Matthew Gunther, MD, MA
Clinical Assistant Professor, Psychiatry and Behavioral Sciences - Medical Psychiatry
Bio
Dr. Matthew Gunther graduated with a BA in psychology from the University of Southern California in 2009. Afterwards, he pursued training as a Marriage and Family Therapist, earning a Master of Arts in Clinical Psychology at Pepperdine University in 2011. His career goals shifted from a focus on psychotherapy towards medicine, subsequently graduating from medical school from the University of California, Irvine in 2018. Dr. Gunther completed his general adult psychiatry residency at the University of Southern California/LAC+USC Medical Center in 2022 where he served as Chief Resident for the inpatient service. He subsequently completed his Consultation-Liaison Psychiatry fellowship at Stanford University in 2023.
Dr. Gunther has a passion for teaching and mentorship of medical trainees at all levels. Throughout all stages of training, he was actively involved in admissions, as well as program development. During residency, his particular focus was on curriculum development for inpatient psychiatry, as well as quality improvement projects focused on staff safety and accessibility of psychiatry services for the Los Angeles County population. His work on these areas, in addition to teaching efforts and scholarly work, earned him the Excellence in Residency award for each year of residency training.
Dr. Gunther joined the faculty as a Clinical Assistant Professor of Psychiatry at the Stanford University School of Medicine in July 2023 and currently serves as Assistant Program Director of the Consultation-Liaison Psychiatry Fellowship. His interests in psychiatry include critical care psychiatry, transplant psychiatry, neuropsychiatry, medical education, psychopharmacology in the medically ill, and integrated care. Dr. Gunther works in the Integrated Behavioral Health program where he is Director of Education, with particular focus on resident-based primary care clinics. In addition, he is an attending on the Critical Care and Inpatient Consult-Liaison Psychiatry services.
Clinical Focus
- Psychiatry
- Consultation-Liaison Psychiatry
- Critical Care Psychiatry
- Transplant Psychiatry
- Neuropsychiatry
- Psychopharmacology in the Medically Ill
- Integrated Care
Academic Appointments
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Clinical Assistant Professor, Psychiatry and Behavioral Sciences - Medical Psychiatry
Administrative Appointments
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Assistant Program Director, Consultation-Liaison Psychiatry Fellowship, Stanford School of Medicine (2024 - Present)
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Director of Education, Integrated Behavioral Health Program (2023 - Present)
Boards, Advisory Committees, Professional Organizations
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Member, American Psychiatric Association (2014 - Present)
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Member, Academy of Consultation-Liaison Psychiatry (2019 - Present)
Professional Education
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Medical Education: University of California at Irvine School of Medicine (2018) CA
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Board Certification: American Board of Psychiatry and Neurology, Psychiatry (2022)
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Fellowship, Stanford University, Consultation-Liaison Psychiatry (2023)
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Residency, University of Southern California/LAC+USC Medical Center (2022)
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MD, University of California, Irvine (2018)
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MA, Pepperdine University, Clinical Psychology with an Emphasis in Marriage and Family Therapy (2011)
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BA, University of Southern California, Psychology (2009)
All Publications
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Zolpidem for the Management of Catatonia: A Systematic Review.
Journal of the Academy of Consultation-Liaison Psychiatry
2024
Abstract
Catatonia is a psychomotor syndrome associated with neurotransmitter disturbances, common in both psychiatric and medical settings. Hypoactivity of the GABAA receptor is one of the predominant theories behind the pathophysiology of catatonia, affecting both motor functioning and emotional regulation. Benzodiazepines such as lorazepam are considered the first-line treatment for catatonia. However, up to 27% of catatonia cases fail to respond to benzodiazepines alone. Zolpidem, which can be used as a challenge, monotherapy, or augmentation agent, serves as a promising pharmacological agent for catatonia due to its unique pharmacodynamic and pharmacokinetic profile.We sought to systematically examine the evidence behind zolpidem's use among adult patients to understand its clinical utility in the management of catatonia against prevailing treatments such as lorazepam and electroconvulsive therapy (ECT).We conducted a systematic review using search terms related to zolpidem and catatonia in PubMed, EMBASE, and Web of Science. We followed PRISMA guidelines and identified 29 studies, including case studies and case series, that met inclusion criteria.We reviewed 35 cases in which zolpidem was used for catatonia management (age: M =51.5 ± 21.0 SD years; 68.6% female; Bush Francis Catatonia Rating Scale: M=22.2 ± 9.0 SD). Proportions of positive responses for zolpidem on catatonia varied by treatment approach: 91% as a challenge agent (n=10), 100% as a first-line monotherapy agent (n=3), 57% as a first-line combination therapy agent (n=4), 70% as a second-line monotherapy agent (n=7), and 100% as a second-line augmentation agent (n=4). In total, 28 out of the 35 reported cases of catatonia (80%) responded positively to zolpidem.An 80% positive response rate for zolpidem in lysing catatonia is encouraging but may be an overestimate due to reporting bias of case level data. Results may be explained by zolpidem's selectivity for the α1 subunit of the GABAA receptor. Thus, zolpidem may be an under-utilized catatonia treatment and prove useful in situations when benzodiazepines fail or when ECT access is limited. Given that current literature on the use of zolpidem for catatonia is limited to case reports, more robust research in this area is warranted.
View details for DOI 10.1016/j.jaclp.2024.10.004
View details for PubMedID 39522949
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Steroid-Induced Musical Hallucinosis.
The primary care companion for CNS disorders
2024; 26 (4)
View details for DOI 10.4088/PCC.24cr03705
View details for PubMedID 39121190
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Pimavanserin for Delirium Management in the Setting of Parkinson's Disease: A Case Report.
Journal of the Academy of Consultation-Liaison Psychiatry
2024
View details for DOI 10.1016/j.jaclp.2024.07.007
View details for PubMedID 39069171
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Comparison of delirium assessment tools in critically-ill patients: The CAM-ICU versus the Stanford Proxy Test for Delirium (S-PTD). Which one performed best?
PERGAMON-ELSEVIER SCIENCE LTD. 2024
View details for DOI 10.1016/j.jpsychores.2024.111757
View details for Web of Science ID 001276847900057
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Dextroamphetamine as Adjunctive Pharmacotherapy for Aggression Secondary to Korsakoff Syndrome: A Case Report.
Journal of the Academy of Consultation-Liaison Psychiatry
2024
View details for DOI 10.1016/j.jaclp.2024.02.006
View details for PubMedID 38417703
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Nortriptyline-Induced Room Tilt Illusion
CUREUS JOURNAL OF MEDICAL SCIENCE
2024; 16 (1)
View details for DOI 10.7759/cureus.52101
View details for Web of Science ID 001154040100002
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Herba Epimedii and Increased Opioid Cravings While on Buprenorphine: A Case Report.
Cureus
2024; 16 (1): e51886
Abstract
Herba Epimedii, commonly known as yin yang huo, inyokaku, and horny goat weed, is a traditional Chinese herbal medicine utilized for treating osteoporosis and enhancing libido. Studies conducted in vitro have demonstrated that Herba Epimedii interacts with the enzyme cytochrome P450 3A4 (CYP3A4). This interaction poses a potential risk for drug-drug interactions, particularly with medications metabolized by CYP3A4, such as buprenorphine. This paper presents a case of a patient experiencing exacerbated opioid cravings following the initiation of Herba Epimedii. This is the first reported case supporting this interaction, emphasizing the necessity of screening for alternative medicines in patients undergoing medication-assisted treatments for opioid use disorder.
View details for DOI 10.7759/cureus.51886
View details for PubMedID 38327958
View details for PubMedCentralID PMC10849866
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Nortriptyline-Induced Room Tilt Illusion.
Cureus
2024; 16 (1): e52101
Abstract
Room tilt illusion (RTI) is a rare and transient perceptual disturbance in which an individual perceives their surroundings as having been rotated or tilted, usually at 90 or 180 degrees. Primarily linked with vestibular disorders and neurological lesions, this report details the only reported occurrence of the RTI phenomena in nortriptyline use for treatment-refractory depression. The patient developed RTI six days after starting the medication and the disturbance resolved after medication cessation. Although the mechanism behind such a phenomenon with medication use has not been elucidated, its etiology may rest on the effect of tricyclic antidepressants on the vestibulo-thalamo-cortical system and visual-vestibular integration. Clinicians should be aware of the potential for such a medication-induced perceptual disturbance, especially in the workup for more serious etiologies in elderly patients with co-morbidities.
View details for DOI 10.7759/cureus.52101
View details for PubMedID 38344625
View details for PubMedCentralID PMC10858726
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Irreversible Lithium Neurotoxicity: A Review and Case of Toxicity Leading to Bilateral Globus Pallidus Injury
ELSEVIER SCIENCE INC. 2023: S129
View details for DOI 10.1016/j.jaclp.2023.11.260
View details for Web of Science ID 001161339100244
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Delayed-Onset Psychosis After Lung Transplant Secondary to Tacrolimus Neurotoxicity
ELSEVIER SCIENCE INC. 2023: S99
View details for DOI 10.1016/j.jaclp.2023.11.667
View details for Web of Science ID 001161339100187
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Delayed-Onset Psychosis Secondary to Tacrolimus Neurotoxicity After Lung Transplant: A Case Report and Systematic Review.
Journal of the Academy of Consultation-Liaison Psychiatry
2023
Abstract
Tacrolimus is the most common immunosuppressant used after transplant, yet it can result in moderate-to-severe neurotoxicity in up to 32% of patients. Signs of neurotoxicity can vary from mild (tremor or headache) to severe (posterior reversible encephalopathy syndrome or psychosis. Prompt recognition and management is needed to lead to symptom resolution.The objective of this study is to describe the clinical presentation of tacrolimus-induced psychosis, a type of tacrolimus-inducted neurotoxicity, and distinguish it from other central nervous system disturbances, including delirium.We present a case of delayed onset tacrolimus-induced psychosis with focus on unique clinical features and management strategies. We conducted a systematic review of cases of tacrolimus-induced psychosis using the PubMed database and included 15 manuscripts in our review.Tacrolimus-induced psychosis is a unique presentation of tacrolimus-related neurotoxicity and can present without the cardinal symptoms of delirium. The data on isolated psychotic symptoms are limited with current literature focusing on more common presentations of tacrolimus-induced neurotoxicity, such as delirium and tremor. Development of psychosis can occur later in the treatment course and at normal tacrolimus serum levels. It can improve with antipsychotic therapies, but primary management should include cross-titration to an alternate immunosuppressant regimen.
View details for DOI 10.1016/j.jaclp.2023.09.002
View details for PubMedID 37778461
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Bilateral Globus Pallidus Injury in the Setting of Lithium Toxicity: A Case Report
JOURNAL OF THE ACADEMY OF CONSULTATION-LIAISON PSYCHIATRY
2023; 64 (5): 484-485
View details for Web of Science ID 001073580400001
View details for PubMedID 37689462
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Accelerated-Onset Diabetes Insipidus Secondary to Lithium Use.
The primary care companion for CNS disorders
2023; 25 (3)
View details for DOI 10.4088/PCC.22cr03427
View details for PubMedID 37347676
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Bilateral Globus Pallidus Injury in the Setting of Lithium Toxicity: A Case Report.
Journal of the Academy of Consultation-Liaison Psychiatry
2023; 64 (5): 484-485
View details for DOI 10.1016/j.jaclp.2023.04.008
View details for PubMedID 37689462
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Management of Neuropsychiatric Manifestations of Susac Syndrome Using Valproic Acid
JOURNAL OF THE ACADEMY OF CONSULTATION-LIAISON PSYCHIATRY
2023; 64 (1): 92-93
View details for Web of Science ID 000967841000001
View details for PubMedID 36764750
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Antipsychotic Safety in Liver Disease: A Narrative Review and Practical Guide for the Clinician
JOURNAL OF THE ACADEMY OF CONSULTATION-LIAISON PSYCHIATRY
2023; 64 (1): 73-82
Abstract
Clinicians treating psychiatric disorders in medically ill patients need a comprehensive resource for comparing the risk and types of liver injury associated with antipsychotic therapy.We conducted a narrative review aimed at developing a comprehensive resource comparing antipsychotics with regard to risk of inducing or worsening liver injuries, types of liver injury, associated pharmacokinetic changes, dosing, monitoring, and patient counseling recommendations.We conducted database searches of LiverTox.nih.gov, DailyMed.nlm.nih.gov, and PubMed through June of 2022. Sources describing premarketing data, observational studies, case reports and case series of antipsychotic-induced liver injuries, types of hepatic dysfunction, interventions, recovery, and treatment for 15 antipsychotics were included. Duplicate reports were excluded. Antipsychotics were graded as low, low to moderate, moderate, moderate to high, or high risk for causing or worsening a liver disease.Of the 1861 publications, 21 papers met criteria and were included. Evidence shows antipsychotic-induced liver dysfunction is uncommon to rare. Chlorpromazine, clozapine, and olanzapine pose the greatest risk of hepatoxicity; quetiapine and risperidone pose a moderate risk with haloperidol considered to pose low to moderate risk. Paliperidone, aripiprazole, lurasidone, and loxapine are lower-risk agents with no reports of liver failure. Transaminitis that is mild and self-limiting is the most common antipsychotic-induced liver injury followed by hepatocellular disease, steatosis, and mixed liver injury. A careful risk-benefit analysis should guide the decision to discontinue the antipsychotic in cases of severe liver disease. Dose adjustments and careful monitoring are recommended for a mild to moderate disease when the benefits of treating psychosis outweigh the risks. Patients without an existing liver disease initiating a treatment with a higher-risk antipsychotic should be counseled to report symptoms of liver injuries along with regular lab monitoring.Antipsychotic selection, dosing, monitoring, and counseling should be individualized based on whether a patient has an existing liver disease and if they are receiving an agent that poses a higher risk of liver injury. The consultation-liaison psychiatry provider can guide the primary team in management through thoughtful integration of the known pathophysiologic changes in hepatic disease and risk-benefit analysis of antipsychotic safety profiles.
View details for Web of Science ID 000967822100001
View details for PubMedID 36180017