ANAMNESE ADULTO

Data do atendimento: ____________________

1 – IDENTIFICAÇÃO:

Nome: ________________________________________________________________________
Idade: _____________ Sexo: __________________ Nacionalidade: ______________________
Estado Civil: ______________________ Data de nascimento:___________________________
Grau de instrução:_______________________________________________________________
Profissão:______________________________________________________________________
Residência (Cidade/Estado): ______________________________________________________
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Telefones para contado: _________________________________________________________

2 – ATENDIMENTO:

Frequência:______________________________ Data/hora:____________________________

a) Queixa Principal:
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b) Secundária:
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c) Sintomas:
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3 – HISTÓRICO DA DOENÇA ATUAL:

a) Início da patologia:
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b) Frequência:_________________________________________________________________
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c) Intensidade:_________________________________________________________________
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d) Tratamentos anteriores (já fez terapia): _______________________________________

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e) Medicamentos: _____________________________________________________________
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4 – HISTÓRICO PESSOAL:

a) Infância:____________________________________________________________________
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b) Rotina: _____________________________________________________________________
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c) Vícios: _____________________________________________________________________
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d) Hobbies: ___________________________________________________________________
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e) Trabalho: ___________________________________________________________________
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5 – HISTÓRICO FAMILIAR:

a) Pais: _______________________________________________________________________
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b) Irmãos: ____________________________________________________________________
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c) Cônjuge: ___________________________________________________________________
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d) Filhos: _____________________________________________________________________
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e) Lar: _______________________________________________________________________
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f) Patológica Pregressa (enfermidades e tratamentos atuais e anteriores):

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6 – EXAME PSÍQUICO:

a) Aparência:__________________________________________________________________
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b) Comportamento:____________________________________________________________
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c) Atitude para com o entrevistador:

( )cooperativo ( ) resistente( ) indiferente

d) Orientação:
( )Autoidentificatória( ) corporal( ) temporal ( ) espacial ( ) orientado em relação a
patologia
Observações:
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e) Atenção:
Vigilância: ____________________________________________________________________
Tenacidade: __________________________________________________________________

f) Memória:
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g) Inteligência:
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h) Sensopercepção:
( ) normal ( ) Alucinação

i) Pensamento:
( ) acelerado ( ) retardado ( ) fuga ( ) bloqueio ( ) prolixo ( ) repetição
*Conteúdo:
( ) obsessões ( ) hipocondrias ( ) fobias ( ) delírios
* expansão do eu:
( ) grandeza ( ) ciúme ( ) reivindicação ( ) genealógico ( ) místico, missão salvadora ( )
deificação ( ) erótico( ) de ciúmes ( ) invenção ou reforma ( )ideias fantásticas ( )
excessiva saúde ( ) capacidade física ( ) beleza ( )
outros: ______________________________________________________________________

* retração do eu:
( ) prejuízo ( ) auto-referência ( ) perseguição ( ) influência ( ) possessão ( )
humildades ( ) experiências apocalípticas ( ) outros:-
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* negação do eu:
( ) hipocondríaco ( ) negação e transformação corporal ( ) autoacusação ( ) culpa ( )
ruína ( ) niilismo ( ) tendência ao suicídio ( ) outros: ______________________________

j) Linguagem:   
( ) disartrias (má articulação )
( ) afasias, verbigeração(repetição de palavras)
( ) parafasia(emprego inapropriado de palavras com sentidos parecidos)
( ) neologismo
( ) mussitação (voz murmurada em tom baixo)
( ) logorréia (fluxo incessante e incoercível de palavras)
( ) para-respostas (responde a uma indagação com algo que não tem nada a ver com o
que foi perguntado.

k) Afetividade: ________________________________________________________________
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l) Humor:
( )normal ( ) exaltado ( )baixa de humor ( )quebra súbita da tonalidade do humor
durante a entrevista

m) Consciência da doença atual: 

( ) sim ( )parcialmente ( ) não

7 – OBSERVAÇÕES:   
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psicólogo e crp