INTERVIU CLINIC

1. ANAMNEZA

• Numele şi prenumele:
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• Data naşterii:
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• Locul naşterii:
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• Structura familială:
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• Condiţii materiale:
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• Statut:

- Personal:
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- Profesional:
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• Stare civilă:
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• Relaţii cu:

- părinţii:
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- fraţii:
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• Evenimente de viaţă:
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• Relaţii sociale:
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• Educaţie în familie:
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• Grad de instruire:
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2. MOTIVELE PREZENTĂRII LA ÎNTÂLNIRE:

• Cu voia lui, urgenţă, etc.:

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• Descrierea simptomelor:
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• Caracterul bolii:
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• Circumstanţele debutului:
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• ANTECEDENTE HEREDO- COLATERALE:

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3. ANTECEDETE PERSONALE:

• Internări cu alte probleme:

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• Intervenţii chirurgicale:
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• Traumatisme:
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4. EXAMINARE SOMATICĂ GENERALĂ:

• Mersul:
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• Motricitate:
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• Sensibilitate:
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• Coordonare:
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• Reflexe:
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 5. EXAMEN PSIHIATRIC:

• Ţinuta vestimentară:
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• Stare de igienă:
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• Facies:
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• Privire:
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• Mimică şi pantomimică:
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• ORIENTARE SPAŢIO- TEMPORALĂ:

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6. FUNCŢII PSIHICE:

• Afectivitate (dispoziţii):
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• Voinţa şi activitatea:
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• Atenţia:

- Voluntară:
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- Involuntară:
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• Senzaţii şi percepţii (iluzii şi halucinaţii):

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 • Gândirea:

• Coerenţa/ incoerenţa/ ritm:

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• Flux ideativ:
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• Idei obsesivo- fobice:

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• Idei dominante:
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• Idei prevalente:
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 • Idei delirante expansive/ depresive:
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• Nivel intelectual:

• Limbaj (stereotipii / dislalii):

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• Memoria (fixare/ evocare/ amnezii):

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• Instincte:

- Alimentar:
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- Sexual:
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 • Conştiinţa: (optuzii/ stupoare/deliranta/oniroida/crepusculară):
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7. RITM NICTEMERAL:

• Somn/ coşmaruri/ mod de trezire):

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