ANAMNESI

NOM I COGNOMS:
DATA DE NAIXEMENT:

EDAT:

LLENGUA MATERNA:
DATA:

MOTIU DE CONSULTA:

QUI VEU LA NECESSITAT: pares, escola, el pacient, metge........

ANTECEDENTS FAMILIAR:

PSIQUITRICS I ORGNICS

Addicions

SI

NO

Violncia intrafamiliar SI

NO

TDAH

SI

NO

DISLEXIA

NO

SI

Altres antecedents
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
___

HISTRIA PERSONAL:
Embars:
Part:
Lactncia:
Control Esfnters :
Locomoci:
Parla:
Altres a destacar:
____________________________________________________________________________________
____________________________________________________________________________________
___________________________________________________________________________________
____

Antecedents Somtics i Psiquitrics:

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
___

Ingressos i intervencions quirrgiques:

____________________________________________________________________________________
____________________________________________________________________________________
___________________________________________________________________________________
____

EVOLUCI DEL PROBLEMA:

GENOGRAMA:

ESDEVENIMENTS TRAUMTICS:
____________________________________________________________________________________
____________________________________________________________________________________

________________________ _____________________________________________

_
Dades farmacolgiques:
Malaltia

Prescripcions
Frmac

Dosis

Temps de tractament

Efectes diries

Allrgies:
____________________________________________________________________________________
___________________________________________________________________________________
___

Altres:_____________________________________________________________________________
____________________________________________________________________________________
__

SITUACI ACADMICA:
Correcta adquisici aprenentatges:

SI

NO ______________________________

Absentisme:

SI

NO ______________________________

Relaci amb grup digual:

Problemes de Comportament:

SI
SI

NO ______________________________
NO ______________________________

Altres:_____________________________________________________________________________
____________________________________________________________________________________
__

ACTIVITAT SOCIO RELACIONAL:

Grup digual:

Es relacional amb facilitat: SI NO

Consolida amistats:

SI

NO

Altres:_____________________________________________________________________________

_
Activitats
extraescolars_____________________________________________________________

EXPLORACI PSICOPATOLGICA Actual

Aspecte:___________________________________________________________________________
__
Conducta motora: agitaci, lentitud, tics tremolors manierismes, aspecte ansis,
tens,

perplex,

normal,

______________________________________________________________
Actitud: Irritable, agressiu, cautels defensiu, indiferent, aptic, cooperador,
____________________________________________________________________________________
_
Nivell

de

conscincia

orientaci:

alerta,

espavilat,

confs,

embotit,

disllia,

ecollia,

retard,

_____________
Llenguatge:

lent,

rpid,

disfmia

incoherent,

quequeig,

mutisme.

Altres:_____________________________________________________________________
Comunicaci

no

verbal:

:_____________________________________________________________
Trastorns

perceptius:

allucinacions,

illusions

____________________________________
Hipersensibilitat

estmuls

sensorials______________________________________________
Hipo

sensibilitat

estmuls

sensorials________________________________________________
Contingut

del

pensament:

deliris

de

persecuci,

grandesa,

transmissi

del

pensament, idees de referncia, fbies, obsessions, idees hipocondraques, ideaci

sucida,
____________________________________________________________________________________
_
Estat

dnim:

aplanament

eutmic,

afectiu,

hipertmic,
trist,

hipotmic,

irritable,

melanclic,
agressiu,

aptic,

angoixa,

inhibit,

allat,

terrors

nocturns,

lbil__________________________
Trastorns

de

la

son:

insomni,

somnambulisme,

par

somnis,

hipersmnia,
________________________________________________________________________
Trastorns

alimentaris:

anorxia,

anorxia

nerviosa,

remota,

recent,

bulmia,

pica,

altres,

__________
Trastorns

de

la

memria:

immediata,

inatenci

_______________________
Control

desfnters:

enuresi

(primria/secundaria),

(primria/secundaria),

encopresi
ocasional,

__________________________________________________________________________
RETARD MENTAL: lleu, moderat, greu.
Crisis
comicials:____________________________________________________________________
Altres aspectes dinters:
____________________________________________________________________________________
___________________________________________________________________________________
____________________________________________________________________________________
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