Hello,
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress for your brother.

Important aspects of your query are:
•     34 year old male
•     Total illness duration 13 years, precipitated by Typhoid
•     Known case of Schizophrenia
•     Complaints of: living in own world and lack of acceptance for presence of illness

Schizophrenia is a chronic and severe psychiatric disorder with remission and exacerbation of symptoms during its course. I can understand your concern regarding your brother illness, as it lead to significant distress to caregivers.

The basic pathology in this illness is increase dopaminergic neuro-transmission in brain. Many time illness remain in body (Asymptomatic phase) for years without manifesting any clinical symptoms, but stressor (like Typhoid in his case) bring illness to symptomatic phase.

Due to illness patient hear or see things which is not seen or heard by others. They also have thought disturbance which leads to formation of false and firm belief system. All these things make patient to live in imaginary world.

It is treatable condition and behavior improved after treatment. It is treated with medicines which decrease dopamine neuro-transmission. This condition should be treated after adequate assessment by treatment with medicines (like antipsychotics).

In symptomatic phase of illness patient do not have insight regarding illness as they do not considered themselves ill. Due to that they deny need for any treatment, in such cases after assessment medicines can be given in form of depot injections or medicines in food (syrup or tablets).

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Regards,

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