ANAMNESE ADULTO

Data do atendimento: ______________________________________________________

Identificação:

Nome:___________________________________________________________________
Idade: __________Sexo: _________________ Nacionalidade: ______________________
Estado Civil: ____________________ Data de nasc.:______________________________
Grau de instrução:__________________________________________________________
Profissão:_________________________________________________________________
Residência (cidade/estado): __________________________________________________
Telefones para contado: _____________________________________________________

Atendimento:

Frequencia:___________________________ Data/hora:___________________________

Queixa Principal:
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Secundária:
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Sintomas:
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[Digite aqui] AV. Padre Antonio Tomás, 2277 [email protected]

(85) 3246.8000 CEP 60140-160 - Aldeota @erikacardoso.psicologa

Atendimento particular e Unimed

 Histórico da Doença Atual:

Início da patologia:
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Frequência:_______________________________________________________________
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Intensidade:_______________________________________________________________
Tratamentos anteriores: _____________________________________________________
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Medicamentos:____________________________________________________________
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Histórico Pessoal:

Infância:__________________________________________________________________
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Rotina___________________________________________________________________
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[Digite aqui] AV. Padre Antonio Tomás, 2277 [email protected]

(85) 3246.8000 CEP 60140-160 - Aldeota @erikacardoso.psicologa

Atendimento particular e Unimed

 Vícios:___________________________________________________________________
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Hobbies:__________________________________________________________________
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Trabalho:_________________________________________________________________
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Historico Familiar:

Pais:____________________________________________________________________
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Irmaos:___________________________________________________________________
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Conjugue:________________________________________________________________
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Filhos:___________________________________________________________________
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Lar:______________________________________________________________________
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Historia Patológica Pregressa (enfermidades e tratamentos atuais e anteriores):

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[Digite aqui] AV. Padre Antonio Tomás, 2277 [email protected]

(85) 3246.8000 CEP 60140-160 - Aldeota @erikacardoso.psicologa

Atendimento particular e Unimed

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Exame Psíquico:

Aparência:
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Comportamento:
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Atitude para com o entrevistador:

( )cooperativo , ( ) resistente, ( ) indiferente

Orientação

( )Auto-identificatória, ( ) corporal, ( )temporal, ( ) espacial, ( ) orientado em relação a

patologia
Observações:
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[Digite aqui] AV. Padre Antonio Tomás, 2277 [email protected]

(85) 3246.8000 CEP 60140-160 - Aldeota @erikacardoso.psicologa

Atendimento particular e Unimed

 Atenção

Vigilância: ________________________________________________________________
Tenacidade:_______________________________________________________________

Memória
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Inteligência
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Sensopercepção

( ) normal, ( ) Alucinação

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, idéias fantásticas,
excessiva saúde, capacidade física, beleza...).

Retração do eu: (prejuízo, auto-referência, perseguição, influência, possessão, humildades,

experiências apocalípticas).

Negação do eu: (hipocondríaco, negação e transformação corporal, auto-acusação, culpa,

ruína, niilismo, tendência ao suicídio).
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[Digite aqui] AV. Padre Antonio Tomás, 2277 [email protected]

(85) 3246.8000 CEP 60140-160 - Aldeota @erikacardoso.psicologa

Atendimento particular e Unimed

 Linguagem

( ) disartrias (má articulação )

( ) afasias, verbigeração (repetição de palavas)
( ) 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)

Afetividade
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Humor

( )normal; ( ) exaltado; ( )baixa de humor; ( )quebra súbita da tonalidade do humor

durante a entrevista;

Consciência da doença atual

( ) sim, ( )parcialmente, ( ) não

HIPÓTESE DIAGNÓSTICA
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[Digite aqui] AV. Padre Antonio Tomás, 2277 [email protected]

(85) 3246.8000 CEP 60140-160 - Aldeota @erikacardoso.psicologa

Atendimento particular e Unimed