27 year old female with fixed ideas not shared by anyone else

Basanti 27 years old female, thinks her nose is ugly; her idea is fixed and not shared by anyone else. Whenever she goes out of home, she hides her face with a cloth. She visits a surgeon. Next step in management would be;

A. Investigate and then operate
B. Refer to Psychiatrist
C. Reassure the patient
D. Immediate operation

Answer is B. Refer to Psychiatrist.
The patient is suffering from a delusional disorder with all findings consistent with the diagnosis of delusional disorder.

• Operation has obviously no role
• Reassuring a patient with a firm and unshakable delusional belief is not of any help
• Only a psychiatrist is equipped with the necessary knowledge to handle such a patient. Hence, refer if you must.