A Anamanense Adulto

Anamnese Completa do Adulto

Nome:____________________________________________________________________

Idade:_____________            Sexo:_______________      

Endereço:__________________________________________________________________________________________________________________________________________

Telefones para Contato:______________________________________________________

Bairro:____________________________   Cidade:________________________________

Religião:___________________________ Escolaridade:___________________________

Filhos (nome, idade e sexo)___________________________________________________

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Profissão:_________________________________________________________________

Est.Civil:___________________  

Cônjuge (nome, idade e profissão):_____________________________________________

Queixa principal:___________________________________________________________

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Possibilidade de horários:____________________________________________________

Fez terapia anteriormente? (citar qual e quando)___________________________________

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Expectativas e objetivos do paciente:___________________________________________

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Sintomas apresentados:______________________________________________________

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Parte I – Diagnóstico

Eixo I:____________________________________________________________________

Eixo II:___________________________________________________________________

Eixo III (doenças físicas):____________________________________________________

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Eixo IV (estressores psicossociais):_____________________________________________

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Eixo V (funcionamento global):________________________________________________

Conceituação Psicológica do Caso:_____________________________________________

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Transtornos psiquiátricos anteriores:____________________________________________

Transtornos psiquiátricos familiares:____________________________________________

Doenças Importantes que teve:________________________________________________

Medicação que está tomando:_________________________________________________

Medicação alternativa (chás, compostos, etc.)_____________________________________

Aplicação de Testes? Se sim, qual e resultado:____________________________________

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Histórico da Queixa

Quando se iniciou:__________________________________________________________

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Eventos traumáticos de vida:__________________________________________________

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Eventos/fatores que precipitam ou agravam crises:_________________________________

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Uso de drogas?_____________________________________________________________

Tentativa de suicídio?_______________________________________________________

Focos de intervenção psicoterápica:_____________________________________________

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Parte II – Relacionamentos Importantes

Mãe:______________________________________________________________________________________________________________________________________________

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Pai:_______________________________________________________________________________________________________________________________________________

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Irmãos:____________________________________________________________________________________________________________________________________________

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Filhos:_____________________________________________________________________________________________________________________________________________

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Outros importantes:_________________________________________________________

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Observações sobre dinâmica familiar atual:______________________________________

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