Perplexity

The sense of perplexity is a key feature of delusional mood/atmosphere which plays an important role in the phenomenology of early psychosis. Here we begin this chapter by presenting a clinical scenario of the psychosis prodrome and refer to this case study as our basis of discussion. We provide a detailed picture of psychiatric and philosophical literature to investigate in depth the phenomenon of perplexity drawing from theories such as Conrad’s stage model of beginning schizophrenia before placing the original case study into context and discuss concepts related to a loss of common sense and delusional elaboration in the pathogenesis of the perplexed feelings experienced by many prodromal individuals. We end the chapter with clinical implications and offer potential suggestions for improving the assessment, diagnosis and treatment of early psychosis, in particular the importance of recognising the individual’s suffering and acknowledge his own reality.