ANAMNESIS DE NIOS ADOLESCENTES

I.

DATOS GENERALES:
Apellidos y Nombre: ___ _______________________________________________________________
Fecha de Nacimiento: __________________________________________________________________
Edad: _______________________ Sexo: __________________________________________________
Lugar de Nacimiento: __________________________________________________________________
Ocupacin: __________________________________________________________________________
N de Hermanos: ________________________ Lugar que ocupa: _______________________________
Direccin: ___________________________________________________________________________
Grado de Instruccin: __________________________________________________________________
Estado civil: _________________________________________________________________________
Informante: __________________________________________________________________________
Entrevistador: ________________________________________________________________________
Fechas de entrevista: __________________________________________________________________

II. ENFERMEDAD ACTUAL:

a.) Cmo se siente?
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b.) Desde cuando se siente as?
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c.) Estaba usted bien, completamente bien, antes de esa fecha?
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d.) Recuerda usted el primer sntoma?
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e.) Dnde estaba usted cuando lo sinti? Qu estaba haciendo? Qu haba hecho ese da, y el anterior?
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f.) Qu hizo entonces?
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g.) Cmo sigui?
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h.) Qu es lo que siente ahora?
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III. HISTORIA FAMILIAR:
a.) De dnde es usted?
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b.) Vive con su padre?
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c.) Vive con su madre?
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d.) Tiene usted hermanos?
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e.) Ha conocido usted a sus abuelos?

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f.) Ha habido enfermos nerviosos en su familia?
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g.) Ha vivido siempre con sus padres?
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h.) Por qu?
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i.) Cmo asido criado usted? Engredo o educado severamente?
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j.) Ha sido castigado mucho? Por quien?, Cmo?, Por qu?, Cmo reacciono ante los castigos?
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k.) Quin lo engra ms?
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l.) a quien quiere ms a su padre o a su madre? Por qu?

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m.) Cmo se lleva usted con sus hermanos?
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n.) Estaba usted contento en su casa?

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o.) Cmo se llevan sus padres?
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IV.

NIEZ:
a.) Qu clase de nio era usted?
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DATOS DE EVOLUCION

b.) Embarazo y parto normal?

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c.) Alimentacin al pecho? Artificial? Por qu?
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d.) Peculiaridad y preferencias? Rechazo el alimento?
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e.) Cul fue la reaccin de la familia ante la alimentacin?
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DATOS DEL DESARROLLO PSICOMOTOR

f.) A qu edad camino? Qu edad hablo?

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g.) Hasta qu edad se orino en la cama?
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h.) Ha tenido pesadillas?
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i.) Qu reaccin tuvo tu familia ante ello?
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j.) Hasta qu edad se chupo el dedo? Se comi las uas?
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k.) Ha tenido pataletas? Con que motivo?
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l.) Masturbacin infantil? Fantasa sexual? Otras particularidades?
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V.

EDUCACION:
a.) A que edad se fue al colegio?
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m.) Le gustaba ir a la escuela? Por qu?

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n.) Tenia mucho amigos?
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o.) Termino la instruccin primaria y secundaria? A que edad?
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p.) Estudio superior?
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q.) Qu materia prefera? Por qu?
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r.) Qu hubiera querido ser? Por qu?
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VI. TRABAJO:
a.) Cul fue su primer trabajo?
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b.) Le gusta su trabajo actual? Por qu?
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c.) Esta contento usted contento con el? Por qu?
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d.) Cules son sus aspiraciones?

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e.) Cunto gana actualmente y esta contento con su salario?
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VII. CAMBIOS DE RESIEDENCIA:
a.) Cundo salio usted por primera vez de su lugar natal?
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b.) Por qu hizo ese viaje?
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c.) Cmo le fue en su nueva residencia?

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VIII. ACCIDENTES Y ENFERMEDADES:
a.) Ha tenido usted accidentes?
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b.) En qu lugar ocurri?
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c.) Qu reaccin obtuvo?
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d) Ha tenido algn cuadro clnico? Qu le afectado psicolgicamente?

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IX.

VIDA SEXUAL:

EN LOS HOMBRES:

a.) Ha sido usted muy mujeriego?

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b.) Cundo tuvo usted los primeros conocimientos sexuales?
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c.) A que edad comenz a masturbarse?
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d.) Se masturba todava algunas veces?
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e.) Fue su primera relacin sexual con un hombre o con una mujer?
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f.) Cundo tuvo usted su primera relacin sexual? Con quien fue? Cmo fue? Qu le pareci?
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g.) Cmo ha continuado usted sus prcticas sexuales?
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h.) Cmo son ellas en la actualidad?
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i.) Ha sido usted muy enamorado?

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j.) Cul ha sido su primer amor? Por qu se enamoro?
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l.) Matrimonio?
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ll.) Por qu se caso?

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m.) Se pelea usted mucho con su esposa?
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n.) Tiene usted hijos? Por qu?
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.) Cmo se siente usted sexualmente con su esposa?
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o.) Tiene usted aventuras fuera de su matrimonio? Por qu?

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p.) Qu piensa usted de las mujeres?
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EN LAS MUJERES:

a.) A qu edad comenz a menstruar?

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b.) Estaba usted prepara o se asusto cuando se le presento por primera vez?
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c.) Cmo ha sido su menstruacin?
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d.) Ha tenido mucho enamorados?
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e.) Cundo tuvo el primero enamorado?
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f.) Tiene usted enamorado ahora?
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g.) Por qu se caso?
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h.) Cmo la impresiono su noche de bodas?
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i.) No ha pensado que podra ser ms feliz con otro hombre?

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j.) Qu piensa usted de los hombres?
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X. HABITOS E INTERESE:
a.) Qu hace usted cuando no trabaja?
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b.) Tiene usted amigo ntimos?Que hacen juntos?
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c.) Es usted religioso?Porque?
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d.) Bebe usted mucho?
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e.) Fuma usted mucho?
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f.) Otra drogas?
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g.) Qu ideas polticas tiene y concepciones filosficas?
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XI. ACTITUD FRENTE A LA ENFERMEDAD:

a.)

A que cree usted que se debe su enfermedad?

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b.)

Cmo cree usted que pueda curarse?

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c.)

Qu har usted cuando se cure?

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XIII. SUEO:
a.)

Duerme bien?
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b.)

Tiene usted pesadillas? Comnteme la mas seguida o repetida

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c.)

Suea usted?q suea?

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OBSERVACIONES:
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