When should I consider referring a patient with delusional disorder to a psychiatrist for further evaluation?

Consider referring a patient with delusional disorder to a psychiatrist for further evaluation when:

• There is diagnostic uncertainty or difficulty distinguishing delusional disorder from other psychotic or mood disorders, as specialist assessment can clarify diagnosis and guide management ¹.
• The patient exhibits significant functional impairment, risk of harm to self or others, or complex comorbid psychiatric or medical conditions requiring integrated care ¹.
• Initial treatment attempts in primary care have been ineffective, or the patient requires initiation or adjustment of antipsychotic medication, which should be managed by a psychiatrist ¹.
• The delusional symptoms are persistent, distressing, or worsening despite standard interventions, indicating the need for specialist input to consider alternative or adjunctive therapies (González-Rodríguez et al., 2022).
• There is a need for multidisciplinary collaboration, including psychological therapies or liaison with other medical specialties, which psychiatrists are best placed to coordinate (González-Rodríguez et al., 2022).

Early referral facilitates comprehensive assessment, risk management, and access to specialised treatments, improving patient outcomes ¹ (González-Rodríguez et al., 2022).