary":"Source-grounded workflow assembled from therapies indexed to Substance use. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as source-grounded therapy reference only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"motivational-interviewing-mi-for-substance-use-disorders","label":"Initial option","description":"Best used at engagement, assessment, early treatment, and whenever motivation is unstable. It is especially useful for alcohol misuse, broader substance use disorders, and patients who are reluctant, unsure, or inconsistent in change efforts. NICE alcohol guidance makes motivational intervention universal at intake, and SAMHSA TIP 35 positions MI as a core SUD treatment approach for enhancing participation and retention."},{"therapySlug":"relapse-prevention-therapy-for-substance-use-disorders","label":"Alternative option","description":"Best used after initial motivation has improved and the patient is actively trying to reduce, stop, or maintain abstinence, especially in alcohol use disorder and broader substance use disorders. NICE alcohol guidance recommends offering community-based interventions to promote abstinence or moderate drinking and prevent relapse, and recommends CBT/behavioural therapies focused on alcohol-related problems."},{"therapySlug":"contingency-management-cm","label":"Alternative option","description":"Best used for stimulant use disorder, for illicit drug use in methadone maintenance, and for engagement / abstinence targets in drug services. NICE explicitly recommends introducing CM to reduce illicit drug use and/or promote engagement for people on methadone maintenance and for people who primarily misuse stimulants."},{"therapySlug":"community-reinforcement-approach","label":"Follow-up option","description":"Best for alcohol and other drug use disorders where lifestyle, reinforcement, social context, and recovery capital are central. Evidence is strongest historically for alcohol, cocaine, and opioid-related disorders, but it should be framed as one structured addiction therapy rather than a universal replacement for pharmacotherapy, withdrawal care, or contingency management. A systematic review found limited-to-moderate evidence for CRA, with or without medication or contingency management, across alcohol and substance-related disorders. (NCBI)"},{"therapySlug":"mindfulness-based-relapse-prevention-mbrp","label":"Follow-up option","description":"Best viewed as an adjunctive or selective relapse-prevention treatment for SUDs rather than a clearly dominant stand-alone first-line therapy. The 2025 systematic review and meta-analysis found small benefits for withdrawal/craving symptoms and negative consequences of substance use, but no statistically significant differences versus comparators for relapse, frequency of use, treatment dropout, depressive symptoms, anxiety symptoms, or mindfulness scores overall."},{"therapySlug":"twelve-step-facilitation-tsf","label":"Follow-up option","description":"The strongest evidence is for alcohol use disorder (AUD). A 2020 Cochrane review found AA/TSF was at least as effective as other established treatments and often better for continuous abstinence and remission over follow-up, with evidence of healthcare cost savings. It is more accurate to present TSF as especially evidence-supported for AUD than as equally established across all SUDs. (cochrane.org)"}]},{"slug":"trauma-pathway","name":"Trauma pathway","clinicalProblem":"Trauma","summary":"Source-grounded workflow assembled from therapies indexed to Trauma. Marked incomplete until clinician review confirms sequencing.","cautions":"Use as source-grounded therapy reference only. Confirm acuity, risk, patient preference, and local service capability.","incomplete":true,"reviewStatus":"needs_review","steps":[{"therapySlug":"trauma-focused-cognitive-behavioural-therapy-tf-cbt","label":"Initial option","description":"Strongest use is PTSD. It is also appropriate for clinically important post-traumatic symptoms after trauma, depending on timing, severity, and readiness. In Australian guidelines, TF-CBT, CPT, CT, and PE are all recommended adult PTSD treatments."},{"therapySlug":"eye-movement-desensitisation-and-reprocessing-emdr","label":"Alternative option","description":"For adults with PTSD, Phoenix Australia gives EMDR a strong recommendation. NICE recommends EMDR for adults with PTSD or clinically important PTSD symptoms more than 3 months after non-combat-related trauma, and suggests considering it between 1 and 3 months after non-combat trauma if the person prefers EMDR."},{"therapySlug":"cognitive-processing-therapy-cpt","label":"Alternative option","description":"Strongest use is PTSD. Australian guidelines give a strong recommendation for CPT in adults with PTSD. It is especially useful when maladaptive trauma meanings, guilt, shame, and self-blame are central."},{"therapySlug":"prolonged-exposure-pe","label":"Follow-up option","description":"Strongest use is PTSD in adults. Phoenix Australia gives a strong recommendation for PE in adult PTSD. NICE also includes prolonged exposure therapy within recommended adult trauma-focused CBT interventions."},{"therapySlug":"narrative-exposure-therapy-net","label":"Follow-up option","description":"In Australian PTSD guidelines, NET has a conditional recommendation for adults with PTSD where trauma is linked to genocide, civil conflict, torture, political detention, or displacement. It is best understood as a selective trauma therapy, not a universal first-line PTSD treatment alongside TF-CBT, CT, CPT, PE, or EMDR."},{"therapySlug":"written-exposure-therapy","label":"Follow-up option","description":"Best as a brief trauma-focused PTSD treatment option when a concise, lower-burden exposure-based therapy is needed. Current VA/DoD guidance places WET as a second-line PTSD psychotherapy, not above PE, CPT, or EMDR. It is not currently included in NICE or Phoenix Australia PTSD guideline recommendations, so in Australian practice it should be framed as promising and evidence-supported internationally, but not yet an Australian first-line guideline therapy."}]}] \ No newline at end of file diff --git a/scripts/build-medication-interaction-index.ts b/scripts/build-medication-interaction-index.ts index e480388189..9945165ef8 100644 --- a/scripts/build-medication-interaction-index.ts +++ b/scripts/build-medication-interaction-index.ts @@ -60,6 +60,16 @@ type IndexRow = { counterparties: string[]; termIds: string[]; resolved: boolean; + /** + * Groups of slugs where the row's alert requires at least one member from + * EVERY group to be present in the patient's list, not merely any one + * `counterparties` entry. Populated only for rows whose prose joins classes + * with a literal "+" ("ACEi + Diuretic + NSAID") β€” the corpus's own convention + * for a required combination, distinct from the comma/list style used + * everywhere else for a plain either-of counterparty set. Absent (or empty) + * for every other row, which keeps existing any-of behaviour unchanged. + */ + requiredGroups?: string[][]; /** * Verbatim `row.val`. * @@ -227,6 +237,7 @@ function main(): void { const severity = bareAbsence ?? (severityToken ? (SEVERITY_BY_TOKEN[severityToken] ?? "unknown") : "unknown"); const counterparties = new Map(); const termIds = new Set(); + const requiredGroups: string[][] = []; let sawClassifiableTerm = false; for (const segment of segments) { @@ -259,6 +270,8 @@ function main(): void { for (const id of segmentTermIds) termIds.add(id); for (const [slug, target] of segmentCounterparties) counterparties.set(slug, target); } + + requiredGroups.push(...extractRequiredGroups(segment, record.slug)); } const hasUnenumeratedMechanism = Array.from(termIds).some((id) => UNENUMERATED_MECHANISM_TERM_IDS.has(id)); @@ -278,12 +291,72 @@ function main(): void { termIds: Array.from(termIds).sort(), resolved, note: value, + ...(requiredGroups.length > 0 ? { requiredGroups: requiredGroups.map((group) => group.sort()) } : {}), }); }); } if (rows.length > 0) bySlug[record.slug] = { rows, unresolvedRowCount: rows.filter((row) => !row.resolved).length }; } + /** + * "ACEi + Diuretic + NSAID" style rows ("Triple Whammy" and its relatives) + * name a required COMBINATION, not an either-of list β€” the corpus marks that + * with a literal "+" between classes, distinct from the comma/list style used + * for genuine either-of counterparty sets elsewhere. Splitting on "+" and + * resolving each clause independently turns that combination back into + * separate required groups instead of the flat union `segmentCounterparties` + * would otherwise produce, which let any ONE class (an NSAID alone, a + * diuretic alone, or even another ACEi) fire the full combination alert. + * + * A clause naming only the source drug's own class (ramipril's row saying + * "ACEi") is dropped rather than turned into a group: that class is already + * supplied by the source drug, so it is not a further requirement. This + * self-exclusion is deliberately local to conjunction-group extraction β€” + * `addTermTargets`'s ordinary either-of matching is untouched, because a + * source drug that is itself a class member very often legitimately warns + * about OTHER members of that same class (an opioid's own row warning about + * other opioids, a benzodiazepine's row warning about other benzodiazepines). + * Excluding the class there would silently drop those real alerts; it is + * safe only here, where "+" already marks the mention as naming a required + * combination rather than an independent either-of counterparty. + * + * Fewer than two resolvable clauses means there is nothing to require beyond + * the existing any-of `counterparties` set, so no groups are returned. + */ + function extractRequiredGroups(segment: string, sourceSlug: string): string[][] { + // Require whitespace on both sides of the "+": "ACEi + Diuretic" is the + // combination marker, but ionic/charge notation like "Fe3+" or "K+-sparing" + // has no surrounding space and must not be split into spurious clauses. + const clauses = segment + .split(/\s+\+\s+/) + .map((clause) => clause.trim()) + .filter(Boolean); + if (clauses.length < 2) return []; + + const groups: string[][] = []; + for (const clause of clauses) { + const target = new Map(); + for (const { surface, term } of LEXICON_SURFACES_BY_LENGTH) { + if (term.kind !== "catalogue") continue; + if (!mentions(clause, surface)) continue; + if (term.sourceDenySlugs?.includes(sourceSlug)) continue; + const slugs = termSlugs.get(term.id) ?? []; + if (slugs.includes(sourceSlug)) continue; + for (const slug of slugs) { + if (slug === sourceSlug || target.has(slug)) continue; + target.set(slug, { slug, name: nameBySlug.get(slug) ?? slug, via: term.id }); + } + } + for (const { surface, slug } of drugSurfaces) { + if (slug === sourceSlug || !mentions(clause, surface)) continue; + if ((nameBySlug.get(slug) ?? slug) === (nameBySlug.get(sourceSlug) ?? sourceSlug)) continue; + if (!target.has(slug)) target.set(slug, { slug, name: nameBySlug.get(slug) ?? slug, via: surface }); + } + if (target.size > 0) groups.push(Array.from(target.keys())); + } + return groups.length >= 2 ? groups : []; + } + function addTermTargets(term: LexiconTerm, into: Map, sourceSlug: string): void { if (term.kind !== "catalogue") return; for (const slug of termSlugs.get(term.id) ?? []) { diff --git a/scripts/generate-site-map.ts b/scripts/generate-site-map.ts index ea25868d3c..f12ff25fa4 100644 --- a/scripts/generate-site-map.ts +++ b/scripts/generate-site-map.ts @@ -144,7 +144,7 @@ const routeDescriptions: Record = { "/specifiers/builder": "Structured diagnostic wording builder.", "/specifiers/compare": "Side-by-side psychiatric specifier comparison.", "/specifiers/map": "Psychiatric specifier family map.", - "/therapy-compass": "Therapy home (source-grounded therapy decision support).", + "/therapy-compass": "Therapy home (source-grounded therapy reference).", "/therapy-compass/[slug]": "Therapy record detail.", "/therapy-compass/[slug]/brief": "Therapy brief-intervention view.", "/therapy-compass/[slug]/sheet": "Therapy patient-sheet builder.", diff --git a/src/components/therapy-compass/screens/brief-screen.tsx b/src/components/therapy-compass/screens/brief-screen.tsx index 392dc29df6..8c8ce58818 100644 --- a/src/components/therapy-compass/screens/brief-screen.tsx +++ b/src/components/therapy-compass/screens/brief-screen.tsx @@ -10,11 +10,12 @@ import { Button } from "@/components/ui/button"; import { Tabs } from "@/components/ui/tabs"; import { BrowserPrintButton, PrintOutput } from "@/components/ui/print-output"; import { cn } from "@/components/ui-primitives"; -import { therapyRecordHref } from "@/lib/therapy-compass-navigation"; +import { therapyRecordHref, type TherapyBriefDuration } from "@/lib/therapy-compass-navigation"; import { useTcBindings } from "../bindings"; import { InteractiveRow } from "@/components/ui/interactive-row"; import { parseSteps, summarise } from "../data/select"; +import type { Therapy } from "../data/types"; import { LoadingState } from "../ui"; import { useClipboard } from "../use-clipboard"; import { TherapyCompareAction } from "../record/compare-action"; @@ -29,6 +30,20 @@ const CHECKLIST = [ "Confirm patient-facing language", ]; +const BRIEF_DURATION: Record string | null }> = { + "5min": { label: "5-minute", text: (therapy) => therapy.briefVersion }, + "15min": { + label: "15-minute", + text: (therapy) => therapy.fifteenMinuteVersion || therapy.fullSessionVersion || therapy.briefVersion, + }, + ground: { + label: "Grounding", + text: (therapy) => + therapy.clinicianScripts.find((script) => /ground|relax|distress/i.test(`${script.scriptType} ${script.title}`)) + ?.body || therapy.briefVersion, + }, +}; + export function BriefScreen() { const b = useTcBindings(); const t = b.selectedTherapy; @@ -47,14 +62,9 @@ export function BriefScreen() { const { notice, saved, toggleFavourite } = useTherapyFavourite(t?.slug ?? null); if (b.loading || !t) return ; - const durationLabel = b.briefTab === "15min" ? "15-minute" : b.briefTab === "ground" ? "Grounding" : "5-minute"; - const durationText = - b.briefTab === "15min" - ? t.fifteenMinuteVersion || t.fullSessionVersion || t.briefVersion - : b.briefTab === "ground" - ? t.clinicianScripts.find((c) => /ground|relax|distress/i.test(`${c.scriptType} ${c.title}`))?.body || - t.briefVersion - : t.briefVersion; + const duration = BRIEF_DURATION[b.briefTab as TherapyBriefDuration] ?? BRIEF_DURATION["5min"]; + const durationLabel = duration.label; + const durationText = duration.text(t); const steps = parseSteps(durationText, 6); const interventionText = [ `${t.name} β€” ${durationLabel} intervention`, @@ -135,9 +145,8 @@ export function BriefScreen() {