Publications by authors named "Scott R Mooney"

6 Publications

  • Page 1 of 1

Trauma Management Therapy and Prolonged Exposure Therapy for PTSD in an active duty sample: Design and methodology of a randomized clinical trial.

Contemp Clin Trials Commun 2020 Mar 15;17:100491. Epub 2019 Nov 15.

US Army Center for Environmental Health Research, Fort Detrick, MD, USA.

Posttraumatic stress disorder (PTSD) resulting from military service is a common, yet often chronic condition. Treatment outcome often is attenuated by programs that are (a) lengthy in nature and (b) constricted in their target outcomes. These limitations leave much of the emotional and behavioral impairment that accompanies PTSD unaddressed and/or unassessed. Typical PTSD treatment programs are 3-4 months in length, which is challenging for the pace of the nation's military. In this investigation, we will compare two treatments, Trauma Management Therapy (TMT) and Prolonged Exposure (PE), both redesigned to address the needs of active duty personnel (300 participants at 3 military installations). Specifically, we will compare the TMT Intensive Outpatient Program (IOP; 3 weeks) to PE's compressed (2 week) format. Both interventions will be compared to a standard course of PE (12 weeks). In addition to PTSD symptomatology, outcome measurement includes other aspects of psychopathology as well as changes in social, occupational, and familial impairment. Potential negative outcomes of massed treatment, such as increased suicidal ideation or increased alcohol use, will be assessed, as will genetic predictors of PTSD subtype and treatment outcome. This study will inform the delivery of care for military-related PTSD and particularly the use of intensive or compressed treatments for active duty personnel.
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http://dx.doi.org/10.1016/j.conctc.2019.100491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881668PMC
March 2020

Medical Evaluation Board Involvement, Non-Credible Cognitive Testing, and Emotional Response Bias in Concussed Service Members.

Mil Med 2018 11;183(11-12):e546-e554

University of South Carolina-Aiken, 471 University Parkway, Aiken, SC.

Introduction: Military Service Members (SMs) with post-concussive symptoms are commonly referred for further evaluation and possible treatment to Department of Defense Traumatic Brain Injury Clinics where neuropsychological screening/evaluations are being conducted. Understudied to date, the base rates of noncredible task engagement/performance validity testing (PVT) during cognitive screening/evaluations in military settings appears to be high. The current study objectives are to: (1) examine the base rates of noncredible PVTs of SMs undergoing routine clinical or Medical Evaluation Board (MEB) related workups using multiple objective performance-based indicators; (2) determine whether involvement in MEB is associated with PVT or symptom exaggeration/symptom validity testing (SVT) results; (3) elucidate which psychiatric symptoms are associated with noncredible PVT performances; and (4) determine whether MEB participation moderates the relationship between psychological symptom exaggeration and whether or not SM goes on to demonstrate PVTs failures - or vice versa.

Materials And Methods: Retrospective study of 71 consecutive military concussion cases drawn from a DoD TBI Clinic neuropsychology clinic database. As part of neuropsychological evaluations, patients completed several objective performance-based PVTs and SVT.

Results: Mean (SD) age of SMs was 36.0 (9.5), ranging from 19-59, and 93% of the sample was male. The self-identified ethnicity resulted in the following percentages: 62% Non-Hispanic White, 22.5% African American, and 15.5% Hispanic or Latino. The majority of the sample (97%) was Active Duty Army and 51% were involved in the MEB at the time of evaluation. About one-third (35.9%) of routine clinical patients demonstrated failure on one or more PVT indicators (12.8% failed 2) while PVT failure rates amongst MEB patients ranged from 15.6% to 37.5% (i.e., failed 2 or 1 PVTs, respectively). Base rates of failures on one or more PVT did not differ between routine clinical versus MEB patients (p = 0.94). MEB involvement was not associated with increased emotional symptom response bias as compared to routine clinical patients. PVT failures were positively correlated with somatization, anxiety, depressive symptoms, suspicious and hostility, atypical perceptions/alienation/subjective cognitive difficulties, borderline personality traits/features, and penchant for aggression in addition to symptom over-endorsement/exaggeration. No differences between routine clinical and MEB patients across other SVT indicators were found. MEB status did not moderate the relationship between any of the SVTs.

Conclusion: Study results are broadly consistent with the prior published studies that documented low to moderately high base rates of noncredible task engagement during neuropsychological evaluations in military and veteran settings. Results are in contrast to prior studies that have suggested involvement in MEB is associated with increased likelihood of poor PVT performances. This is the first to show that MEB involvement did not enhance/strengthen the association between PVT performances and evidence of SVTs. Consistent with prior studies, these results do highlight that the same SMs who fail PVTs also tend to be the ones who go on to endorse a myriad of psychiatric symptoms and proclivities. Implications of variable or poor task engagement during routine clinical and MEB neuropsychological evaluation in military settings on treatment and disposition planning cannot be overstated.
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http://dx.doi.org/10.1093/milmed/usy038DOI Listing
November 2018

Assessing the accuracy of blood RNA profiles to identify patients with post-concussion syndrome: A pilot study in a military patient population.

PLoS One 2017 1;12(9):e0183113. Epub 2017 Sep 1.

Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America.

Mild traumatic brain injury (mTBI) is a complex, neurophysiological condition that can have detrimental outcomes. Yet, to date, no objective method of diagnosis exists. Physical damage to the blood-brain-barrier and normal waste clearance via the lymphatic system may enable the detection of biomarkers of mTBI in peripheral circulation. Here we evaluate the accuracy of whole transcriptome analysis of blood to predict the clinical diagnosis of post-concussion syndrome (PCS) in a military cohort. Sixty patients with clinically diagnosed chronic concussion and controls (no history of concussion) were recruited (retrospective study design). Male patients (46) were split into a training set comprised of 20 long-term concussed (> 6 months and symptomatic) and 12 controls (no documented history of concussion). Models were validated in a testing set (control = 9, concussed = 5). RNA_Seq libraries were prepared from whole blood samples for sequencing using a SOLiD5500XL sequencer and aligned to hg19 reference genome. Patterns of differential exon expression were used for diagnostic modeling using support vector machine classification, and then validated in a second patient cohort. The accuracy of RNA profiles to predict the clinical diagnosis of post-concussion syndrome patients from controls was 86% (sensitivity 80%; specificity 89%). In addition, RNA profiles reveal duration of concussion. This pilot study shows the potential utility of whole transcriptome analysis to establish the clinical diagnosis of chronic concussion syndrome.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0183113PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581162PMC
October 2017

Rationale for Spiritually Oriented Cognitive Processing Therapy for Moral Injury in Active Duty Military and Veterans With Posttraumatic Stress Disorder.

J Nerv Ment Dis 2017 02;205(2):147-153

*Duke University Medical Center, Durham, NC; †King Abdulaziz University, Jeddah, Saudi Arabia; ‡School of Public Health, Ningxia Medical University, Yinchuan, China; §Durham Veterans Administration Medical Center, Center for Aging, Duke University Medical Center; ∥Durham Veterans Affairs Medical Center, Durham, NC; ¶Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University; #Department of Orthopedics, Neurosciences, & Rehabilitation, Eisenhower Army Medical Center, Augusta, GA; **Psychology Department, University of South Alabama, Mobile, AL; and ††Department of Family and Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD.

Wartime experiences have long been known to cause ethical conflict, guilt, self-condemnation, difficulty forgiving, loss of trust, lack of meaning and purpose, and spiritual struggles. "Moral injury" (MI) (also sometimes called "inner conflict") is the term used to capture this emotional, cognitive, and behavioral state. In this article, we provide rationale for developing and testing Spiritually Oriented Cognitive Processing Therapy, a version of standard cognitive processing therapy for the treatment of MI in active duty and veteran service members (SMs) with posttraumatic stress disorder symptoms who are spiritual or religious (S/R). Many SMs have S/R beliefs that could increase vulnerability to MI. Because the injury is to deeply held moral standards and ethical values and often adversely affects spiritual beliefs and worldview, we believe that those who are S/R will respond more favorably to a therapy that directly targets this injury from a spiritually oriented perspective. An evidence-based treatment for MI in posttraumatic stress disorder that not only respects but also utilizes SMs' spiritual beliefs/behaviors may open the door to treatment for many S/R military personnel.
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http://dx.doi.org/10.1097/NMD.0000000000000554DOI Listing
February 2017

Military inpatient residential treatment of substance abuse disorders: the Eisenhower Army Medical Center experience.

Mil Med 2014 Jun;179(6):674-8

Dwight D. Eisenhower Army Medical Center, 300 E. Hospital Road, Fort Gordon, GA 30905.

Opened in 2009, the Dwight D. Eisenhower Army Medical Center Inpatient Residential Treatment Facility (RTF) is the largest and most well-established inpatient substance use disorder treatment facility in the Department of Defense. The RTF is a 28-day inpatient treatment program that employs evidence-based practices and is based on Alcoholics/Narcotics Anonymous principles that are incorporated with a hybrid of military daily structure regime including early morning physical training. Family involvement is encouraged. The RTF is staffed by a multidisciplinary team specializing in addictions and admits Active/Activated Service Members (SMs) from all Service branches, typically those who have failed other military/civilian substance use disorder programs. Eighty-seven percent of SMs referred to the program successfully commenced, with continuous sobriety observed in over half of SMs 6 months later, and 1 year relapse rates comparable to other alcohol treatment programs. Limitations of our program evaluation efforts, lessons learned, and recommendations for the way ahead are shared.
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http://dx.doi.org/10.7205/MILMED-D-13-00308DOI Listing
June 2014

Concussions and the military: issues specific to service members.

PM R 2011 Oct;3(10 Suppl 2):S380-6

Traumatic Brain Injury Program, Neuroscience and Rehabilitation Center, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA.

Since October 2001, more than 1.6 million American military service members have deployed to Iraq and Afghanistan in the Global War on Terrorism. It is estimated that between 5% and 35% of them have sustained a concussion, also called mild traumatic brain injury (mTBI), during their deployment. Up to 80% of the concussions experienced in theater are secondary to blast exposures. The unique circumstances and consequences of sustaining a concussion in combat demands a unique understanding and treatment plan. The current literature was reviewed and revealed a paucity of pathophysiological explanations on the nature of the injury and informed treatment plans. However, through observation and experience, a theoretical but scientifically plausible model for why and how blast injuries experienced in combat give rise to the symptoms that affect day-to-day function of service members who have been concussed has been developed. We also are able to offer treatment strategies based on our evaluation of the current literature and experience to help palliate postconcussive symptoms. The purpose of this review is to elucidate common physical, cognitive, emotional, and situational challenges, and possible solutions for this special population of patients who will be transitioning into the civilian sector and interfacing with health professionals. There is a need for further investigation and testing of these strategies.
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http://dx.doi.org/10.1016/j.pmrj.2011.08.005DOI Listing
October 2011