Continuity of Care in Persistent Delusional Disorder: The Role of the Family Doctor

Family doctors (FDs) play a central role in the early recognition and longitudinal management of severe mental illness (SMI), often acting as gatekeepers to psychiatric care. However, some patients refuse mental health services due to limited insight, stigma, or mistrust. In such cases, continuity of care and a strong therapeutic relationship in primary care can be crucial in facilitating engagement. We report the case of a 62-year-old man who presented to the emergency department after ingesting multiple paracetamol tablets for abdominal pain. In light of the persecutory delusions observed during assessment, psychiatric evaluation was requested, and hospitalization was recommended. The patient, however, refused admission and did not attend follow-up. During subsequent primary care visits, he remained delusional and declined psychiatric referral. Over the following year, his FD maintained regular follow-up, and a consistent empathetic approach gradually earned the patient's trust. This was followed by the patient's acceptance of referral and attendance at an initial psychiatric appointment, although he subsequently disengaged from follow-up once again. Due to clinical deterioration, involuntary psychiatric admission was required. He was diagnosed with persistent delusional disorder, and after 23 days of antipsychotic treatment, his condition improved significantly. Following discharge, he remained clinically stable with ongoing psychiatric follow-up. This case highlights the role of FDs in maintaining patient engagement when psychiatric care is initially refused. FD continuity of care may help facilitate later engagement with psychiatric services and improve access to treatment in patients with SMI.