Question: This is for my brother XXXX who is suffering from some type of psychological issues since 2009. Describing his present condition, he is feeling extremely low confident and is not willing to go out in public. He mostly stays confined in his room, does not brush his teeth or take shower on regular basis and is careless about his outlook including hair, beard and clothes. He has lost interest in all the activities. He eats very less in the meal but keeps munching snacks all day long and most of the time he does not know what he is eating and how much he has ate. I found him eating raw grain one day. He has suspicious mind and do believe that everybody around him is trying to dominate him or purposely trying to torture him. He becomes extremely aggressive sometimes. Under aggression, he uses abusive language and sometimes throws and breaks things. He has hit my mother a few times when she tried to speak against him.

Before 2009, he was a very brilliant student with bright academics and dreamed to become a great civil engineer. Once he was awarded as the best student of the school. In 2007, my family moved to a new city as my father got transferred. My brother was 15 and just completed his 10th standard before they moved. In the new place, he did not have any close friends. He had issues in copings up with age related changes and went under wrong guidance of a spiritual person who used to be my father's friend. He forcefully tried to suppress his emotions by doing deep meditation and Jaapa. In 2009, he entered in a university to pursue his civil engineering. In his college, he was not able to talk to anybody specially girls or watch movies or even TV to suppress his feeling for the opposite gender. He could not concentrate on his studies and failed in the exams. This was a big blow on his mind as he was such a bright student and also considering what people will think when they find out that he has failed. So to gain more strength, he started doing more meditation and Jaapa. He used to stay in a closed room whole day doing meditation. During this time, my parents consulted a psychiatrist and the psychiatrist diagnosed that he is having Obsessive Compulsive Disorder as he used to force himself to suppress his thought about the opposite gender. Doctor recommended Olanzapine 2.5mg along with fluvoximine 50mg but we didn't go for it as we were not prepared to put him under psychiatric medication. Actually, honestly we couldn't understand his problem. At this stage, he was considering himself as someone gaining spiritual power and his ego was rising. Later on, my whole family including grand parents and uncle tried to stop him doing his meditation and Jaapa forcefully. As a result, he ran away from the house. My family found him in some stranger's house after 3-4 hours when they contacted us. After this, my parents took him to our religious priest and as per his advice he finally stopped doing meditation and Jaapa. Actually, he real purpose of meeting the priest was to gain more knowledge on meditation and Jaapa but the priest advised him to stop what he was doing and recommended him to take Ayurvedik medicines which he aggressively refused, insulted the priest and left. From that day, whatever may be the reason, he stopped his meditation and Jaapa. He gradually started coming back to normal but he still could not concentrate on studies. My father consulted some psychiatrist and psychotherapist to help him. He didn't agree to take any kind of medicine or go for any therapy. He used to come to visit the therapists and doctors but never agreed to follow what they say. Eventually he quit his study. My parents tried to make him enroll in a different university and online course but he gave up on study completely. He used to blame the house for his failures saying that it is too compact. My parents even moved to a rented home which was big and was exactly per his demand. Later, he asked to move do a different house with more demands. He had issues with the housemaid cleaning the house and he started getting irritated with sudden and unusual noise. In 2012, he started becoming aggressive and he broke the TV for the first time. He used to make unusual demands to buy expensive things and if my parents deny, he used to get irritated and even aggressive until demands are fulfilled. He didn't use any of the expensive things that he demanded after they were purchased. My parents started giving him medicines (Fluvoximine 50mg and Risperidone 3mg and sometimes Epitril in case he is more anxious) in food without his knowledge but with there wasn't any improvement. They tried different medicines on and off but didn't continue anything as there wasn't any improvement. 2 year back he almost stopped eating food and lost weight to 46 Kgs from 62 Kgs. He lost interest in all activities including his personal hygiene. He didn't used to drink enough water and he was becoming weak. Even in this condition, he was too stubborn to take any vitamin tablets or even do any medical tests. My parents once forcefully admitted him to give him glucose bottles as he almost passed out in the house. In the hospital he fought with the doctor. My parents also tried some Ayurvedik and Homeopathic medicines in his food but again with no improvement. Instead my parents used to observe side effects like more aggression when they were giving him medicines. His anxieties and bad behavior was at peak and he was unable to sleep at night when we started giving him Tolaz md 5mg in his food approximately 8 months ago. After that he gained his weight and his condition became much better. His anxieties and aggression was comparatively less than before but not completely gone. He thinks that our neighbors are deliberately trying to make noise while shutting their door in order to disturb him. He started shouting at them and once even threw a stone at their house. This kind of incidents has happened many times where he breaks things or says bad words in abusive language. He does this specially when someone does things against his will. He was never like that before and when I see him doing this, he feels like a totally different person. He has fear of people and fear of stepping out of the house. He is very indecisive and has a constantly fluctuating mind.

At present, my parents and XXXX are visiting me in USA. In the first 10 days, he was fresh and used to go out with us. But from last 4-5 days he is being aggressive again saying bad words. He threw things couple of times too. He thinks that he and my husband have a conflicting ego which in reality is not true. He became very aggressive on him a few times for no reason.

We all are out of clues on what to do now. My parents came here with a hope that he will feel better if he will stay with me for a while as we share a close bond. They have tried everything that they could. They have visited many doctors and therapist but nothing has helped as he is not ready to accept any help. He sometimes accept that he has problems but when asked to seek a solution, he says that he will come out of this by himself and he is in the process of achieving it. He has said the same thing many times in last few years but we didn't see him making any efforts from his side after saying it.

Please guide us on this situation and tell us what should we do as a family to help him. We cannot see him in this condition and we are helpless at the same time.