PAI Flashcards
What is the PAI used for?
PAI is a multi-scale, self-report test of personality. It is used to provide information relevant to clincial diagnosis, treatment planning, and screening for psychopathology.
What is the age range for the PAI?
18 years +
What are the validity scales on the PAI?
- Inconsistency Scale (ICN) = degree to which respondents answer simila questions in different ways
- Infrequency Scale (INF) = degree to which respondents rate extremely bizarre or unusual statements as true e.g. careless of random responding
- Negative Impression Management (NIM) = degree to which respondents describe themselves in a negative/overly negative light
- Positive Impression management (PIM) = degree to which respondents describe themselves in a positive/overly positive light
What does the Somatic Concerns Clinical Scale Measure?
SOM = physical concerns/complaints.
Subscales = Conversion, Somatisation, Health Concerns
What does the Anxiety Clinical Scale measure?
ANX = general feelings of tension, worry and nervousness
Subscales = Cognitive, Affective, Physiological
What does the Anxiety Related Disorders Clinical Scale measure?
ARD = more specific anxiety symptoms that relate to different categories of anxiety disorders
ARD subscales = Obsessive-Compulsive, Phobias, Traumatic Stress
What does the Depression Clinical Scale measure?
DEP = general feelings of worthlessness, sadness, and lethargy
Subscales = Cognitive, Affective, Physiological
What does the Mania Clinical Scale measure?
MAN = level of high energy and exciteability
Subscales = activity level, grandiosity, irritability
What does the Paranoia Clinical Scale measure?
PAR = suspiciousness and concern about others harming them
Subscales = hypervigilance, persecution, resentment
What does the Schizophrenia Clinical Scale measure?
SCZ = unusual sensory experiences, bizarre thoughts, and social detachment
Subscales = psychotic experiences, social detachment, thought disorder
What does the Borderline Features Clinical Scale measure?
BOR = problems with identity, emotional instability, and problems with friendships
Subscales = affective instability, identity problems, negative relationships, self-harm
What does the Antisocial Featues Clinical Scale measure?
ANT = level of cruel/criminal behaviour and selfishness
Subscales = antisocial behaviours, egocentricity, stimulus seeking
What does the Alcohol Problems Clinical Scale measure?
ALC = problems with excessive drinking
What does the Drug Problems Clinical Scale measure?
DRG = problems with excessive recreational drug use
What are the Treatment Consideration Scales?
- Aggression = different kinds of aggressive behaviorus towards others (subscales = aggressive attitude, verbal aggrssion, physical aggrssion)
- Suicidal ideation = frequency and severity of suicidal thoughts and plans
- Stress = controllable and uncontrollable hassles and stressors repored by client
- Nonsupport = how socially isolated a respondent feels, and how little support the respondent repors having
- Treatment rejection = measures attributes related to psychological treatment adherance; motivation, willingness to accept responsibility, openness to change and new ideas
What are the interpersonal scales on the PAI?
Dominance = degree to which respondent acts dominant, assertive and in control in social situations (low scores = submissiveness)
Warmth = degree to which a respondent acts kind, empathic, and engaging in social situations, assesses interest in supportive and empathic social relationships
How does the PAI assess both breadth and depth of constructs measured?
Depth of content coverage = PAI includes items that address the full range of severity (mild to more severe items)
Breadth of content coverage = PAI includes differents signs of a disorder e.g. physiological, cognitive and affective signs/items
When introducing the PAI for informed consent, what should be covered?
-Nature and purpose of the PAI
-Parameters of the assessment and how information will be obtained and used
-Time taken, location, fees
-When information will be shared and with whom
The test is standardised so results are compared to those of others in similar circumstances e.g. treatment, or pre-employment
What should be considered to assess clients for self-report administration?
- Are clients by the nature of their disorder confused, disoriented, distractible, or manifesting extreme psychomotor retargation or agitation
- Cognitive abilities compromised by the effects of AOD intoxication or withdrawal, or disorientation from neurological deficit or disease
- Physical or sensorimotor deficits e.g. visual acuity, motor weakness in dominant hand might impact ability to complete the test
- Reading level of at least a 4th grade level
How should PAI test feedback be given?
- Review the nature of the test e.g. test norms etc
- Feedback on the client’s/collaborative assessment questions formed at the beginning
- Findings that are more positive in nature and those that the client is more likely to be acknowledged by the client
- Findings that the client may have less insight too
- Present all findings with recurring themes within the data and tie to the client’s goals for assessment and treatment
- End session with client summarising their interpretation of feedback and describing their subjective impressions of the session
How does the PAI scoring work?
The PAI scoring is based on t scores = mean of 50t and SD of 10t.
Each item receives a score of 0,1,2,3 depending on what the client endorsed. Items for scales are summed for raw scores (or items of subscales are summed then summed to form a full scale).
Approximate percentile equivalents = 1 SD (60t) = 63rd percentile (borderline) 2 SD (70t) = 96th percentile (clinical)
How is the inconsistency scale scored?
10 item pairs are compared:
- The first 8 pairs = consistent responding would result in item scores that are similar –> to score, the absolute value of any difference between the scores of the item pair adds cumulatively to the raw score of the ICN
- The last 2 pairs = consistent responding would result in item scores being opposites for the pairs (e.g. 0 and 3) –> to score, subtract one of the item scores from 3; this new number is then subtracted from it’s pair and this difference is added cumulatively to the raw score of the ICN
After completing and scoring the PAI, what is the first step in interpretation?
Assessing the potential of profile distortion (the validity of the profile):
- Do the results provide an accurate reflection of the experience of the respondent or whether they are distorted in some way?
- Factors before the assessment arae considered here too e.g. nature of referral, intended use of results, utimate recipients of the test information
When would you use a clinical reference group for interpretation?
Community versus clinical comparisons
- T scores of 70t+ = unusual degree of problem/symptoms compared to the general population = likely indicating a problem of clinical significance and a shift in contextual reference point to clinical focus would be appropriate
- PAI profile clinical skyline = a reference point for scores that are unusual in a clinical setting = the clinical skyline is 2 SDs from the mean of a CLINICAL population (which isn’t necessarily 50t and will vary on each scale)
How should individual scales be interpreted?
- By examining the: full scale score (or scores if comparing to different normative contexts), subscale scores, and individual scale items
- Assuming little/no profile distortion, the initial focus should be on those full scales that obtain scores of 70t of greater = representing pattern of difficulties that merit clinical attention, and comparing these to clinically referenced standard scores identifies which elevations are most central to the profile
- Interpretation of the subscales clarifies meaning of full-scale evaluations e.g. there may be a lack of supporting data from subscale configuration to support a diagnosis (DEP-A is elevated, but DEP-P and DEP-C are not)
- Interpretation of individual items is imporant for specific difficulties experienced by the respondent e.g. ARD-P includes single items that tap commonly geared objects as well as social phobia and public situations. Also imporant to analyse the 27 critical items (delusions, hallucinations, self harm potential)
What methods of interpreting profile configuration are possible?
- Profile code typs = classifying a profile configuration by its two-point code (two most elevated scales). This is the most simple and traditional approach but meaningful differences can be lost e.g. identifical codes for two people but very different responses, and very small differences between the scales can question reliability
- Mean profile comparison = comparing PAI profile to those who share particular similarities such as diagnosis or symptoms. But comorbidity among emotional disorders and variations in diagnostic practice may not fully capture elements of the PAI reflecting that disorder.
- Conceptual indexes = configural rules on theory-driven hypotheses or clinical observations e.g. malingering and defensiveness indexes, or clinical decision making configural indexes such as violence potential, suicide potential, and treatment process. But these need cross-validation research but may be useful in combination with other strategies.
- Acturaial decision rules = applying multivariatae functions to combine scale scores and identify formulas for decisions e.g. for defensiveness, malingering and substance abuse denial. But this requires large sample sizes to construct the functions and only a limited amount have been develope.
What do scores of 70t mean?
70t = a clincial score for clinical scales 70t = a significant score for other scales
60t-69t = might mean mild difficulties/non-serious difficulties/transient symptoms
If someone scored above the clinical skyline for depression, what does that mean?
They scored 2 SDs above the mean for depression in a clinical population
If someone scored 60-69 on anxiety and 70-79 on depression, how would you interpret these scores?
- Transient/mild anxiety symptoms
- Clinical symptoms of depression
If someone did the PAI and received an 84 on the PIM scale, what can you interpret from this?
The client seems to be representing themselves as doing better than what they are.
