Reassessing carbamazepine in the treatment of bipolar disorder: clinical implications of new data

This monograph summarizes the proceedings of a roundtable meeting convened to discuss the role of carbamazepine in the treatment of bipolar disorder, in light of new data and the recent indication of carbamazepine extended-release capsules (CBZ ERC) for use in the treatment of acute manic and mixed episodes. Two lectures were presented, followed by a panel discussion among all 6 participants. A summary of the two pivotal trials of CBZ ERC and their pooled data along with other relevant data is presented first. Next, historical trends of carbamazepine and the agent's use in acute mania, bipolar depression, and maintenance are reviewed, emphasizing clinical implications of efficacy, safety, tolerability, and drug interactions. Finally, the panel discussion provides recommendations for the use of carbamazepine in different phases of the illness, taking into account adverse effects and drug-drug interactions. Panel discussants agree that current data confirm the utility of CBZ ERC as an effective treatment for acute manic and mixed episodes in bipolar disorder. Carbamazepine may also prove to be an option for maintenance treatment. Tolerability of the drug is related to dose and titration, and overall safety limitations regarding carbamazepine usage are comparable to other medications. For some patients, the main challenges to use of carbamazepine may be common drug-drug interactions and increased side effects related to aggressive introduction during treatment of acute manic and mixed episodes. Thus, carbamazepine may be a lower priority option for patients who are taking multiple medications, such as elderly individuals with medical comorbidity, due to the potential for drug interactions. Important benefits of carbamazepine include the low propensity toward weight gain and evidence of good tolerability with long-term treatment. (At present there are no available data from long-term, placebo-controlled studies evaluating the effects of carbamazepine or CBZ ERC on weight.) Thus, carbamazepine may be a good option for patients who are concerned about weight gain or who are intolerant of or respond poorly to other medications. Further efforts are needed to update physicians on the use of carbamazepine relative to other medications in the treatment of bipolar disorder.     

Consequences of autonomous and team-oriented forms of dispositional proactivity for demonstrating advancement potential

Under the paradigm of individualism, proactive personality has garnered much attention in connection with indicators of career success. We regard this construct as an autonomous form of dispositional proactivity and explored it along with team-oriented proactivity as a predictor of self-perceived influence and observed advancement potential in a team-based setting. We proposed that insofar as advancement potential entails demonstrating adeptness at furthering collective performance, autonomous proactivity would be detrimental whereas team-oriented proactivity would be beneficial. This proposition was the basis for a structural model with self-perceived influence as a mediator. Results from data on 672 personnel in 70 teams supported the model and the hypothesized consequences of autonomous (negative) and team-oriented (positive) forms of dispositional proactivity for observed advancement potential.     

Job-content Perceptions, Performance–reward Expectancies, and Absenteeism among Low-wage Public-sector Clerical Employees

This study explored relations of job-content perceptions (i.e., skill variety and task significance), and performance–reward expectancies, with absenteeism among 134 low-wage public-sector clerical employees. Results indicated that those employees who perceived limited performance–reward expectancies (i.e., lower instrumentality), and who considered their jobs to be either higher on skill variety or task significance, were likely to be absent more often. Moreover, the link between skill variety and absenteeism was moderated by instrumentality in a manner suggesting that respondents may have utilized absenteeism as a means of compensating for perceived workplace contributions not extrinsically rewarded. These findings further suggest that employees in occupational settings for which performance-related extrinsic rewards are less available may not respond to favorable job-content perceptions in the positive manner generally predicted by job characteristics theory.     

Achievement Orientation and Psychological Involvement in Job Tasks: The Interactive Effects of Work Alienation and Intrinsic Job Satisfaction1

As the tendency to strive for competence in one's work, achievement orientation is considered to engender psychological involvement in job tasks (i.e., job involvement‐role). However, this study posits that the positive relationship between achievement orientation and job involvement‐role is moderated by an attitude of disaffection toward the work role in general (i.e., high work alienation) and by dissatisfaction with the content of one's present job (i.e., low intrinsic job satisfaction). The results of hierarchical moderated regression analyses support the existence of complex interactions and suggest that a positive outlook toward the work role is necessary for achievement orientation to translate into greater job involvement‐role. Practical implications and directions for future research on job involvement role are considered.     

Intracerebroventricular Administration of Mineralocorticoid Receptor Antisense Oligonucleotides Attenuates Salt Appetite in the Rat

The anterior ventral third ventricle (AV3V) region of the brain contains high concentrations of mineralocorticoid receptors (MR) and glucocorticoid receptors (GR) that are important in the maintenance of body fluid and electrolyte balance as well as other physiological processes. Daily intracerebroventricular pulse injections of MR antisense oligonucleotides significantly suppressed deoxycorticosterone acetate (DOCA) induced salt appetite in a dose-related manner. Similar administration of GR antisense or scrambled/sense oligonucleotide into the third ventricle failed to inhibit salt appetite. Salt appetite aroused after adrenalectomy was not suppressed by MR antisense oligonucleotide treatments but was suppressed by an antisense oligonucleotide directed against the angiotensin II AT1 receptor subtype. Receptor binding analysis demonstrated that MR and GR oligonucleotide treatments each reduced their respective receptor subtypes. Finally, although GR antisense oligonucleotide treatment was ineffective in suppressing DOCA-induced salt appetite, this treatment did increase stress induced corticosterone release as well as delayed the recovery of corticosterone to basal levels after stress.     

Energetic Cost and Stability During Human Walking at the Preferred Stride Velocity

The possibility that preferred modes of locomotion emerge from dynamical and optimality constraints and the energetic and dynamical constraints on preferred and predicted walking frequency are explored in this article. Participants were required to walk on a treadmill at their preferred frequency, at a frequency predicted as the resonance of a hybrid pendulum-spring model of the legs, and at frequencies +/-15%, +/-25%, +/-35% of the predicted frequency. Walking at the preferred and predicted frequencies resulted in minimal metabolic costs and maximal stability of the head and joint actions. Mechanical energy conservation was constant across conditions. The head was more stable than the joints. The joints appeared to be in service of the head in maintaining a stable trajectory. The major findings of this study suggest a complementary relationship between energetic (physiological) and stability constraints in the adoption of a preferred frequency of walking. Multiple subsystems may be involved in constraining observed macroscopic behavior in intact biological systems. The approach and results of the study imply that a useful tack in understanding how dynamical control structures arise is to study the potential criteria that serve to act as constraints on skilled movement patterns in unimpaired and impaired populations.     

The cognitive foundations of cultural stability and diversity

The existence and diversity of human cultures are made possible by our species-specific cognitive capacities. But how? Do cultures emerge and diverge as a result of the deployment, over generations and in different populations, of general abilities to learn, imitate and communicate? What role if any do domain-specific evolved cognitive abilities play in the emergence and evolution of cultures? These questions have been approached from different vantage points in different disciplines. Here we present a view that is currently developing out of the converging work of developmental psychologists, evolutionary psychologists and cognitive anthropologists.     

Rethinking Economic Inequality

Secular discourse about problem of economic inequality rests on two foundational premises that are problematic from a theological point of view. First, individuals enter into society with the aim of bettering their own condition. Second, bettering one's own condition entails accruing more wealth and power so that one can fulfill more of one's desires. In this paper I argue that insofar as these premises shape market behavior, they actively promote excessive economic inequality. Ethical responses to the problem of economic inequality that do not challenge these assumptions are unlikely to effectively promote justice. A theological response to the problem of economic inequality should work to promote cultural change by reminding us that genuine human flourishing depends on communal ties and the higher human goods that material wealth is properly meant to support.     

Explaining Leader Well-Being in the Workplace from Leaders’ Identity,Reputation, and Charisma

Informed by evolutionary leadership theory, the current study investigates two forms of leader well-being in the workplace as explained by leaders’ self-perceived identity (i.e., self-ratings of dark personality), follower-judged reputation (i.e., subordinate-ratings of leaders' dark personality), and attributed charisma. Results, based on data from 386 followers matched with 268 leaders, linked both a Dark Triad identity and a Dark Triad reputation to less perceived social worth and job satisfaction among leaders. Additional results found leader charisma surpassed a Dark Triad identity and reputation as an explanatory factor, a finding we attribute to the salience and observability of charisma to followers. Lastly, our results also indicate a leader identity × charisma interaction. The pattern of moderation suggests followers respond to leader charisma in ways that encourage a leader and thereby buffer the otherwise inimical consequences of a Dark Triad identity. Overall, our research suggests that leaders’ subjective quality of work life is shaped by an interplay between internal propensity and acclaim from followers in the form of attributed charisma. Implications for organizations and evolutionary leadership theory are discussed.