ANAMNESIS GUIDE Pre Natal Data 1. Age of mother- what was the age of the mother when the client was conceived and born? 2. Maternal Parity — Is the client the youngest or the eldest or what rank among the children? How many brothers and sisters? How many previous pregnancies (dead or alive) prior to the birth of the client? What are the intervals of pregnancies? 3. Diseases non-infectious — what non-infectious had the mother during pregnancy or while conceiving the client? (hypertension, diabetes , hyperthyroidism , heart disease etc.)Give dates, duration, and how they were treated. 4. Infectious diseases - what infectious diseases did the mother contract, while conceiving? (fever, typhoid , P.T.8 , mumps, etc.) Give dates , and duration , how treated 5. Maternal Sensitization — To what RH factor does the mother belong? What blood type? Any sign of allergic condition on the part of the mother? Describe 6. Nutrition- Describe nutrition of the mother during pregnancy, Describe also nutritional condition of family during and between pregnancies. Was the mother of the client under pre-natal care? was she taking special diet, vitamins, etc. during pregnancy. Describe. 7. Drugs- Had the mother of the client been taking drugs , alcohol , opium , etc. during pregnancy. Describe if there were any 8. Physical Agents- Was the mother of the client exposed to X-rays , Radiation, etc. , during pregnancy? Was she subjected to any severe jarrings, electric shock, and other physical trauma? 9. Emotional factors- Describe any significant emotional tension the mother of the patients underwent during conception. FIRST YEAR OF LIFE AND INFANT FEEDING PROBLEM: 1. Was the client premature or of normal birth? Was the client delivered with difficulty, with forceps, or any surgical operation? 2. Was the client born in the hospital or by a “Comadrona” at home by whom?10. 11. 12. 13. 14. 15. 16. 17. 18. When and how was the first feeding, was the first sucking process satisfactory or unsatisfactory, was the patient breast fed, wet nursed or bottled fed? Was it given regularly or irregularly? Was the feeding under the supervision by Physician or by whom? What was the occupation of the client’s mother at that time? Was she working outside? Was she a very busy woman to neglect her child? Was the client, at times left crying alone or was the client carried all the time to prevent crying? Was the client at that time much taken cared of by the mother, carried and fondled , especially during and between sucking or feeding periods? Were there periods when the client was breast fed or bottle fed that the client refused to suck? At what age? How often? Describe. Was the infant biting the mother’s nipple? Was the client always abandoned by the mother and the feeding left to the care of other people or to some other members of the family? Describe the attitude of the one caring for the client at suck early days. Was the client vomiting after feeding? What did the one taking care use to in such case? Was the client at that early period always fretful or irritable just after feeding? Describe circumstances Was the mother an impatient woman during the period of the client’s early feeding? Was she so busy or occupied in other work as to neglect the feeding hours? How and explain further. What were the remedial measures taken were there any? ‘At what age was the client weaned? At what age was the breast feeding interrupted or suspended due to other cause? What was the cause? Was weaning gradual or abrupt? Did the client use to refuse eating several days or weeks after weaning? Until what age did the client continue sucking artificial nipple? Do you consider the client an abandoned infant at the time? Explain further. Did the client use to have diarrhea or constipation during this first year of life? Were there thumb sucking, lips biting, biting of the nipples, and nails biting? Until what age? Early Psychological development: A. To fix its eyes towards a person around? B. To look or follow certain objects or persons by the eyes?1. To respond to Sound, voice or approach of anybody? To be sensitive to sound? To play with an object? To learn grasping objects, fingers, etc. To such the thumb or fingers? H. Begin rolling? |. Begin sitting? Begin standing without help? K. Begin to walking? Begin running? Begin climbing? Begin jumping? To have the first eruption of teeth To utter first words? What words? To utter phrases? Sentences To sing? YPpPpPTOZE To Mix with other children to play? Describe language development at this stage. TWO TO THREE YEARS OF LIFE (TOILET TRAINING) During the second and third year of life, did the client intentionally or rebelliously move his/her bowel or urinate anywhere? Did the client find pleasure in playing with the faces or urinate, smearing all around, in spite of the parents’ disapproval? Were the father, mother, brothers, sisters, or caretaker (specify) strict in training the client where and when he move the bowel or pass the urine in Proper places? How was toilet cleanliness taught?10. it? Was the client punished severely Was the client stubborn or resistive in complying wit (describe)? Did the client use to have constipation or diarrhea (specify) during those early years of life? Until what age? What were the treatments given? Did the client often reveal outbursts of temperamental fits during those first years of life? In what way (describe)? Was the patient abandoned or left crying alone by the parents? Was the client a stubborn and resentful child or very submissive or over ~ obedient during those early years? In what way? Describe Was the client destructive child at this age? Was it due to anger or curiosity? (Describe) under what situations? What were the methods employed by the parents or other members of this family to divert or discipline the client during those years? Was the child corrected harshly or tactfully. Describe the language development of += the_-—child-—«sat_—tthis_— stage. THREE TO FIVE YEARS UP TO PUBERTY: ( Accidental Experiences and Early relations) Was the child shown attitude of shame, disgust or embarrassment in relation to genitals when being bathed? Was genital cleanliness emphasized? How? While dressing and undressing the child, were comments uttered to the child such as “shame on you” and other jokes in relation to genital organs?{initial emphasis) Was the child teased that he or she is no longer favored by parents because of the coming or of the newly born brother or sister? How often? Was he/she compared with the other children? How? (sibling rivalries) Was the child noticed to show behavior of jealousy toward the brother, sister, father, mother specify how? Please recall very well Was excessive tenderness and over indulgences shown by parents (who) brother and sister (who?) specify and describe.10. a Was severe punishment given to the child by parents? Who, father, mother, or other members Of the family? in what instances? How punished? Were they frequent? How severe? Were they physical or verbal? Describe father or mother were dead, how did the child react to the death of either one? if dead brother, sister how did the child react? Was there any definite change of behavior or discipline after death? At what age was the child first noticed to be losing appetite seemingly getting weak? Was the child a voracious eater or did he barely take food? Was the child mingling normally with other children or very selective? Describe language development at this stage EDUCATIONAL HISTORY Age on first entering school. Date and place How did the client adopt to his classmate and playmates (friendly , quarrelsome, timid , a leader on follower at games , good sport or poor loser) Did he obtain good marks, regular promotion or any failure? Cite them chronological. Was there any exceptional talent? Were there any hobbies or unusual outside interests during school years Any truancy or escaping from school or any delinquency such as lying, cheating, stealing, cruelty to another children or sex delinquency Was the child ambitious for education or indifferent or refused to study? Why? (state causes if known) How far did he/she go to school? Was schooling obtained at great sacrifice, i.e., under financial or other difficulties that require outside work, borrowing, selling property, etc.? if so describe the circumstances. Did the client acquire desired amount of education or was there longing for more? Was there disappointment to such extent that his/her behavior changed? What influences the client in choosing his/her career contrary to his/her real ambition? What made the client changed life or her career? How did the patient take it?10. 11. 12. a. SPN De wn pe 10. 11. a2. 13. 14. 35. 16. Did ti aan he client have special training in vocational and business school? What other training or accomplishment did he/she have? HN ; ow old was client when he/she stopped schooling? Reason for stopping {financial , school was not interesting to him/her ; or her family did not encourage him/her ; was expelled from school, etc, please specify}. Was there any change of school? Give reason Any quarrel with teachers and professors. Specify incidences and state reason. OCCUPATIONAL HISTORY What influenced his/her present choice of work? What influenced his/her past choice of work? Did the parents have strong hand in this? Has economic security been a strong determining factor in vocational choice? What are the client’s vocational aim? Is the client satisfied with the present progress? Is the client working now? Is it a permanent job? How many jobs (name chronologically the kind or nature of this jobs has the patient held during and after leaving his/her schooling? What is the longest time the client ever held one job? Give reasons How did the patient like his/her job or various job? Give reasons. Had the client received any promotions in job? When the client was or is working who supported him/her or is supporting him/her? How was the client getting along with his/her co-worker? Were there various quarrels, troubles, (describe and specify) did he or she selected few friends? Was the client ever been discharged from any job? Give reasons. Did the client use any influence in securing any of those jobs (specify) or was he/she qualified in any? What was his/her qualifications?FAMILY HISTORY (Describe father, mother and siblings, name, age, education, employment Personality, form or discipline applied, relationship among each other at home) 1. Is home life happy? 2. Were friends allowed? 3. Are recreations and good time encouraged? in what ways explain, (past and present) 4. Was client given responsibility in home affairs? How? 5. How did the client react to home discipline? Were parents very strict? In what way? Other strict members of the family? Who? In what way? 6. Did the client ever run away from home? How? Under what situations? 7. With whom is the client living now? 8 When did the client leave his/her childhood home if any? Why? With whom did she/he live after? 9. Has the client enjoyed a happy childhood? (If not, what was wrong with the home?) 10. Did the family home move around or transfer frequently? 11. Did the parents get along well together or were the parents always quarrelling? Explain. 12. How did the client get along with the parents? Is the client favored by either or both parents (To what degree?) 13. How did the client get along with the brothers and sisters? To whom was he/she more attached and to whom less attached? Describe further. 14, Other family problems? Describe. PERSONAL HISTORY (Social Relationships) 1. Attitude towards people a. Does the client have many friends? b. To what extent does he or she like to go to parties? 1s the client sociable or does he/she prefer to stay alone? d. Did the client ever feel that the family or friends did not like him/her?e Did the client ever complain that People (the boss, friends or family) ever complain of the feeling that he/she has some enemies working against him/her or trying to trick him/her or some troubles? 2. Social Adjustments: ei ao 2 |n childhood, were there opportunities for happy relationships with playmates? Were close friendships made (from early childhood to adulthood? Were friendships easily and often broken? Have friends treated the client well? Could the client take criticism and kidding? Has the client been self-conscious in groups with other people? Has the patient ever complain of feeling “queer”, “peculiar”, and “different”? Does he/she plan things which will bring social recognition? Has the client worked at athletics or recreations in order to achieve popularity? Has life treated the client satisfactory thus far? Does the client feel always in bad mood and want to be alone? Does the client indulge with alcoholic drinks, tobacco or drugs, moderately, excessively or especially during emotional stress? To what extent? Is client a member of any social or professional society? Enumerate and State how active. 3. Finding Satisfactory Outlets and Interests: a b. G What have been the client's interests outside his/her work (hobbies and recreations?) Does the client like sport games? What type and to what extent? Does the client like to make things out of wood, metal, etc.? Did the client ever collect anything like stamps, antiques, coins, minerals, plants, insects and animals, etc., at what age and to what extent? Does the client like hunting or fishing? Does the client indulge in all these alone or in group activities? Explain. 4. Religious Activities:What is the client's religion? wi hat is the dient’s attitude towards religion? H ‘ow Much pressure of religion was placed on the client? What was the response? Was the client religious as a child and as an adolescent? Was this changed? What was the real determining factor in the choice of religion by the patient? ze What is his present tolerant of religious differences? How did religious beliefs cause conflict in relation to sex or any other current problems? J. Describe to what extent does the patient observe and practice his/her religious work. Vill. (Behavior History) 1. Has the client ever gotten into any kind of serious jams with the law? 2. Was the client ever arrested or summoned to the courts? Specify, give dates and reasons, Does the client drink alcoholics? How did the client begin the habit, when, why, how often and under what circumstances? 3. To what extent and why does the client indulge in smoking cigar, cigarettes, opium, etc. 4. Any other vice, To what extent and reasons? 5. Any relations with people of ill-characters, as gangster gamblers, etc.? Specify and state under what circumstances. 6. Any serious accidents (while driving himself or herself, or as a passenger?) How many of them, in what manner and under what circumstances? 7. Any individual accidents? Dates and extent of injury. 8. Did the client ever run away from home? At what age, when and why? Latency Period: (5 to 12-13 years of age) 1. What conspicuous new behavior was noticeable in the client during this age regarding especially changes in sexual interest, curiosity or sexual activity, whether increase, decrease, or change into another form? Compares with first five years of life.What pros Prominent changes of interest in other activity such as playmates of the same sex F opposit Ite Sex, kind of play, type of work, interest to study, kind of play? What pr Prominent changes in ‘temper was client more irritable or less irritable and under what circumstances? D *scribe conspicuous changes in attitude towards parents and siblings? If any, relatives and other people. Was client very aggressive, frank vocal mixer, friendly during the period, or very inhibited, casily shameful, loathsome, scrupulous? Describe any prominent behavior. Describe especially the parent-child relationship at this age, closeness to the particular Parent, training and discipline. Puberty and Adolescence: (12-21 years of age) 1. Was there special preoccupation about physical status at this age? Any special diet, exercise, physical activities? 2. Any conspicuous manifestation of independent striving or desire to be freed from Parental authority, family discipline etc.? Describe any special interested group companionship, gangs, or group activities? 3. Any unusual skeptism in religion, family discipline, school discipline? Describe. 4. Any conspicuous ideal for person, activi /, hero, etc., that the client special admire and consider a model for his life. 5. Describe any change in emotional behavior, attitude towards people, towards members of the family, towards the authorities? 6. Was the client a mixer or an isolationist? Describe. IX. SEX HISTORY 1. How was the child fondled? Did people around indulge in kissing the child too long? Did they often play and tease the client of the genital organs? (Erotic emphasis) 2. Did the client, as a child, use to play with his/her sexual organs? How? Try to recall very well.10. 1, 12 13. 14. 15. 16. 17. 18. 19. 20. What age w. as the chi Child when first noticed to show interest in his/her sexual organs? How Sid he/she show it? Was he/she ex! ashamed of it? hibiting or proud of his/her genitals or was he/she Was the child Caught masturbating and if so, how was the child prohibited or handled? Was the child prohibited or handled? Was the child Punished or tactfully handled? In what way? When was the child noticed to be curious of the differences in sex? How did the parents meet the curious of the differences in sex? Training to sex, Pregnancies or deliveries? Was the child seduced to sexual play by other children? How? Where the occasions when the child witnessed parental sexual intercourse? Until what age did the child use to sleep with the parents? (Primal scenes) Has the client ever had venereal disease? How is the client’s sexual power (desire, erection, interest, etc.?) At what age did interest in sex first manifest itself? How is the client’s sexual development? How was that met by the parents? How old was the client when he/she first noticed to masturbate or did any other sexual play? What did the client ask and how was the client early sex curiosity? What was the parent's attitude towards the masturbation of children? Were the early as preventive measure? Was sexual information given freely or with reluctance, given directly or by reading materials? ‘At what age was the child when sexual information was first given, how? Was the client manifesting shyness during social contact with opposite sex? To what extent?2 2 hes — ue —- experiences which have produced prolonged emotional distress? ‘ sexual intercourse, childhood courtships and rivalries, homosexual » an the opposite sex, rape, seduction, etc.) ly childhood, was there any game or play, such as husband and wife, etc.? Any other sex play? 23. When did he have his first sweetheart? Under what circumstances was it first made? Induced by somebody? How long was the courtship? 24. With the first sweetheart, were there frequent quarrels jealousies, disappointments, etc.? Describe. 25. When was the first kiss? How was it taken? 26. How many sweethearts up to present? (Give cause or cause of changing sweethearts.) 27. When was first sexual intercourse? How often up to present? With whom? (Marital and extramarital) X. MARITAL HISTORY: (If married) Note: Describe Wife/Husband, Age, Education, Employment and their relationship with each other. 1. Is the client married, separated, divorced? Give dates, age at marriage or marriages. 2. Give reasons for any of the above. 3, To Male: -Does his wife work away from home (by preference or necessity?) 4. Does the client make dates with opposite sex? How often? 5, Is there any mark difference in age between marital partners? 6. What were the reasons (if there is any) for the unusual early or late marriage? 7. Have the families of both partners anything to do with the marriage? 8, Are there harmony, compatibility and common interest between partners? Describe, 9. Give frequency of intercourse and degree of sexual satisfaction. Is orgasm produced in the female partners? If there is any sexual difficulty, what is its nature? (Whether impotence, frigidity, desire for perversion or nasty sexual practice by one of the partners, premature ejaculation, etc.)xi 10, 11, 12. 13. 14. 15, Are contraceptives used, and how is this regarded by both from the religious, aesthetic and other standpoints? Number of children and respective ‘ages? (Name of children) Was marriage founded on common interest or creating partnerships of home and family were there other force which brought about marriage? Any problem of infidelity or divorce on either husband or wife? Explain. Did the couple live with the in-laws? How did they get along? Describe the details. This is very important. , laws, Any other family difficulties? Extra marital affairs or conflict with in-law: neumonia, State all previous illness from infancy such as fever, diarrhea, dyspepsia, p' " treatment. malaria, etc. and corresponding dates, duration by who treated results of on i to the present. Any previous mental diseases which might or might not be similar to Describe. nd subjective Inventory of System: (history of previous illness by the system. Objective a nse and results symptom-description). State dates and duration, by whom treated treatment.