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Modelo 2022 - Ananmese Adulto
Modelo 2022 - Ananmese Adulto
ANAMNESE ADULTO
1 – IDENTIFICAÇÃO:
Nome:_________________________________________________________________________
Idade: _____________ Sexo: __________________ Nacionalidade: ________________________
Estado Civil: ______________________ Data de nascimento:_____________________________
Grau de instrução:________________________________________________________________
Profissão:_______________________________________________________________________
Residência (Cidade/Estado): _______________________________________________________
Telefones para contado: ___________________________________________________________
2 – ATENDIMENTO:
Frequência:______________________________ Data/hora:______________________________
a) Queixa Principal:
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b) Secundária:
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Gabrielle de Fátima Pires, CRP-04/72449, Rua Mozart Portela, 38.175-000, (34) 9 9987-7063.
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Gabrielle Pires – CRP-04/72449
c) Sintomas:
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a) Início da patologia:
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b) Frequência:__________________________________________________________________
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c) Intensidade:__________________________________________________________________
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d) Tratamentos anteriores:________________________________________________________
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e) Medicamentos: _______________________________________________________________
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Gabrielle de Fátima Pires, CRP-04/72449, Rua Mozart Portela, 38.175-000, (34) 9 9987-7063.
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Gabrielle Pires – CRP-04/72449
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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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Gabrielle de Fátima Pires, CRP-04/72449, Rua Mozart Portela, 38.175-000, (34) 9 9987-7063.
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Gabrielle Pires – CRP-04/72449
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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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Gabrielle de Fátima Pires, CRP-04/72449, Rua Mozart Portela, 38.175-000, (34) 9 9987-7063.
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Gabrielle Pires – CRP-04/72449
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6 – EXAME PSÍQUICO:
a) Aparência:___________________________________________________________________
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b) Comportamento:______________________________________________________________
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d) Orientação:
( )Autoidentificatória( ) corporal( ) temporal ( ) espacial ( ) orientado em relação a
patologia
Observações:
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e) Atenção:
Gabrielle de Fátima Pires, CRP-04/72449, Rua Mozart Portela, 38.175-000, (34) 9 9987-7063.
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Gabrielle Pires – CRP-04/72449
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, de missão salvadora( )
deificação ( ) erótico( )de ciúmes ( ) invenção ou reforma ( )ideias fantásticas ( ) excessiva
saúde ( ) capacidade física ( ) beleza ( ) outros: ____________
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* 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: ____________________________
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j) Linguagem:
( )disartrias (má articulação )
Gabrielle de Fátima Pires, CRP-04/72449, Rua Mozart Portela, 38.175-000, (34) 9 9987-7063.
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Gabrielle Pires – CRP-04/72449
k) Afetividade: __________________________________________________________________
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l) Humor:
( )normal ( ) exaltado ( )baixa de humor ( )quebra súbita da tonalidade do humor
durante a entrevista
Gabrielle de Fátima Pires, CRP-04/72449, Rua Mozart Portela, 38.175-000, (34) 9 9987-7063.
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Gabrielle Pires – CRP-04/72449
7 – HIPÓTESE DIAGNÓSTICA:
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Gabrielle de Fátima Pires - CRP-04/72449
Gabrielle de Fátima Pires, CRP-04/72449, Rua Mozart Portela, 38.175-000, (34) 9 9987-7063.
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