Taís Emiliana – CRP 04/37512
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) Sintomas:
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Taís Emiliana – CRP 04/37512
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:________________________________________________________
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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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Taís Emiliana – CRP 04/37512
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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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Taís Emiliana – CRP 04/37512
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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:
( ) auto identificatória ( ) corporal
( ) temporal ( ) espacial ( ) orientado em relação a patologia
Observações:
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Taís Emiliana – CRP 04/37512
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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 ( ) beleza
( ) genealógico ( ) místico, de missão salvadora ( ) deificação
( ) erótico ( )de ciúmes ( ) invenção ou reforma
( )ideias fantásticas ( ) excessiva saúde ( ) capacidade física
* retração do eu:
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Taís Emiliana – CRP 04/37512
( ) 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 )
( )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 – HIPÓTESE DIAGNÓSTICA:
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Taís Emiliana – CRP 04/37512
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