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case study of Matthew. Complete the following forms in the PCN-485 Client File: Presenting Problem Risk Assessment NOTE: As a case manager, you will have to update your documentation based on feedback from your supervisor. In this course, the components of the Client File will be assigned and graded progressively as you proceed through the Topics. However, it is expected that you make any corrections from instructor feedback for each component. Part of the Topic 8 assignment is to submit the Discharge Summary in combination with the rest of the Client File components as one fully gradable assignment. THE CASE IS: CASE STUDY MATTHEW AS FOLLOWS:Matthew Smith 42-years-old African American Referred by: Dr. Thomas Charles Medical symptoms: Drinking/possible abuse of OxyContin Abdomen pain from military service injury Anxiety Depression Education: Masters of Science in Computer Information Systems Army Veteran/Discharged December, 1992 Client Demographic Information Matthew Smith is a 42-year-old African American male. He has a Master’s Degree in Computer Information Systems. He classifies himself as a Southern Baptist. Matthew’s annual income is over $40,000 and he is employed full-time as an Information Specialist at a local university. He is married to Jasmine and they have one child: Brandon, who is eight years old. He describes himself as “nonpolitical” since he returned from the Gulf War in 1992 and states he "is angry at many people within the government." He and his family currently live in a small home in the suburbs, which is a 45-minute commute for him to drive to work. Client History Matthew graduated high school in 1989 and left for the United States Army shortly thereafter. After boot camp, he was deployed to Operation Desert Storm in January of 1991. Stationed in Kuwait, Matthew’s main job was to operate the electronic systems inside one of the tanks. He was responsible for coordinating ammunition and maintaining communications with his commanding officer at the base. While on a particularly dangerous mission at night, Matthew and his comrades were ambushed, and most of his platoon was killed. Matthew himself was injured when a piece of shrapnel was lodged inside his abdomen, rendering him helpless in the operation of the electronic equipment within the tank. After being rescued by other men from his unit, Matthew was taken to the Veteran’s Hospital in Virginia to recover from the injury to his abdomen that he sustained during the mission. During that time, Matthew became very depressed. At night, he would have nightmares about the incident. At the most unexpected times, Matthew’s thought process would shift from a normal event back to the time of the ambush. He tried not to let these things bother him, but he states "it was becoming increasingly difficult." It was in the hospital that he met Jasmine, one of the nurses. She was assigned as his nurse, and helped him with his physical therapy. Upon discharge, Matthew asked her on a date and they were married a few months later. High-Risk Behaviors The first few months of their marriage were blissful. Matthew hadn’t experienced any nightmares, nor did he have flashbacks or intrusive thoughts, but he did find himself taking more and more OxyContin to dull the pain in his abdomen. He had never had any concerns with physical pain before in his life, and the pain medication seemed to be something he was beginning to rely on, since he was prescribed this during his recovery time in the hospital. Many times, he felt as if he were in a “fog.” Jasmine had their first child, Brandon, several years later. It was in the delivery room where Matthew had his first panic attack in a long time. Seeing his wife give birth triggered something in his mind that caused him to emotionally shut down. He tried to bond with his son, but was having more difficulty as time passed. Jasmine was very angry at him and didn’t understand how he couldn’t love such a sweet baby. After she and the baby went to bed, Matthew would take more pain killers and wash them down with whiskey until he fell asleep in the recliner. Matthew felt that he needed to go to college and use his GI Bill, hoping it would make him feel more like a father and husband. He quickly obtained his Bachelor’s Degree, and then received his Master’s Degree in Computer Information Systems. Matthew felt like he could handle the emotional pain of going through his experiences in the war, and that a few drinks before class helped him concentrate better. He felt as if his life was getting better and he found a job at the local university as a computer technician. He disclosed to his supervisor that he was taking prescription medication for an old “war injury”, but it wouldn’t impact his performance. He worked his way up the ladder and now he is an Information Specialist. After one particularly difficult day at work, Matthew felt like he needed to take some OxyContin that he was prescribed from the attending physician when he was recovering from his war injuries. Sitting in his car, he took an extra pill and drank from a flask he had in his glove box. As he was driving home, he witnessed a car accident. A van had run a red light and side-swiped a car. He wanted to help, but just froze. He felt as if he couldn’t move. He pulled his car over to the nearest parking lot and began having a panic attack. He felt as if he couldn’t breathe and thought he was having a heart-attack. Looking out his window, he saw a bar and grill. He went to the bar and ordered a shot of something that burned going down. Next thing he knew, it was midnight and the bartender had cut him off. Matthew went back to his car and fell asleep. Co-Occurring Disorders The next day, Jasmine was furious that Matthew hadn’t come home the night before. When he tried to explain, she didn’t believe him. He told her that he was experiencing flashbacks from the war, remembering the blood and men screaming in the night. He broke down and started crying and Jasmine realized that he must be experiencing extreme stress. She called the local veteran’s mental health agency to schedule an appointment for the following week. Matthew felt as if he couldn’t wait that long for his appointment. He called in sick to work and drove to the liquor store where he purchased hard liquor. He had taken plenty of shots with his Army buddies, so he felt as if he knew how to hold his liquor. He just wanted to take the edge off until Jasmine got home from work. Psychotropic Medication Matthew met with the case manager he was referred to by the Veteran’s Administration. When the case manager asked Matthew why he was there and what motivated him to receive treatment, he replied “I just want my life and my family back―I’m so sick of this war in my head.” The agency’s psychiatrist, Dr. Thomas Charles, met with Matthew and decided that Matthew should begin taking an anti-depressant to help him stabilize his mood. The doctor also prescribed Xanax, an anti-anxiety medication, for the times in which Matthew experiences a panic attack or feels that he is getting ready to have a flashback or intrusive thought. Service Gaps in Treatment After a few months, Matthew felt on top of the world. His medication had balanced out his mood and he and Jasmine were getting along. He was able to hide the drinking from her and Brandon, and felt like he was being a better father. He realized it wasn’t Brandon’s fault that he kept “freaking out.” Matthew let his prescription lapse because he felt he was doing "Okay." After about two weeks, Matthew started feeling more depressed and anxious and felt he needed alcohol to help him through. Since he didn’t have any more medication, he was worried about telling his wife and making another appointment with the doctor. He felt like a failure.