When should I consider referring a patient with delusional disorder to

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

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 .
The patient exhibits significant functional impairment, risk of harm to self or others, or complex comorbid psychiatric or medical conditions requiring integrated care .
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 .
The delusional symptoms are persistent, distressing, or worsening despite standard interventions, indicating the need for specialist input to consider alternative or adjunctive therapies .
There is a need for multidisciplinary collaboration, including psychological therapies or liaison with other medical specialties, which psychiatrists are best placed to coordinate .

Early referral facilitates comprehensive assessment, risk management, and access to specialised treatments, improving patient outcomes .

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