P. 1
ANAMNESE PSICOLÓGICA

ANAMNESE PSICOLÓGICA

5.0

|Views: 48.702|Likes:
Publicado porRute Raquel

More info:

Published by: Rute Raquel on Jun 09, 2011
Direitos Autorais:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as DOC, PDF, TXT or read online from Scribd
See more
See less

04/12/2015

pdf

text

original

ANAMNESE PSICOLÓGICA

Identificação
Nome do filho(a) __________________________________________________
Sexo ______________ Idade _______ ano! _______ me!e! A"elido _______
Na!cimento ______________________ Nacionalidade ___________________
E!cola#idade _______________ S$#ie _________ Pe#%odo ________________
E!cola __________________________________________________________
Ende#eço (da e!cola) ______________________________________________
&' (iliação
Pai _____________________________________________ Idade __________
P#ofi!!ão ________________________ Nacionalidade ___________________
Mãe ____________________________________________ Idade __________
P#ofi!!ão ________________________ Nacionalidade ___________________
Ende#eço ________________________________________________________
)ai##o ____________________________ (one *e!' _____________________
*eli+ião _________________________________________________________
Indicação do t#atamento ____________________________________________
Indicação do nome do "#ofi!!ional ____________________________________
Info#maç,e! Com"lementa#e!
A mãe t#a-alha fo#a. ____ /0#no _____ com 10em fica a c#iança.________
O0t#a! "e!!oa! 10e #e!idem na ca!a
______________________________________________________________
Motivo da consulta
- 20eixa
________________________________________________________________
________________________________________________________________
3
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
- 4i!t5#ia de 10eixa (10ando e em 10e ci#c0n!t6ncia começo07 como !e
de!en8ol8e0)
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
- /#atamento(!) ante#io#(e!)
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Antecedentes Pessoais:
a) Conce"ção
A c#iança foi de!e9ada. __________
O-!e#8aç,e! _____________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
&
-) Ge!tação
Como a mãe e!ta8a emocionalmente. __________________________________
________________________________________________________________
/e8e com"licaç,e! o#+6nica!. Em 10e m:!. ____________________________
/#a0mati!mo. ____________________________________________________
c) Pa#to
Mate#nidade ______________________________________________________
Como fo#am ;! &< ho#a! ante#io#e! (mãe) e ;! &< ho#a! "o!te#io#e! (mãe e c#iança) no
"a#to.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Condiç,e! do "a#to no#mal ( ) ce!=#ea ( )
tem"o __________ "#ecoce > 10anto me!e!
________
tamanho ________ "e!o _________
O-!e#8aç,e! _____________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
d) ?e!en8ol8imento
3> Alimentação
lact:ncia mate#na. ________________ (ca!o não) Po# 10e. ________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
@
Como aceito0 alimento! !5lido!. _____________________________________
20ando na!ce#am o! "#imei#o! dente!. ________________________________
/em "#o-lema! de alimentação at0almente. 20ai!. _______________________
________________________________________________________________
________________________________________________________________
20al a atit0de da fam%lia. ___________________________________________
________________________________________________________________
O-!e#8aç,e! _____________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Sono
Como foi o !ono de!de "e10eno. _____________________________________
________________________________________________________________
4o08e $"oca em 10e melho#o0 o0 "io#o0. ________ 20ando. _____________
________________________________________________________________
________________________________________________________________
At0almente7 como $ o !ono. _________________________________________
________________________________________________________________
20al a atit0de do! "ai!. ____________________________________________
________________________________________________________________
________________________________________________________________
O-!e#8aç,e! _____________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
?e!en8ol8imento moto#
20ando !0!tento0 a ca-eça. ________________ Sento0. __________________
<
En+atinho0. __________ (ico0 em "$. ______________ Ando0. ___________
?ific0ldade! no de!en8ol8imento tend:ncia a cai#. ___________ a mach0ca#>!e.
______ +ol"ea8a>!e. _______ ?ific0ldade! em mani"0la# o-9eto!. _______
O0t#a!. ___________ ?ific0ldade! at0ai! ____________________________
________________________________________________________________
20al a atit0de do! "ai!. _____________________________________________
Late#alidade _____________________________________________________
O-!e#8aç,e! _____________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
A' Cont#ole de e!f%ncte#e!
a) 20ando deixo0 a! f#alda!. ________________________________________
______________________________________________________________
-) A"#endiBa+em do 0!o de "inico. ___________________________________
______________________________________________________________
c) Como foi feito. (com facilidade7 ca!ti+o!). ______________________
________________________________________________________
________
20em feB o cont#ole. _____________ Com 10e idade. ____________________
Ce!ical di0#no. __________________ anal di0#no. ______________________
Ce!ical not0#no. _________________ anal not0#no. _____________________
O-!e#8aç,e! _____________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
D' Lin+0a+em
20ando falo0 a! "#imei#a! "ala8#a!. ____________ 20ai! fo#am. ___________
________________________________________________________________
E
P#o-lema! de fala. 20ai!. ___________________________________________
_________________________________________________________________
?e!de 10ando. ____________________________________________________
20al a atit0de do! "ai!. _____________________________________________
________________________________________________________________
O-!e#8aç,e! _____________________________________________________
________________________________________________________________
________________________________________________________________
- Socia-ilidade
/em ami+o!. ________ 20e idade. ___________ Como $ o #elacionamento
com ele!. ______________________________________________________
_______________________________________________________________
20e ti"o de -#incadei#a! "#efe#e. ____________________________________
_______________________________________________________________
Como !e com"o#ta com ad0lto!. ____________________________________
_______________________________________________________________
20al a atit0de familia#. ____________________________________________
_______________________________________________________________
O-!e#8aç,e! ____________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
E!cola#idade
G#a0 de In!t#0ção _____ E!cola __________________________________
Leit0#a ( ) -em ( ) #e+0la# ( ) ma0 E!c#ita ( ) -em ( ) #e+0la# ( ) ma0
?ific0ldade de a"#endiBa+em ____ di!ci"lina! _______________________
F= foi #e"#o8ado _____ 20anta! 8eBe! _____ Atit0de tomada _________
20e e!cola(!) f#e1Gento0. ___________________________________________
________________________________________________________________
A
Com 10e idade in+#e!!o0._______ /e8e "#o-lema! em !e ada"ta# ; e!cola.
20ai!.
________________________________________________________________
________________________________________________________________
A"#e!ento0 dific0ldade! at0almente7 10ando ao #endimento e!cola#. _________
________________________________________________________________
________________________________________________________________
________________________________________________________________
20al o com"o#tamento. ____________________________________________
________________________________________________________________
O 10e diB a "#ofe!!o#a. _____________________________________________
________________________________________________________________
20al a atit0de do! "ai!. _____________________________________________
________________________________________________________________
O-!e#8aç,e! _____________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
- Sex0alidade
Manife!ta c0#io!idade !ex0al. __________ 20e "e#+0nta faB. _____________
_______________________________________________________________
20al a atit0de do! "ai!.____________________________________________
_______________________________________________________________
/e8e o#ientação. Po# "a#te de 10em. _________________________________
_______________________________________________________________
Ma!t0#-a>!e. _______ )#incadei#a! !ex0ai! com o0t#a! c#iança!. __________
20ai!. _________________________________________________________
20al a atit0de do! "ai!. ___________________________________________
D
________________________________________________________________
________________________________________________________________
- Mani"0lação e ti10e!
H!o0 ch0"eta. _______ at$ 10ando. __________ Ch0"a8a o dedo. ________
At$ 10ando. _________ A"#e!enta o0t#a! mani"0laç,e!. 20ai!. ___________
________________________________________________________________
________________________________________________________________
/i10e!. _________________________________________________________
20al a atit0de do! "ai!. ____________________________________________
O-!e#8aç,e! ____________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
(o#ma! de *eaç,e! (;! o#den!7 ;! "#oi-iç,e!7 f#0!t#aç,e!7 #elacionamento diante
e!t#anho!7 defende>!e7 etc')
________________________________________________________________
________________________________________________________________
________________________________________________________________
/#aço! de Pe#!onalidade (/%mida7 in10ieta7 hi"e#ati8a7 #et#a%da7 !aliente7 am=8el7 etc')
- ?oença!
?oença! infanti! (10ai! e em 10e idade). _______________________________
________________________________________________________________
O"e#aç,e! (10ai! e em 10e idade). ____________________________________
________________________________________________________________
/#a0mati!mo7 10eda! (idade). ________________________________________
________________________________________________________________
?e!maio!7 a0!:ncia! (idade) _________________________________________
________________________________________________________________
I
/em al+0ma doença at0almente. ________ 20al. ________________________
________________________________________________________________
E!t= !endo t#atado. ________________________________________________
O-!e#8aç,e! _____________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Antecedente! (amilia#e!
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Exame P!%10ico ( ci#c0n!t6ncia de atendimento7 a"a#:ncia7 "!icomot#icidade7 h0mo#7
"en!amento7 o#ientação7 mem5#ia7 8ontade7 #a""o#t7 etc')
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
*elato E!"ont6neo
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
J

como se - desenvolveu): ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ - Tratamento(s) anterior(es): ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Antecedentes Pessoais: a) Concepção: A criança foi desejada? __________ Observações: _____________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ .2 ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ História de queixa (quando e em que circunstância começou.

You're Reading a Free Preview

Descarregar
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->