Darwin Ernesto Taya Mejía

PSICOLOGO CLINICO
Registro SENESCYT: 1054-13-13066 Registro MSP: L4 F53 N 158
EMAIL: mundopsicologicodarwin@outlook.com, renacerpsicologico@gmail.com
Cell: 0985080023 COTACACHI-ECUADOR

HISTORIA CLÍNICA PSICOLÓGICA

1.- DATOS DE IDENTIFICACIÓN

NOMBRES: ____________________________________________________________________
EDAD: _______________________________________________________________________
LUGAR Y FECHA DE NACIMIENTO: ________________________________________________
INSTRUCCIÓN: ________________________________________________________________
OCUPACIÓN: __________________________________________________________________
FECHA DE ELABORACIÓN: __________________ ELABORADO POR: _____________________

2.-MOTIVO DE CONSULTA
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3.- HISTORIA DE LA ENFERMEDAD

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4.-PSICOANAMNESIS PERSONAL
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5.-EXÁMEN DE FUNCIONES PSICOLOGICAS

CONSCIENCIA
Consciencia autopsiquica: Orientada Desorientada
Consciencia alopsiquica: Orientada Desorientada
Atención: Normal Alterada
Memoria: Normal Alterada
Sensopercepciones: Normal Alteradas
Afectividad: Normal Alterada

PENSAMIENTO
PNL: programación Neurolingüística; HIPNOTERAPIA: clásica, conversacional y
clínica; EMDR: Desensibilización y reprocesamiento por medio de movimiento de
ojos; CE: Contención emocional; CF: Constelaciones familiares; Tapping: Liberación
emocional. TCR: Terapia constructivista reprogramativa.
 Darwin Ernesto Taya Mejía
PSICOLOGO CLINICO
Registro SENESCYT: 1054-13-13066 Registro MSP: L4 F53 N 158
EMAIL: mundopsicologicodarwin@outlook.com, renacerpsicologico@gmail.com
Cell: 0985080023 COTACACHI-ECUADOR
CURSO: Adecuado Inadecuado

CONTENIDO: Normal Anormal

ESTRUCTURA: Adecuada Inadecuada

VOLUNTAD
INSTINTOS: Conservados Alterados
HABITOS: Conservados Alterados
JUICIO Y RAZONAMIENTO: Conservado Alterado

6.-IMPRESIÓN DIAGNÓSTICA
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7.- PSICOANAMNESIS ESPECIAL

Factores pre-disponentes
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Factores determinantes
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Factores desencadenantes
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PNL: programación Neurolingüística; HIPNOTERAPIA: clásica, conversacional y

clínica; EMDR: Desensibilización y reprocesamiento por medio de movimiento de
ojos; CE: Contención emocional; CF: Constelaciones familiares; Tapping: Liberación
emocional. TCR: Terapia constructivista reprogramativa.
 Darwin Ernesto Taya Mejía
PSICOLOGO CLINICO
Registro SENESCYT: 1054-13-13066 Registro MSP: L4 F53 N 158
EMAIL: mundopsicologicodarwin@outlook.com, renacerpsicologico@gmail.com
Cell: 0985080023 COTACACHI-ECUADOR

PNL: programación Neurolingüística; HIPNOTERAPIA: clásica, conversacional y

clínica; EMDR: Desensibilización y reprocesamiento por medio de movimiento de
ojos; CE: Contención emocional; CF: Constelaciones familiares; Tapping: Liberación
emocional. TCR: Terapia constructivista reprogramativa.
 Darwin Ernesto Taya Mejía
PSICOLOGO CLINICO
Registro SENESCYT: 1054-13-13066 Registro MSP: L4 F53 N 158
EMAIL: mundopsicologicodarwin@outlook.com, renacerpsicologico@gmail.com
Cell: 0985080023 COTACACHI-ECUADOR

8.- REACTIVOS PSICOLOGICOS APLICADOS

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9.- DIAGNÓSTICO ACTUAL
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10.- RECOMENDACIONES
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PNL: programación Neurolingüística; HIPNOTERAPIA: clásica, conversacional y

clínica; EMDR: Desensibilización y reprocesamiento por medio de movimiento de
ojos; CE: Contención emocional; CF: Constelaciones familiares; Tapping: Liberación
emocional. TCR: Terapia constructivista reprogramativa.
 Darwin Ernesto Taya Mejía
PSICOLOGO CLINICO
Registro SENESCYT: 1054-13-13066 Registro MSP: L4 F53 N 158
EMAIL: mundopsicologicodarwin@outlook.com, renacerpsicologico@gmail.com
Cell: 0985080023 COTACACHI-ECUADOR
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11.- TRATAMIENTO (PLANIFICACIÓN TERAPÉUTICA)

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12.- RESPONSABLE:

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PNL: programación Neurolingüística; HIPNOTERAPIA: clásica, conversacional y

clínica; EMDR: Desensibilización y reprocesamiento por medio de movimiento de
ojos; CE: Contención emocional; CF: Constelaciones familiares; Tapping: Liberación
emocional. TCR: Terapia constructivista reprogramativa.