GUIDE FOR HISTORY MAKING OR ANAMNESIS

MOTTO IN LIFE___________________________________________________________________________

0. PROFILE
0.1 Full Name (with Nickname)
0.2 Age
0.3 Gender
0.4 Ordinal Rank
0.5 Birhday
0.6 Birthplace
0.7 Single
0.8 Religion
09. Educational Attainment
0.10 Address
0.11 Email address
0.12 Cell Number

1. INFORMANT
1.1 Name
1.2 Address
1.3 Relationship to patient
1.4 Length of time known to subject

2. FAMILY HISTORY

2.1 Maternal and Paternal Grand Lineage

2.1.1 History of nervous and mental disease, alcoholism, delinquency, drug addiction, suicide,
dependency, chronic unemployment, and other traits of inefficiency.
2.1.2 Has any of them to take care of the subject and how long. Mention also the reason why &
how this grand relative took care of the subject.
2.1.3 How did the godparents discipline the parents of the subject.
2.1.4 How was the subject disciplined by the grandparents?( if patient had lived or living with
them)

2.2 Father
2.2.1 What kind of a man is the father? Give his salient personality traits. Give his routine family
discipline & personal philosophy about husband & wife relationship and about
upbringing of children.
2.2.2 What is his social & financial status, his education & experiences? What are his
achievements & failures that might have influenced the family life especially those of
his children’s personalities, or that of the subject.
2.2.3 If dead, was his death premature, and to have caused financial difficulty or rupture of
family ties? What are the consequences on the subject?
2.2.4 What are his habits – both natural & acquired? (Note alcoholism, drug intoxication, etc)
2.2.5 Does he gamble, sacrificing the whole family? Is he sexually perverted as to sacrifice family
finances for women of ill-refute or for other women?

2.3 Mother
2.3.1 What kind of woman is the mother?(habits)
2.3.2 Is she working to supplement family budget, entrusting her care of the children to
 relatives/neighbors?
2.3.3 Methods of disciplining the children
2.3.4 How is her relationship towards her husband and other members of the household?
2.3.5 How does she handle disagreements/quarrel with the husband? Is it done in front of the
siblings?
**include:
> how the parents met
> how’s the courtship/who initiated first
> whose dominant in during the girlfriend/boyfriend relationship
> describe the marriage/ is it a wanted or unwanted marriage? (gunshot wedding)

2.4 Siblings
2.4.1 Number of brothers & sisters; their ages & present status ( civil status, work, etc)
2.4.2 Influences of the siblings on the parents.
2.4.3 Cause of death & age of dead siblings. Any miscarriages or abortions.
2.4.4 Relationship of siblings towards each other and towards other members of the household.
2.4.5 History of delinquency, anti social behaviors or personality traits
** include:
> relationship to mother/father/sibling/community
> whose dominant in the family

3. PERSONALITY HISTORY

3.1 Prenatal
3.1.1 Attitude of the mother towards this pregnancy (wanted or not)
3.1.2 Did she have adequate obstetrical observation?
3.1.3 Well-nourished
3.1.4 Describe mother’s emotion during the entire pregnancy which might have influenced the
growing fetus.
3.1.5 Workload of the mother during pregnancy/Stressors

3.2 Birth
3.2.1 Full term or premature and date of birth (type of birth)
3.2.2 Unusual incidents attending birth
3.2.3 a) difficulty of labor
b) instrument sequels
c) condition at birth
3.2.4 Place- home or hospital, transportation, etc.
3.2.5 Attended by whom
3.2.6 How was the cord cut?

3.3 Infancy and Childhood Characteristics

3.3.1 Breast or bottle fed
a) describe feeding habits
b) cuddling feeding time
c) describe how weaning was implemented
3.3.2 Was left under the care of the mother or the “yaya”
3.3.3 Age of teething, talking and walking
3.3.4 When and how the subject was toilet trained
3.3.5 Note history of enuresis, thumb sucking, night terrors, tantrums, stammering, history
of family, falls, infantile convulsions, and other childhood diseases, include duration and
how it started, traumatic experiences, negativism & how the family cope with it.
3.4 Psychosexual History
3.4.1 Age of sex awareness
3.4.2 Masturbatory practices observed. Note frequency & reactions of both subject & parents
3.4.3 Age of menstruation: note regularity of period & reaction (moods during menstruation)
3.4.4 In male – age when voice lowered in pitch, appearance of seminal secretions.
3.4.5 Age of circumcision.(reaction of family to masturbatory practices)

3.5 Play life

3.5.1 What games were played or preferred?
3.5.2 Plays with those of his same or opposite sex
3.5.3 Plays with older or younger children
3.5.4 Leader or follower in the game
3.5.5 Plays near or far from home or neighborhood
3.5.6 Any influence of sequel in habit-formation brought about by the particular games
or particular playmates.
3.5.7 Does he abandon homework or school work for the sake of playing?
3.5.8 Attitudes towards play
3.6 School History
3.6.1 Age of entering school
3.6.2 Age of completing school
3.6.3 Grade completed
3.6.4 Attitudes towards school (attendant)
3.6.5 Any school maladjustment – reasons for his maladjustment
3.6.6 Relations to teachers and classmates
3.6.7 Attendance – regular or irregular
3.6.8 Time spent for homework or lesson
3.6.9 Interest in studies
3.6.10 Does he pass every year/semester?(include: accomplishments, club membership etc)
3.6.11 His grades or marks obtained
3.6.12 Special liking to different subjects

3.7 Religious and Social Adaptability

3.7.1 Number of friends, their ages, sex, social levels and character
3.7.2 Social attitudes & characteristics (friendly, shy, superior, jealous, cruel, stubborn,
moody, irritable, oversensitive, self-assertive, submissive, choosy, daydreams, seclusive,
selfish, conceited & other peculiar habits)
3.7.3 Degree of religious interest & involvement
3.7.4 Reactions towards failure and success
3.7.5 Are there conflicts of religious practices in the family (religious hopping)
3.7.6 Types/Attitudes of leisure (stages of substance of abuse)
3.7.7 Characteristics of friends s/he goes with

3.8 Occupational History

3.8.1 Present occupation
3.8.2 Kind of work undertaken or job hold
3.8.3 Length of time of different undertakings or in different jobs
3.8.4 Reasons for changes of jobs
3.8.5 Salaries and savings
3.8.6 Attitude towards work with superiors and subordinates
3.8.7 Measures employed to increase production

3.9 Marital/Love History

3.9.1 Love affairs & disappointments
 3.9.2 Circumstances of relationship
3.9.3 Attitude of each other toward sex relations & degree of sex satisfaction
3.9.4 Age of first crush
3.9.5 Age of first love/relationship
3.9.6 Moderate or excessive sexual desires
3.9.7 Perverted or overt sexual practice – abnormal method of gratification with same
or opposite sex
3.9.8 Miscarriage or abortions, sterility
3.9.9 Refusal of partners to sexual intercourse
3.9.10 Birth control measures
3.9.11 Infidelity of either one
3.9.12 Reasons for separation
3.9.13 Any nervous symptoms before, during or after menstruation
3.9.14 Menstruation
a) age when menstruation stopped or begin to be irregular, nervous symptoms during the
period

3.10 Psychosocial Stressors

3.10.1 What incident precipitated subject’s present condition?
3.10.2 Describe the symptoms manifested by the subject
3.10.3 Any referral to a quack doctor or alternative medicine
3.10.4 Signs and symptoms manifested immediately after experience of psychosocial stressor
3.10.5 Any measures/management done to alleviate the symptoms