Dear Dr. of Psychiatry, I am writing to you because my

Thank you for choosing this website. My approach is mental health not mental illness. Although you are writing to a psychiatrist I have been a psychologist with 30 years and have worked with this type of client. I am concerned about your brothers relapse and agree that a medication reevaluation needs to be done. His doctor seems to have titrated down his medication to prevent over medication which is very admirable.
The main reason that I was writing to you however is my concern that he is just getting medication. Medication is useful to the reduction of symptoms however psychotherapy remains the main motivator for someone taking control of their life. In addition your brother needs education in terms of the psychotic processes going through. I would strongly recommend him seeing a psychologist who has had experience working with chronically psychotic individuals. While he is in such an acute stage hospitalization or at least day treatment is also a strong recommendation.
You described his symptoms as hallucinations, anorexia, insomnia and a fear of death. His hallucinations can be of monsters who were trying to kill him to God telling him not to eat. As caretaker you're beginning to see this condition is deteriorating and I understand your concern.
Paranoid schizophrenia is a break from reality which usually begins with a pattern of emotional difficulty, lack of responsiveness, impairment in social cognition, paranoid hallucinations, delusions and difficulty thinking clearly. Schizophrenia effects point three to point seven percent of the world population or 24 million people worldwide. Symptoms are consistent between cultures. Age of onset is usually 20 to 28 Most people who've been diagnosed with schizophrenia go on to live an independent life with some support from the community. There is a 42% chance of full remission after the first psychotic break. With the advent of the new atypical anti psychotic medication there's been a tremendous decrease in the recidivism of psychotic symptoms. These new medications offer a much reduced level of side effects as well. There have been significant studies done to indicate that a combination of appropriate anti psychotic medication and psychotherapy has most success in allowing people with this diagnosis to lead a relatively normal life.
I know you are asking for as much detail as possible and you are currently off-line. I can give you much more information on the demographics, prognosis, recent developments medication and psychotherapies that are most effective. I would be very interested in your response to my answer and look forward to providing more information for you to help your brother lead a less disturbing and more successful life.