This study examined the contribution of complex posttraumatic stress disorder (PTSD) diagnosis and symptomatology to the difficulties of anger, aggression, and self-harm in a Northern Ireland clinical community sample. A "current complex PTSD" (CCPTSD) group (n=11) was compared with a "current PTSD" group (n=31) on self-report measures of these variables. The CCPTSD group demonstrated significantly higher levels of physical aggression and self-harm than the PTSD group. The complex PTSD symptom of 'alterations in self-perception' was a significant predictor of aggression and history of self-harm, suggesting the potential role of posttraumatic shame and self-loathing in PTSD theoretical models of these destructive behaviors. Social desirability was a notable confounding influence in the assessment of anger, aggression, and self-harm in traumatised individuals.

This research investigated auditory hallucinations (AH) in a sample with chronic posttraumatic stress disorder (PTSD) and examined dissociation and thought suppression as potential associated mechanisms. In all, 40 individuals with PTSD were assessed on the hallucinations subscale of the Positive and Negative Syndrome Scale and on measures of dissociation and thought suppression. Half of the sample reported AH (n = 20, 50%). Those reporting AH had higher general and pathological dissociation scores but did not differ on thought suppression or PTSD symptom severity. Results suggest that (a) AH in chronic PTSD is not a rare phenomenon, (b) dissociation is significantly related to AH, and (c) dissociation may be a potential mediating mechanism for AH in PTSD.

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1 Aspects of quality of life (symptoms, psychological well-being and activity) were evaluated by self-administered questionnaires in a 4 month randomised double-blind trial of titrated doses of verapamil slow release (n = 41) compared with nifedipine retard (n = 40). An untreated diastolic blood pressure of 95-115 mm Hg was required for inclusion in the trial. 2 The mean age in both groups was 55 years. A significant difference between the two drugs was found in the average reporting of symptoms with an increase on nifedipine (P < 0.01). The reporting of swollen ankles and flushing (P < 0.05) increased on nifedipine, and nocturia (P < 0.05) increased on verapamil. Measures of psychiatric morbidity tended to improve on verapamil and deteriorate on nifedipine. Only the change in cognitive function was significant between the drugs, being worse on nifedipine (P = 0.05). 3 There was no difference between the two groups in the fall in diastolic blood pressure (average 18 mm Hg on nifedipine and 17 mm Hg on verapamil). There was a significantly greater fall in systolic blood pressure on nifedipine (23 mm Hg) compared with verapamil (13 mm Hg) (P < 0.01). 4 The two drugs differed in their effects on measures of quality of life. The improvements in symptomatic complaints and psychological well-being on verapamil may have been due to inclusion in a trial, although we cannot exclude the possibility of a drug effect. Conversely the increase in symptoms and self-assessed cognitive impairment on nifedipine were considered to be side-effects of the drug.

Greater emphasis is being placed on multidisciplinary team (MDT) working for complex clinical presentations in the NHS. Whilst such integrated working has the potential for considerable benefits for clients, it also raises the issue of constructive and destructive decision-making within teams that bring together different individuals and professional groupings. This paper outlines a model which attempts to address how individuals in a MDT can hold onto their own personal and professional identity whilst simultaneously adopting a team identity. Thus how the 'me' and the 'we' operate to assist the client. The model, termed the 'Narcissistic-We', was developed out of multidisciplinary team working with traumatised individuals in Belfast and has particular relevance for decision-making in MDTs. The model argues that MDTs operate along two continua, the first running from 'me' to 'team' and the second running from 'me' to 'client'. When overlaid these continua create four quadrants. It is suggested that no clinical decisions should be made in the 'Me-Me' quadrant and most decisions should come from the 'Client-Team' quadrant. However, there are times when decisions are required from the 'Me-Client' and 'Me-Team' quadrants. The development, practical implications and research possibilities of this model are discussed.