Those who are at risk of potentially developing schizophrenia could receive an early diagnosis if the early use of brain scans were implemented. Those who have schizophrenia, on average, differ in terms of the total tissue volume and brain activity (Cahn, Hilleke, Hulshoff, & Elleke, 2002). Early intervention of the disease has become important in order to know how best to treat the disorder, therefore a two-hit theory has been established in order to attempt to diagnose the condition sooner rather than later. The two (third) hit theory which is used in physical disorders and has been propounded for the diagnosis of schizophrenia early on, describes damage such as infection during the perinatal period is added as an original genetic weakness (Huttunen, Machon, & Mednick, 1994). This would be described as the first hit which impairs neuronal development, therefore creating the potential basis for onset, throughout adolescence and early adulthood, psychological stressors would cause the second hit as symptoms would be manifesting. Subsequently, exacerbation and recurrence will be repeated making negative symptoms more prominent (Iritani, 2013). These processes are called the critical period, it is believed that the prognosis of the disease could have a different outcome if this period is missed. Missing opportunities for the appropriate intervention
during the critical period or being unable to provide appropriate responses is called the third hit, which is believed to accelerate the progression of the disease due to the lack of appropriate support. The theory attempts to explain that a combination of genetic susceptibility together with a distinct developmental problem can potentially prime an individual for a later event that ultimately leads to the onset of a full clinical diagnosis of schizophrenia. It also relates to the hypothesis that thinking and cognitive impairments in schizophrenia are related to abnormalities of the neural network which is composed of axons, dendrites, and synapses (Davis, et al., 2016). Brain structural changes in both grey and white matter prior to illness can indicate where the brain structural anomalies can be seen in chronic schizophrenia and which structures in the brain are affected will be beneficial with MRI predictors on who will develop schizophrenia later on in life. Although, as yet it is not possible to have medication that targets certain areas for treatment, continued research and an understanding of the illness will be able to determine whether early pharmacological treatment, will be able to prevent, the cortical progressive brain changes and if they will have a significant effect on future clinical outcomes (Szöke, Pignon, & Schürhoff, 2019).