anamnesis seguin

7/23/2019 Anamnesis Seguin

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ANAMNESIS – SEGUIN

I. DATOS DE FILIACION

• Nombre: _______________________________

• Edad: _______________________________ • Sexo: _______________________________ • Fecha de Nac.: _______________________________ • Lugar de Nac.: _______________________________ • Estado cii!: _______________________________ • "rado de i#strucci$#: _______________________________ • Ocu%aci$#: _______________________________ • Domici!io: _______________________________ • Exami#ador: _______________________________

II. &OTI'O DE CONS(LTA

Como %arte %r)ctica de! curso de Ea!uaci$# * Diag#$stico +sico!$gico II.

III. ,ISTO-IA FA&ILIA-

a /De d$#de es usted0 ____________________________________________________________

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b /'ie su %adre0 Si !a res%uesta es a1irmatia. /Cu)#tos a2os tie#e0 /Est) sa#o0 /E# 3u4traba5a0 /6u4 car)cter tie#e0 /7ebe mucho0 ____________________________________________________________

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____________ Si !a res%uesta es #egatia /A 3u4 edad muri$0 /De 3u40 /6u4 e#1ermedades tuo a#tes0/6u4 car)cter te#ia0 /7ebedor0 ____________________________________________________________

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c /'ie su madre0 Si !a res%uesta es a1irmatia. /Cu)#tos a2os tie#e0 /Esta sa#a0 /E# 3uetraba5a0 /6u4 car)cter tie#e0 /7ebe mucho0 ____________________________________________________________

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____________ Si !a res%uesta es #egatia /A 3ue edad muri$0 /De 3u40 /6u4 e#1ermedades tuo a#tes0/6u4 car)cter te#ia0 /7ebedora0 ____________________________________________________________

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d /Tie#e (d. herma#os0E# caso a1irmatio i#terrogar %or cada u#o de e!!os cro#o!$gicame#te * a#otar !os datos#umera#do !os herma#os. ____________________________________________________________

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e /,a habido e#1ermos me#ta!es e# su 1ami!ia0 /T8os9 %rimos9 etc.0 /Suicidas0 /+erso#asraras;0 ____________________________________________________________

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1 /,a iido siem%re co# sus %adres0 Si !a res%uesta es #egatia: /+or 3u40 ____________________________________________________________

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g /C$mo ha sido (d. criado0 /E#gre8do o educado seerame#te0 /,a sido castigado0



/&ucho0 /+or 3u40 /+or 3ui4#0 /C$mo reaccio#aba (d. a#te !os castigos0 /6ui4# !oe#gre8a m)s0 /A 3uie# 3uer8a m)s0 ____________________________________________________________

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h /C$mo se !!eaba (d. co# sus herma#os0 /A cu)! %re1er8a9 %or 3u40 ____________________________________________________________

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i /C$mo se !!eaba# sus %adres0 ____________________________________________________________

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I'. ,ISTO-IA +E-SONAL

NI<E=

a /6u4 c!ase de #i2o era usted0 ____________________________________________________________

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b Datos de !a eo!uci$#: /Embara>o * %arto #orma!es0 /A!ime#taci$# de %echo0/Arti1icia!es0 /+or 3u40

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c /-echa>o de a!ime#tos0 ____________________________________________________________



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d /A 3u4 edad cami#o0 /A 3u4 edad hab!o0 /E#1ermi>o0 ____________________________________________________________

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e S8#tomas #eur$ticos./,asta 3u4 edad se ori#o e# !a cama0 /,a te#ido %esadi!!as0 Terrores #octur#os * reacci$#de !os %adres a#te e!!os. ____________________________________________________________

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1 /,asta 3u4 edad se chu%o e! dedo0 /Se comi$ !as u2as0 ____________________________________________________________

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g /,a te#ido %ata!etas0 /+or 3u4 motio0 ____________________________________________________________

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h /&asturbaci$# i#1a#ti!0 /Fa#tas8as sexua!es0 /Otras %articu!aridades0 ____________________________________________________________

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ED(CACION

a /Le gustaba ir a !a escue!a0 /+or 3u40 ____________________________________________________________



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b /Te#8a muchos amigos0 /Te#8a te#de#cia de ser !8der o a seguir a !os otros0

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c /Termi#o !a i#strucci$# %rimaria0 /A 3u4 edad0 Si #o !o hi>o9 /+or 3u40 ____________________________________________________________

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d /6u4 hubiera 3uerido ser0 /+or 3u40 ____________________________________________________________

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e /,a seguido estudia#do des%u4s de aba#do#ar e! co!egio0 ____________________________________________________________

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T-A7A?O

a /Cu)! 1ue su %rimer traba5o0 /Le gustaba0 /+or 3u4 !o e!igi$0 /Cu)#to tiem%o estuo e#4!0 /+or 3u4 !o aba#do#o0 ____________________________________________________________

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____________ actua!idad.

b /Le gusta su traba5o actua!0 /+or 3u40 _________________________________________________________________________



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c /Esta (d. co#te#to co# 4!0 /+or 3u40 _________________________________________________________________________ __________________________________________

__________________________________________________________ d /Cu)!es so# sus as%iracio#es0 __________________________________________________________ __________________________________________________________

e /Cu)#to ga#a actua!me#te0 /Est) co#te#to co# su sa!ario0 __________________________________________________________ __________________________________________________________

ANTECEDENTES Y ENFERMEDADES

a /6u4 e#1ermedades ha su1rido desde su #acimie#to hasta !a actua!idad0 __________________________________________________________ __________________________________________________________

b /C$mo reaccio#o a#te e!!o0 _________________________________________________________________________ ___________________________________________

c /6u4 accide#tes tuo0

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d /Co# 3ue 1recue#cia0 /Tuo ca8das0 /-oturas de cabe>a0 __________________________________________________________ __________________________________________________________

e /C$mo reaccio#o a#te e!!o0 __________________________________________________________ _________________________________________________________

1 /Estr4s %sico!$gico0 /,a te#ido e#1ermedades co#tagiosas0 /E# !a 1ami!ia0 _________________________________________________________ __________________________________________________________

'IDA SE@(AL

E# hombres:



a /,a sido (d. mu* mu5eriego0 _________________________________________________________

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b /Cu)#do tuo (d. !os %rimeros co#ocimie#tos sexua!es0 __________________________________________________________

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c /A 3u4 edad come#>$ a masturbarse0 /Se masturba toda8a a!gu#as eces0 __________________________________________________________ __________________________________________________________

d /Fue su %rimera re!aci$# sexua! co# u# hombre o co# u#a mu5er0 /,ab8a te#ido (d. %r)cticas sexua!es co# hombres0 /Las ha te#ido (d. des%u4s0 __________________________________________________________

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e /Cu)#do tuo (d. esa %rimera re!aci$# sexua!0 /Co# 3ui4# 1ue0 /C$mo 1ue0 /C$mo !e %areci$0 __________________________________________________________ __________________________________________________________ ________________________________________________________

1 /C$mo ha co#ti#uado (d. sus %r)cticas sexua!es0

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g /C$mo so# e!!as e# !a actua!idad0 /Es (d. mu* excitab!e sexua!me#te0 /Cada cua#totiem%o tie#e (d. re!acio#es sexua!es0 /C$mo se sie#te (d. des%u4s de cada re!aci$#sexua!0 __________________________________________________________

e /C$mo !e im%resio#o su #oche de bodas0 __________________________________________________________ __________________________________________________________

1 /Se %e!ea (d. mucho co# su es%oso0



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g /Tie#e (d. hi5os0 Si #o9 /+or 3u40 /&edidas a#tico#ce%tias0 /Cu)!es0 __________________________________________________________

__________________________________________________________ h /No ha %e#sado 3ue %odr8a ser m)s 1e!i> co# otro hombre0 /No !o ha i#te#tado0 __________________________________________________________ __________________________________________________________

i /6u4 %ie#sa (d. de !os hombres0 __________________________________________________________ __________________________________________________________

HABITOS E INTERESES

a /6u4 hace (d. cua#do #o traba5a0 Si #o hace #ada /+or 3u40 /E# 3ue ocu%a sus d8as!ibres0 __________________________________________________________ __________________________________________________________

b /Tie#e (d. amigos0 /#timos0 /6u4 hace e# com%a28a de e!!os0 Si #o !os tie#e /+or3u40 __________________________________________________________ __________________________________________________________

c /Es (d. re!igioso0

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d /7ebe (d. mucho0 /7ebidas e# !as comidas0 /Fuera de e!!as0 /E# 1iestas0 /A me#udo0/Le causa da2o0 __________________________________________________________

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e /Fuma mucho0 /Otras drogas0 __________________________________________________________ __________________________________________________________

1 /6u4 ideas %o!8ticas tie#e0 __________________________________________________________ __________________________________________________________



'. ACTIT(D +A-A CON LA FA&ILIA

a /Co# 3ui4# ie u0 Si e! %acie#te es so!tero: /'ie co# sus %adres0 E# caso #egatio/+or 3u40 /Co# 3ui4# ie0 /+or 3u40 __________________________________________________________

__________________________________________________________ b Si es casado /'ie co# sus %adres0 /Co# !a 1ami!ia de su es%osa0 /+or 3u40 __________________________________________________________ __________________________________________________________

c /Co# 3ue otras %erso#as ie0 /+or 3u40 __________________________________________________________ __________________________________________________________

d /'ie (d. tra#3ui!o e# su casa0 __________________________________________________________ __________________________________________________________

e /6u4 re!acio#es tie#e u co# e! resto de su 1ami!ia0 __________________________________________________________ __________________________________________________________

1 /6u4 hace# sus hi5os0 __________________________________________________________ __________________________________________________________ __________________________________________________________

h /,a sido mu* e#amoradi>o;0 __________________________________________________________ __________________________________________________________ ________

i /Cu)! ha sido su %rimer amor0 /+or 3u4 se e#amoro0 /Cu)#to tiem%o duro ese e%isodio0/,asta do#de !!egaro# e# sus re!acio#es0 /+or 3u4 * c$mo termi#aro#0 __________________________________________________________ __________________________________________________________ ________________________________________________________

5 &atrimo#io. /C$mo co#oci$ a !a mu5er 3ue 1ue su es%osa0 /+or 3u4 !e gusto0 /Cu)#totiem%o !a e#amoro0 __________________________________________________________



_________________________________________________________________________ ___________________________________________ B /+or 3u4 se caso0 _________________________________________________________________________ ____________________________________________________

! /Se %e!ea (d. mucho co# su es%osa0 _________________________________________________________________________ _______________________________________________________

m /Tie#e (d. hi5os0 Si #o9 /+or 3u40 /&edidas a#tico#ce%tias0 /Cu)!es0 _________________________________________________________________________ __________________________________________ ________

# /C$mo se e#tie#de (d. sexua!me#te co# su es%osa0 /Frigide>0 /Fa!ta de satis1acci$#

sexua!0 /'aria#tes sexua!es0 __________________________________________________________ ____________________________________________________________________

o /Tie#e (d. ae#turas 1ueras de! matrimo#io0 /+or 3u40 __________________________________________________________ _________________________________________________________ _______

% /6u4 %ie#sa (d. de !as mu5eres0 __________________________________________________________

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E# !as mu5eres:

a /A 3u4 edad come#>$ a me#struar0 /Estaba (d. %re%arada o se asusto cua#do se !e %rese#to %or %rimera e>0 /C$mo ha sido su me#struaci$#0 __________________________________________________________

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b /,a te#ido muchos e#amorados0 /Siem%re !os ha te#ido0 /Cu)#do tuo e! %rimero0 Si!a e#1erma es so!tera /Tie#e (d. e#amorado ahora0



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c &atrimo#io. /C$mo co#oci$ a! ar$# 3ue es su es%oso0 /+or 3u4 !e gusto0 /Cu)#totiem%o !o e#amoro0 __________________________________________________________ __________________________________________________________ _________________________________________________________

d /+or 3u4 se caso0 _________________________________________________________________________ __________________________________________

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