ASSESSMENT - PAI Flashcards
What are the PAI Mean and SD?
Mean 50 for T scores and SD 10
What is the clinical cut off score for the PAI
70 (98th percentile) = 2 SD above mean, Clinically significant
What is the age range and reading level for the PAI
We need to know 18yrs and older and a 4th grade reading level to do the test
What are the 4 validity scales in the PAI
NIM- Negative Impression Management
PIM- Positive Impression Management
INC - Inconsistency
INF - Infrequency
What are the cut-offs for the 4 Validity Scales in the PAI
Positive Impression Management (PIM) – Cut off = 58
Negative Impression Management (NIM) – Cut off = 73
Infrequency (INF) – Cut off = 75
Inconsistency (ICN) – Cut off = 73
How many clinical scales in the PAI?
Clinical and Treatment Scales
Clinical Scale x11 – cover most major psychopathology
Treatment Scales x5
Interpersonal Scales x4
What is the clinical skyline in the PAI?
The clinical cut off scores
Clinical Skyline = scores that are 2 SD above the mean for a clinical population
o It is rare for general population to cross the skyline
What are the scoring levels for the PAI
Scores up to 59 (within 1 SD) = AVERAGE
Scores 60 – 69 = MILD
Scores 70+ (2 SD) = CLINICAL
What is the PAI Useful for?
Can be a comprehensive Ax to identify what might be going on, if presenting
problem is unclear
Q: Someone scores 40 on the PIM - what doesn’t that mean?
Is that person faking goo faking bad profile not valid - no concerns with PIM his questions are inconsistent - answer no concerns
Q;Validity scale 88 for INC what does that mean? -
Client responded INC manner; client responded inc to that session; client has some INF choices; client is faking bad; the whole profile is invalid - answer is he responded inconsistently and you would asks questions - you can only say its inconsistent - you can’t say it cancels the whole PAI
NOT OBVIOUSLY INVALID BECAUSE SOMEONE HAS AN ELEVATED SCORES -
You need to understand 50-59 etc doesn’t apply for validity scales they have specific cut offs
It seems the person has endorsed more positive more than average
Q; You have been referred someone for a psych assessment because they are being treated for an accident and they have a minor injury and the client is saying they have pain and can’t work
The board likes to trick you - into seeing a client who is referred by a Dr who had an accident and their rehab Dr is wondering about their psychological state and why are you doing the PAI to see whether the person is malingering; to make a comprehensive assessment of clients personality (it’s really psychopathological and personality) - to see whether the disability os valid; to give an objective assessment for the dr, or to formulate accurately the clients problems?
You can’t formulate the client’s problems from this scale? - You are not an investigator - no one has told you about malingering
They have been referred for a psych assessment - have you been asked to give an opinion of the neck injury??? NOOOOO stay with the question - you are doing it to ensure you do a comprehensive assessment of the client
- Q: What if a client spends a long time answering questions and she is asking a lot of questions what’s the best way to respond to her?
To help her understand questions; no the PAI because it will take too long;
Ask the client to read out loud to check reading level;
Tell her to ignore the first 2 and answer the ones she can understand;
or continue explaining the meaning to help her understand?
Ans : ask her to read them out aloud- what to do next?
Q: what if a client score 60-69 on all of the subscales on DEP;
- They are avg;
- Extreme end of the scale;
- That the client has mild symptom of depression ;
- That the client is suffering from trauma;
- The client needs anti d’s
3.Ans; mild transient
Q If someone has drug difficulties what would you look at how would you know people are improving in symptoms -
drug scale score elevated to average etc -
they will play around with the different ranges for the PAI and they will give you extreme ranges
If they fake dyslexia- reading ability is not consistent with his school - there’s not much you can say
What does it mean if someone has a low score for resistance (RXT) to treatment?
IF THEY ARE AT THE BOTTOM OF THE GRAPH - the only conclusion you get RXT to treatment is high…they will be hard to work with if below they want help LOW RESITANCE IS THEY WANT HELP - if normal population - if they score avg or 1SD above mean why would they want treatment
Compare to normal population first if DEP is high not only severe for normal but score is high enough for a hospitalized sample too
What is the rule of thumb for the PAI in relation to standard and clinical norms?
RULE OF THUMB - if already 1 SD above for clinical pop also gives you an idea of treatment - if you can ethically and safely -ALWAYS START WITH NORMS - IF CLINICAL YOU WOULDN’T BE TREATING IN A PRIVATE PRACTICE e.g. a dr would not treat an emergency liver problem
What happens if you are working for the Aust govt and you are trying to do the PAI for people who have applied to spend 2 years in the antarctic doing some research and you want to see which people are more suited to survive - what sort of norms would you use?
The 2pt scales, clinical scales only, look at multi-dimension scores of quadratic; norms for general population and look at validity scaled only….A USE NORMS FOR GENERAL POPULATION
The board will make up things that sound scientific or complex for like an infrequency (most of these questions are bogus WTF answers) its likely you can cross that answer out - if it doesn’t make sense do not choo
What you do need to know for the exam…….
Don’t need to worry about how to score for exam
WHAT YOU NEED TO KNOW IS
FULL SCALE PROFILE (called PAI profile
T scores mean of 50 and SD 10
Over 2 SD scores above the mean are 96%tile and plus - only 3-4% population above that - a small percentage will score above 70
What does that tell you when someone scores 70 and above
Clinical scales would mean clinical problems - for depression this person has symptoms on the clinical range likely to meet the criteria for MDD
What PAI also has is some subscales eg depression/ cognitive/affective and physiological side of depression you can see if they are elevated in these areas
Same with anxiety cognitive/affective and physiological side
They will tell you scale they want you interpret
Wont ask about sub-scales - will ask about SCALES
DIFFERENT CUT OFF SCORES for impression mgt
Check the score for 50-59 are considered average - 49 - 58 in the average range
They will give you obvious scores to interpret
Scores up to 40-59 considered average range - 58 for anx considered average
Scores 60 - 69 70 anx dep etc person has mild symptoms or mild prob alcohol and drug use (board calls transient symptoms = mild symptoms)
70 and above are clinical symptoms - people are in the clinical range above 70 for Dep etc CLINICAL PROBLEMS
2 SD above the line for the community - 50 mean and 2 sd will be 70 so only 4% of the population will score 70 and above
What happens when someone score 70 and above - the focus of comparisons shifts to the CLINICAL NORMS
If they score higher that 2SD’s 70 COMPARE TO clinical population - you LOOK AT THE CLINICAL SKYLINE
CLINICAL SKYLINE FOR DEPRESSION is 96 represents a score that is 2 SD’s above the clinical mean of a clinical population e.g. at a psych hospital a psych population will be a lot higher - mean of the clinical population is 76 (depression) eg depression is showing you 2 SD’s above a clinical population
Look at all the scores for community 70
Then I look compared to the clinical population
Have they crossed the clinical skyline
In the example the clinical skyline for suicide is 101 and he is above that - he has crossed the clinical skyline - even compared to a psych hospital her is higher - BIG RISK FOR SUICIDE almost 3SD above the mean for a clinical population
If they break the clinical skyline things are more severe
First impression of this guy is that he is suicidal - would you test this guy in outpatients in private practice NOOOOO he needs hospitalization - RISK Management is not enough
You can not work with a guy with high SUICIDE, DEPRESSION AND DRUG ISSUES in private practice - don’t allow your bosses to force you to work with this type of patient
Most of the questions for PAI - someone score in whatever range for anxiety or alcohol what does that mean - they can either give you a score in the mild or clinical range
Someone scores btw 50 and 59 on all of the clinical scales what does that mean
Know the brackets
You don’t need to remember the cut-offs for impression mgt validity
