MODELO DE ANAMINESE DE PSICOLOGIA
Por: josiane1982 • 10/3/2022 • Exam • 962 Palavras (4 Páginas) • 716 Visualizações
ANAMENESE DE PSICOLOGIA
Nome: ___________________________Sobrenome: _________________________________
Sexo: _________________ Idade ____________________ Data de nasc _________________
Religião ____________________Estado Civil _______________________________________
Profissão ________________________ Escolaridade _________________________________
Endereço: ___________________________________________________________________
Cidade: _______________________ Estado: _____________ Cep:______________________
País: ___________________________Nacionalidade: ________________________________
Telefone: ________________________Celular: _____________________________________
E-mail: ______________________________________________________________________
Entrevistador(a) _______________________________________________________________
Data da entrevista _____________________________________________________________
Encaminhado(a) por quem ______________________________________________________
Contato do responsável:
Nome: _______________________________Relacionamento: _________________________
Endereço: ___________________________________________________________________
Cidade: _____________Estado: ________Telefone: _______________Celular: ____________
E-mail: __________________________________
Razão para o encaminhamento (descrever conforme o paciente (família relata)
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
I- Família
- Fatores Predisponentes: Influências Genéticas
1 - Histórico familiar
Família de origem (nomes e idade): Pais:________________________________________________________________________
Irmãos:______________________________________________________________________
2 - Família atual (esposa(o),companheira(o)filhos(as)namorada(o) nomes e características específicas da interação da relação: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3 - Mortes na família e por qual motivo
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________
4 - Alguém teve problemas com álcool ou drogas(quem /grau de parentesco/tipos de drogas/submeteu-se a tratamento) ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
5 - Quais as atitudes dos familiares diante do problema do paciente ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
6 - Descreva o ambiente familiar: comunicação, vínculo, hierarquia, disfunções relacionais, conflitos, resolução de problemas
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
7- GENOGRAMA
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8 - HISTÓRIA PESSOAL
- Nascimento (complicações) __________________________________________________________________________________________________________________________________________
- Infância
__________________________________________________________________________________________________________________________________________
- Doenças
__________________________________________________________________________________________________________________________________________
- Ambiente familiar
__________________________________________________________________________________________________________________________________________
- Separação/divorcio/cuidador
__________________________________________________________________________________________________________________________________________
- Condições socioeconômicas
_______________________________________________________________________________________________________________________________________________________________________________________________________________
- Traumas
__________________________________________________________________________________________________________________________________________
- Lembranças
__________________________________________________________________________________________________________________________________________
- Escola
__________________________________________________________________________________________________________________________________________
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