Psychotic disorders are severe mental disorders, which are defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) [1] as syndromes rather than diseases. They are listed under the category ‘Schizophrenia spectrum and other psychotic disorders’. This category highlights that psychotic disorders are schizophrenia, other psychotic disorders and schizotypal (personality) disorder. Each psychotic disorder has a specific diagnosis and is distinguished mainly by its duration. However, what brings them all into the same category is the presence of abnormalities in one or more of the following domains: delusions, hallucinations, disorganised thinking, grossly disorganised or abnormal motor behaviour, and negative symptoms [1,2].

The prognosis of psychotic disorders worsens with late detection of symptoms. Therefore, the early detection of clinical manifestations is very important [1]. Attention to the prodromal phases of these disorders has only been recently established. Since then, management strategies have focused on early detection for the prescription of the most appropriate treatment approach [3]. The psychosis continuum includes a variety of psychotic symptoms that can be observed from the subclinical stages to the diagnosis and posterior stages of a psychiatric disorder, this is to say from the subclinical symptoms to the clinically significant symptoms [4]. In relation to this range of symptoms, there is controversy as to whether the psychotic symptoms are in a continuum with the psychoticlike experiences that healthy individuals can have. However, the scientific evidence indicates that the risk of developing a psychotic disorder increases in persons that have had psychoticlike experiences and have been exposed to risk factors [5]. The psychosis continuum model also supports that the transition individuals make through this spectrum throughout life will be determined by the protective factors and risk factors of the subject, and those determined by their family and social environment. Thus, strengthening the protective factors (promotion) and minimising the risk factors (prevention) can enable the individual to have adequate mental health [6]. Adolescence is a key stage for implementing this early detection, as it is a phase of life in which the person has to face neurophysiological, physical, cognitive, emotional and social changes induced by a more active cerebral cortex [2,3,7]. Poor mental health in adolescence can have a direct impact on the development of the person, limiting the potential of the adolescent. It can also have negative consequences, such as impaired social function, low educational attainment, unemployment, substance abuse, violence and suicide [3]. Currently, the literature on the factors that may affect the mental health of adolescents is very heterogeneous but the evidence indicates that stress, bullying and the consumption of toxic substances are the main explanatory factors [8,9]. Adolescence is a stage of life when the cerebral cortex is very active and therefore susceptible to irreversible and scattered changes, which may be magnified by these exogenous factors induced by new habits [8,9]. Therefore, it is sometimes difficult to discern what may trigger these changes [9]. Although the available scientific evidence is diverse and sometimes controversial, the available literature agrees on several aspects [9,10,11,12,13,14,15]. Some authors [8,9] warn that at least half of all mental disorders appear around the age of 14. Gender can be considered as another triggering factor, as psychotic disorders are more frequent in males than in females at younger ages and appear at an earlier age in males [2,10].

The habits and routines that are established at this stage of the life cycle are an essential trigger. The biological predisposition, together with practices such as alcohol and cannabis consumption, which begin at around 13–16 years of age, have an impact on the mental health of the adolescents [9]. Current evidence shows that high levels of cannabis intake increase the risk of psychotic disorders and confirms a dose–response relationship between the level of consumption and the risk of psychosis [11]. Additionally, there is a causal relationship between alcohol use and mental disorders [12]. Both substances are psychoactive and alter the neurophysiological brain dynamics [13,14,15].

Stress is considered both as a precipitating environmental factor and as a marker of a predisposing vulnerability to the development of a psychotic disorder [16,17]. The effect of stress could be responsible for the deregulation of the brain’ pathway mechanisms, modifying the biological pathways involved in psychotic disorders [17,18]. Another environmental factor related to the problem, which has a negative impact on the stress levels, is bullying [19]. Several studies relate bullying to a continuous exposure to stress where victims of bullying report some psychotic disorders [20,21,22,23]. Conversely, practices such as physical exercise may be a protective factor in influencing mental health [24], acting as a regulatory releaser of positive neurotransmitters and enhancing the activity of the cerebral cortex [25]. These factors play an important role in understanding the transition of an individual from a vulnerable state to the development and diagnosis of the psychotic disorder [13]. Currently, one of the models that contemplates and studies the interaction between exogenous factors and their influence on mental health is the vulnerability–stress model [26]. This explanatory model is a theoretical formulation of the origin of psychosis, which is based on a predisposition to psychosis together with a vulnerability triggered by exogenous factors, giving rise to this disorder [26]. As these are exogenous and controllable factors, it is also important to focus on these detrimental practices for the mental health of adolescents. In addition, it is essential to pay attention to the importance of the family environment, which can influence the adolescent in a positive or negative way [13]. The family lifestyle and routines can enhance these risk factors, encouraging habits that compromise mental health, or, on the contrary, act as early detectors of the psychotic disorders [10,11,13]. Therefore, raising awareness among families and the general population in relation to this problem is essential [2,8,9,10,11,19].

Regarding treatment, the management of the psychotic disorders was traditionally focused on the residual phase of the condition and consisted mainly in drug intake [27]. As treatment approaches have been changing and developing, the role of professions such as occupational therapists, which offer non-pharmacological treatment for these types of disorders, have also been evolving. In fact, this discipline is currently being used in early detection programmes. Ramón and Mainar [28] stated that the role of the occupational therapist in the prodromal phase of the psychotic disorders ‘is to minimise the impact of symptoms on functionality ensuring that, in the event that a psychotic break occurs, the patient has a maximum level of functionality, which is an indicator of a better prognosis’.

To date, the available research that analyses the extrinsic risk factors that contribute to the development of psychosis in adolescence has been mainly carried out in populations of Anglo-Saxon and Nordic countries [29]. Likewise, on the basis of our knowledge, there are no previous studies that assess the risk of developing a psychotic disorder in Spanish adolescents. Therefore, the present research is an exploratory study which constitutes a pioneering and novel study in the Spanish population and aims to carry out a first screening of the problem. In this sense, it is important to take into account that the research on contributing factors and vulnerability to developing a psychotic disorder could provide useful knowledge that will contribute to improving and implementing prevention programmes that include occupational therapy. This will prevent harmful and detrimental consequences for the health of adolescents, as well as minimise the appearance of irreversible problems in adulthood.