Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Identificação
Nome:______________________________________________________________
Idade: __________Sexo: _____________ Nacionalidade: _____________________
Estado Civil: ____________________ Data de nasc.:__________________________
Grau de instrução:_____________________________________________________
Profissão:___________________________________________________________
Residência (cidade/estado): _____________________________________________
Telefones para contado: __________________________________
Atendimento
Frequência:___________________________ Data/hora:______________________
Queixa Principal:
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Secundária:
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Sintomas:
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Histórico Pessoal
Infância:____________________________________________________________
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Rotina:_____________________________________________________________
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Vicios:______________________________________________________________
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Hobbies:____________________________________________________________
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Trabalho:____________________________________________________________
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Histórico 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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Exame Psíquico
Aparências:
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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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Atenção
Vigilância:___________________________________________________________
Tenacidade:_________________________________________________________
Memória
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Inteligência
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Sensopercepção:
( ) normal, ( ) Alucinação
Pensamento
( ) acelerado
( )retardado
( )fuga
( ) bloqueio
( ) prolixo
( ) repetição
Linguagem
( ) dispartiras (má articulação )
( ) afasias, verbigeração (repetição de palavras)
( ) parafasia (emprego inapropriado de palavras com sentidos parecidos)
( ) neologismo
( ) mussitação (voz murmurada em tom baixo)
( ) lograria (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
HIPÓTESE DIAGNÓSTICA
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