The Prefrontal Symptoms Inventory (PSI) in acquired brain injury: agreement between the scores of patients, relatives and professionals
*Correspondencia: Dr. Eduardo J. Pedrero Pérez. CAD San Blas. Instituto de Adicciones. Departamento de Calidad de Madrid Salud. Ayuntamiento de Madrid. Alcalá, 527. E-28027 Madrid.
E-mail: ejpedrero@yahoo.es
Introduction: The use of self-reports about symptoms of malfunctioning in daily life derived from functional deficits of a prefrontal origin has become widespread in clinical practice, since they allow incremental ecological validity to be added to other specific tests. Yet it remains to be determined whether self-assessment is sufficient on its own or if the participation of an external evaluator would be preferable.
Subjects and methods: The Prefrontal Symptoms Inventory (PSI) was administered to 115 subjects being treated for a range of brain pathologies. The same test, referring to the patient, was administered to one of the professionals closely following the development of the case and, whenever possible (n = 88), a relative or caregiver. The psychometric goodness of the PSI was explored in the three samples, and the degree of correlation and agreement among the three assessments was estimated.
Results: The three assessments showed significant correlation, although the patients reported fewer symptoms than their relatives and caregivers in terms of executive functioning. The assessments of relatives and patients were superposed and showed a high degree of agreement as regards both profile and magnitude
Conclusions: In addition to the mandatory neuropsychological assessment, we recommend the administration of questionnaires or inventories about symptoms such as the PSI, with proven psychometric robustness, that make it possible to explore the impact of brain dysfunctions in daily functioning. Since many of these dysfunctions are accompanied by different degrees of anosognosia, they should be administered to external observers, relatives or professionals, with the intention of obtaining a more adequate assessment of the magnitude of the functional difficulties.
Sujetos y métodos Se administró el inventario de síntomas prefrontales (ISP) a 115 sujetos en tratamiento por diversas patologías cerebrales. La misma prueba, referida al paciente, se administró a algún profesional que siguiera estrechamente la evolución del caso y, cuando fue posible (n = 88), a un familiar o cuidador. Se exploró la bondad psicométrica del ISP en las tres muestras y se estimó el grado de correlación y concordancia entre las tres evaluaciones.
Resultados Las tres evaluaciones mostraron correlación significativa, aunque los pacientes declararon menos síntomas que sus familiares y cuidadores en funcionamiento ejecutivo. Las evaluaciones de familiares y pacientes se superpusieron y mostraron un alto grado de concordancia en perfil y magnitud.
Conclusiones Se recomienda, junto con la obligada evaluación neuropsicológica, la cumplimentación de cuestionarios o inventarios de síntomas como el ISP, con probada robustez psicométrica, que permitan explorar el impacto de las disfunciones cerebrales en el funcionamiento cotidiano. Dado que muchas de estas disfunciones se acompañan de diversos grados de anosognosia, se recomienda su administración a observadores externos, familiares o profesionales, de cara a obtener una evaluación más adecuada de la magnitud de las dificultades funcionales.
