UNIVERSIDAD DE SAN CARLOS DE GUATEMALA

CENTRO UNIVERSITARIO METROPOLITANO- CUM

ESCUELA DE CIENCIAS PSICOLÒGICAS
SUPERVISOR: MA. LUIS ALFREDO ARDÓN
CICLO ACADEMICO 2010

ANAMNESIS

Lugar y fecha: ____________________ No. De Expediente:

I-. IDENTIFICACIÒN DEL NIÑO

Nombre:___________________________________________________________
Edad: ________________ Lugar y Fecha de Nacimiento: ____________________
Sexo: ________ Grado y sección: _______ Domicilio: ______________________
Teléfono: __________ Edad del Padre: ___________ Escolaridad: ____________
Ocupación: ___________ Religión: ____________ Edad de la Madre: _________
Escolaridad:_____________ Ocupación: __________
Estado Civil de los Padres: _________________ Referido por: _______________

II-. MOTIVO DE CONSULTA

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II-. HISTORIA DEL PROBLEMA ACTUAL (inicio de síntomas, acontecimientos,

actitud familiar, personalidad pre mórbida).

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IV. HISTORIA PERSONAL

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Periodo Prenatal (antecedentes de embarazo, TX. Y control prenatal, reacción de
los padres)
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Peri-natal (ictericia, anoxia, presentación del niño, convulsiones, utilización de

fórceps).
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Post-natal (peso, talla, lactancia, formula, alimentos sólidos, desarrollo motor en

los primeros días)

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Desarrollo Neuropsíquico
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Desarrollo Motor (camino, gateo, salto, pintó).
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Control de Esfínteres (edad, dificultad)

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Lenguaje (antecedentes, dificultades en el habla)

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Sueño (características, alteraciones, acompañamiento)

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Alimentación (trastornos alimenticios)

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Historia Médica (vacunas, enfermedades comunes padecidas, hospitalizaciones,

operaciones, fracturas, antecedentes familiares, estado actual)
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Características del Estado de Ánimo (llanto, independencia, trastorno de

ansiedad, de separación, temor al castigo).
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Factores emocionales (enuresis, encopresis, onicofagia, sociabilidad, síntomas

depresivos, rasgos obsesivos, fobias, temores, tricotilomanía).

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Características conductuales (timidez, agresividad, ansiedad, rebeldía,

inquietud, succión de dedo)
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Sexualidad (curiosidad sexual, juegos sexuales, precocidad, trauma,

masturbación)
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VI. OBSERVACIONES GENERALES (relato y actitud de la madre)

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Firma del Entrevistador (a)