MA - Lindsay Clancy, Strangled 3 Children in Murder/Suicide Attempt, Duxbury, Jan 2023

People who've been psychotic before may know they're starting to decompensate or may know after they start to improve. That's a good prognostic feature in schizophrenia, for example.
That matches what seemed to happen with my former classmate who was eventually diagnosed with schizophrenia. Before her hallucinations and delusions that led to her being formally diagnosed, she was concerned she had schizophrenia and she agreed with the diagnosis when she received it as she was improving. She seems able to recognize it now when it happens, though it sometimes takes some time. During the time she was at her worst, though, she firmly believed the police were hiding bodies on her property with her husband and would almost certainly not have described herself as psychotic.

What I find most interesting about LC calling herself psychotic after the fact here is her husband saying that's the first time she'd used that term. We know she was diagnosed with generalized anxiety disorder at the RI hospital. I've never seen any diagnosis connected to her early January stay in MA, but it seems to me that it's unlikely she was diagnosed as psychotic then if it never came up in the 3 weeks between the release and the murders. MOO
 
Wondering if the RI hospitalization from last year was in October, based on how it's been clarified that she had been prescribed X number of medications from October to January. I'm still obsessed with determining the timeline of the hospital evaluations!
Does this excerpt from this NYTimes article answer your question? Are you looking for the time she was evaluated and found to not have PPD?

“Prosecutors said on Tuesday that she had never reported psychosis to her husband and that a psychiatrist who evaluated her in December had concluded she was not suffering from postpartum depression. On Jan. 5, less than three weeks before the killings, she had been released from a five-day inpatient stay at McLean Hospital, a psychiatric hospital, without any warning that she posed a danger to herself or others.”
 
That makes sense to me and I appreciate your answer.

With LC, she said in the hospital that she had psychosis, and that has stuck with me bc I think of the adage widespread among some patients- if you think you’re psychotic, you’re not. Which may not be strictly accurate but, do you think a person could come out of psychosis so quickly?

Who knows if she was led to say that- but if she said it unprompted, would that demonstrate insight?

That’s my last question, I promise!

The guy I referenced before that I met improved hugely within a week of starting an antipsychotic. He was still a bit confused about which bits had been real and what had been in his head.

On the flip side I saw patients who were ranting and raving who I didn't see noticeably improve in the few weeks I was there.

You can also very much have hallucinations and know they're not real, particularly if you've had them before as others have put more eloquently.
 
TRANSCRIPTION OF PRESS CONFERENCE WITH DEFENSE ATTORNEY

8TH. FEB

Reporter
- Were you pleased with the outcome of the probation decision in terms of allowing your client to keep on getting treatment?

Defense Attorney - I think we were most fortunate in getting one of the most compassionate, strong, judge's in the state of Massachusetts. He did the right thing and he has no compunctions whatsoever and to the very rational, organised order and I'm very grateful for that because she really needs that treatment.

Reporter - When the facts were laid out by the District Attorney - Can you speak about how that was presented?, because the way it was presented, the DA was minimising the mental health aspect and made it sound over and over again like this was premeditated, that there was clear thought, that she planned this by calling these different places and going on Apple map. Can you speak to that?

Defense Attorney - Yeah, I mean, she's a DA. She wants to put the case in the light most favourable to the Commonwealth and whatever inferences she can draw. I think it shows a lack of understanding or appreciation of the serious nature of postpartum psychosis, postpartum depression and the SSRI's suggesting that 'Oh she was able to communicate with her mom and send her a text and hope you had a nice ride' minimises or shows that she was not in the throws of suicidal ideation or god forbid homicidal ideation, or depression, unable to sleep, insomnia which was a complaint brought many times to the doctor's attention so I certainly don't fault the DA for presenting her case like that. I'm glad the judge was able to understand what the real issues are.

Reporter - So she was able to function and make those phone calls and make that (inaudible) - You're saying that doesn't mean that she wasn't suffering?

Defense Attorney - Of course, she would not lose... you don't lose the ability to understand that this is a cell phone and I'm going to shake hands with this person or I'm going to get in a car and drive. I mean, it's not like you're in a total stupor, you know?

Reporter - What is her diagnosis?

Defense Attorney - As far as her medical condition?

Reporter - Her mental health and her physical condition?

Defense Attorney - It's still being evaluated, that's Dr. Paul Zeizel, who is a forensic psychologist. He's been with her for the past three days, so that's still being investigated.

Reporter - Can you describe her condition right now?

Defense Attorney - Very sad affect, she can't move, as you heard in the courtroom. She's confined to the bed. She has to have 24/7 care, for obvious reasons. She has no feeling from the naval down and emotionally there's a very significant risk of suicide. They have to have a person sit in the room, as you heard and watch her 24/7, so it's not good.

Reporter - Do you have a hope that a plea agreement could be reached? Would that be the best way to dispose of this case?

Defense Attorney - I certainly do, I'm hoping that Tim Cruz, who's a former defence attorney and DA for a long time, would be able to understand that this is just a tragic case that really should be resolved without the fanfare of a trial and the emotion.

Reporter - What would be a fair plea?

Defense Attorney - That would be a matter of negotiation.

Reporter - Prosecution was talking about the medical history, that some had said she did not have postpartum depression, that she had no symptoms....

Defense Attorney - I gotta say, she saw one doctor and there was an evaluation, I don't know for how long, I don't know for how in depth, I don't know what the facts were as far as that. And at that point, the DA said that the doctor said that it did not appear to be postpartum depression, even though she may have been posting on Facebook, about a month or so prior to this indicating that she felt that she was anxious and depressed because of postpartum.

Reporter - What was her diagnosis at the clinic? What were they treating her for?

Defense Attorney - I'm getting the records and that's, you know, under investigation.

Reporter - What liability do doctors and pharmaceutical companies have in this case?

Defense Attorney - There's three dead children right now and a young woman, who was a beautiful woman who's confined to her bed and a husband who's a walking shell of a human being. And I really don't want to talk about money losses at this point.

Reporter - How many medications was she taking at the time?

Defense Attorney - Around 12, but they were 4 at a time, they would stop, get her off it, get on the sertraline antidepressant. They put her on the Prozac and then take her off the prozac and put her on the amitriptyline. That's what was happening.

Reporter - Does Dr. Zeizel want to say something about his impressions of Lindsay?

Dr. Zeizel - I've been meeting with Mrs. Clancy for the past few days and multiple hours each day. What I can say, without going too far, is that her affect is absolutely flattened, She's in a very surreal state. It feels dreamlike to her, as she's described to me on multiple occasions. And individuals who can present as being lucid and linear and clear thinking do not make those people not mentally ill. They have the capacity for, on occasion, to be able to do things that they've been doing for a long period of time. When you have delusional thinking. fixed beliefs that are unchangeable and hallucinations, namely command hallucinations, telling you to do things, telling you to do things that are malevolent and you believe those voices that are telling you, you need to follow what they say that's when things go downhill, behaviourally, psychiatrically and familiarly and that's what we see in the most tragic of cases where individuals who could be healthy and normal and, quite frankly, because they're paranoid and worried about what others think, they hold back on what they share. And in some cases throughout the country in the world, these are people who one day will be functioning well, but because they have the onset of command hallucinations, which they adhere to, and they believe the voice that they have to do something, that's when tragedy occurs, and I think that, sort of, is under the override rule break that this case falls under.
 
Does this excerpt from this NYTimes article answer your question? Are you looking for the time she was evaluated and found to not have PPD?

“Prosecutors said on Tuesday that she had never reported psychosis to her husband and that a psychiatrist who evaluated her in December had concluded she was not suffering from postpartum depression. On Jan. 5, less than three weeks before the killings, she had been released from a five-day inpatient stay at McLean Hospital, a psychiatric hospital, without any warning that she posed a danger to herself or others.”
Possibly! Her RI hospitalization was only framed as last year in the article I'd read, without any further indication of a timeframe.

If it was in December, that means she was hospitalized again within a matter of weeks. MOO
 
It seems a bit coincidental that she went from having "thoughts" about harming the children to "command hallucinations" which resolved spontaneously.

Symptoms of postpartum psychosis​

Symptoms usually start suddenly within the first 2 weeks after giving birth - often within hours or days of giving birth. More rarely, they can develop several weeks after the baby is born.

Postnatal depression can start any time in the first year after giving birth.

Signs that you or someone you know might be depressed include:

  • a persistent feeling of sadness and low mood
  • lack of enjoyment and loss of interest in the wider world
  • lack of energy and feeling tired all the time
  • trouble sleeping at night and feeling sleepy during the day
  • finding it difficult to look after yourself and your baby
  • withdrawing from contact with other people
  • problems concentrating and making decisions
  • frightening thoughts – for example, about hurting your baby

My non-professional layman gut opinion is she was mis-diagnosed and had postpartum depression based on what's in the public domain and the "psychosis" is her trying to cover.

JMO
 
You are less likely have to postpartum psychosis with second or third births if you didn't have them with your first, but less likely doesn't mean you won't.

"Interestingly, even though women with no history of perinatal mood episodes were less likely to have an episode in relation to the second pregnancy, 34% still developed a perinatal mood episode in the second perinatal period, which included 10% (22, 95% CI 4.0–16.2%) with affective psychosis and 24% (54, 95% CI 18.1–30.4%) with depression (Table 2)."

"We found in fact that, contrary to our expectations, the risk of having any form of perinatal recurrence was slightly higher in women with a history of non-psychotic perinatal depression than in those with a history of postpartum affective psychosis. Our results therefore emphasise the need in women with bipolar disorder to take into account all previous perinatal episodes, including depression and not to focus exclusively on the most severe episodes of illness. Although women with postpartum psychosis are at the highest risk of developing a further severe postpartum episode, women with bipolar disorder with a history of perinatal depression have in fact the highest rates of any form of recurrence."

"Although confirming the suspicion that these women were at lower risk, we found that the absence of mood episodes in or following the first pregnancy does not guarantee that women will not experience a perinatal episode of illness in relation to subsequent pregnancies. About a third of women will experience some form of perinatal episode in a second pregnancy even if they had no episode of illness following a first pregnancy."


While I am not able to quickly find a study on third pregnancy, I will post if/when I have time to look later. But I can tell you that in clinical practice, any healthcare provider who doesn't account for the possibility that a woman with bipolar disorder will have postpartum psychosis (regardless of number of pregnancies and previous episodes) would very likely not win a malpractice suit as the standard of care is always to stratify the risk and I haven't yet seen anything that says "no risk" in these cases. With postpartum psychosis being so dangerous to both mom and baby, OBs and psychiatrists are trained to keep it in mind during exams and documentation. The patient should also be counseled on it during every single pregnancy AND during menopause as a similar hormonal shift can cause psychosis.
I find it a little nerve-wracking that this is the first time I’m hearing of this, because I am bipolar and I don’t remember once throughout my two pregnancies my doctor even mentioning postpartum psychosis or being questioned during any follow ups after that. It’s especially concerning because I didn’t see just a regular OB, I saw exclusively an MFM, who one would assume would have a great amount of knowledge of everything that could go wrong during a pregnancy.

And just fyi, I totally believe you since I did my own research after you mentioned this, so I’m not questioning you. I’m just rattled a bit. If a MFM treating a woman with an established bipolar diagnosis doesn’t seem concerned about PPP, I can only imagine all the women who could fall through the cracks.
 
There was a woman here in Utah a few years ago that had severe PPD. This was her 5th baby and she had no problems previously. They were trying to get her help, but it didn’t happen fast enough. They went to a dinner at her parents home, and left because she became upset. She was flipping out, so her husband pulled over on the freeway. She jumped out of the car and ran on to the freeway in front of a semi. It happened so quickly, there was no way to stop her. Her husband started a program in her name to help others. It is a diagnosis that is hard to understand and is not the same in everyone.


Woman Hit By Semi On I-15 Identified As Mother Of Five | Gephardt Daily
 
Possibly! Her RI hospitalization was only framed as last year in the article I'd read, without any further indication of a timeframe.

If it was in December, that means she was hospitalized again within a matter of weeks. MOO
Yes, that was my recollection from the arraignment, namely that her negative PPD diagnosis and checking into the hospital were in fairly rapid succession. MOO
 
Per the medical literature:




And for people who may not have experience with palliative care in medical illness and the role of mental health experts:

I'm asking for your description of what palliative care would look like for a psych patient deemed "terminal," to use the specific language of your previously proposed scenario. In your words and in your opinion, what would palliative care look like for a psych patient with a "terminal" prognosis?
 
Per the medical literature:




And for people who may not have experience with palliative care in medical illness and the role of mental health experts:

I'm asking for your description of what palliative care would look like for a psych patient deemed "terminal," to use the specific language of your previously proposed scenario. In your words and in your opinion, what would palliative care look like for a psych patient with a "terminal
prognosis?
 
Yes, that was my recollection from the arraignment, namely that her negative PPD diagnosis and checking into the hospital were in fairly rapid succession. MOO
It's so sad that it seems there were real opportunities for this not to occur. Regardless of her culpability or lack of.

I've changed anti-depressant and it was rough. It sounds like she was being switched between them like they're candy. I'd be curious to know how long she was kept on each one and if they got switched during her last admittance.
 
TRANSCRIPTION OF PRESS CONFERENCE WITH DEFENSE ATTORNEY
<Respectfully snipped for length and focus>

Reporter
- Does Dr. Zeizel want to say something about his impressions of Lindsay?

Dr. Zeizel - I've been meeting with Mrs. Clancy for the past few days and multiple hours each day. What I can say, without going too far, is that her affect is absolutely flattened, She's in a very surreal state. It feels dreamlike to her, as she's described to me on multiple occasions. And individuals who can present as being lucid and linear and clear thinking do not make those people not mentally ill. They have the capacity for, on occasion, to be able to do things that they've been doing for a long period of time. When you have delusional thinking. fixed beliefs that are unchangeable and hallucinations, namely command hallucinations, telling you to do things, telling you to do things that are malevolent and you believe those voices that are telling you, you need to follow what they say that's when things go downhill, behaviourally, psychiatrically and familiarly and that's what we see in the most tragic of cases where individuals who could be healthy and normal and, quite frankly, because they're paranoid and worried about what others think, they hold back on what they share. And in some cases throughout the country in the world, these are people who one day will be functioning well, but because they have the onset of command hallucinations, which they adhere to, and they believe the voice that they have to do something, that's when tragedy occurs, and I think that, sort of, is under the override rule break that this case falls under.
Dr. Zeizel (forensic psychologist):

"When you have delusional thinking. fixed beliefs that are unchangeable and hallucinations, namely command hallucinations, telling you to do things, telling you to do things that are malevolent and you believe those voices that are telling you, you need to follow what they say that's when things go downhill, behaviourally, psychiatrically and familiarly and that's what we see in the most tragic of cases where individuals who could be healthy and normal and, quite frankly, because they're paranoid and worried about what others think, they hold back on what they share. And in some cases throughout the country in the world, these are people who one day will be functioning well, but because they have the onset of command hallucinations, which they adhere to, and they believe the voice that they have to do something, that's when tragedy occurs, and I think that, sort of, is under the override rule break that this case falls under."

My understanding of what Dr. Zeizel is saying:
1) LC had delusional thinking + command hallucinations.
2) LC believed the command hallucinations.
3) LC was paranoid and did not tell others about the command hallucinations.
4) That is how LC ended up crossing the line.
 
I'm asking for your description of what palliative care would look like for a psych patient deemed "terminal," to use the specific language of your previously proposed scenario. In your words and in your opinion, what would palliative care look like for a psych patient with a "terminal
prognosis?
Sorry for the multiple posts. Site is being very glitchy, for me anyway.
 
My understanding of what Dr. Zeizel is saying:
1) LC had delusional thinking + command hallucinations.
2) LC believed the command hallucinations.
3) LC was paranoid and did not tell others about the command hallucinations.
4) That is how LC ended up crossing the line.
Yes, that’s what he’s saying, but he is the defense’s hired expert, and LC never mentioned command hallucinations or psychosis to anyone, ever, until after Dr. Zeizel evaluated her two days in a row. Here’s the kicker from this article:

<Quote>
Sunday, Feb. 5, 1:35 p.m. While sitting with a psychologist hired by her defense attorney to evaluate her mental state, Clancy called her husband using the doctor’s cell phone. She left a voicemail stating she loved him.

Monday, Feb. 6, 10:09 a.m. Clancy again used the doctor’s cell phone to call her husband. This time, he answered, and during their conversation, Clancy said that after Patrick left the house on Jan. 24, she killed the kids because she “heard a voice and had quote a moment of psychosis.” Patrick asked what voices she heard and she said she “heard a man’s voice telling her to kill the kids and kill herself because it was her last chance.”
<End quote>
BBM

IMO, her claims that she had a moment of psychosis and heard command hallucinations, made for the first time after consulting with her own expert, don’t carry much weight. Nor does the excuse of ‘she was too paranoid and worried what others might think to mention this before,’ — she had no problem telling others she was thinking about killing herself and harming her children. How much worse could it be to also admit psychosis?

And what about that “last chance” detail? What on Earth does that mean? I’m no expert, but “because it’s your last chance” doesn’t sound like the kind of command hallucination you’d really want to base an insanity defense on. “Last chance” sounds an awful lot like an admission, probably unintentional, that this was an idea she’d been silently harboring for some time: killing, not “harming,” her children, then herself.
 
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That matches what seemed to happen with my former classmate who was eventually diagnosed with schizophrenia. Before her hallucinations and delusions that led to her being formally diagnosed, she was concerned she had schizophrenia and she agreed with the diagnosis when she received it as she was improving. She seems able to recognize it now when it happens, though it sometimes takes some time. During the time she was at her worst, though, she firmly believed the police were hiding bodies on her property with her husband and would almost certainly not have described herself as psychotic.

What I find most interesting about LC calling herself psychotic after the fact here is her husband saying that's the first time she'd used that term. We know she was diagnosed with generalized anxiety disorder at the RI hospital. I've never seen any diagnosis connected to her early January stay in MA, but it seems to me that it's unlikely she was diagnosed as psychotic then if it never came up in the 3 weeks between the release and the murders. MOO
Whoa, I hadn’t made that connection about the first time she said it. Good point.

I can also recognize psychosis- at the beginning and the end, when meds are bringing me back. But I’ve experienced it many times by this point. The first time it happened it took weeks for me to really grasp what had happened. It sort of gradually came into my understanding- at first I thought I had been granted magical powers from the universe. Then I thought I had achieved a higher meditative state. Then I came to the more logical conclusion that someone had drugged me. Then finally I started to see, I had somehow lost my mind. Then I accepted that maybe I did have psychosis and finally, that this was bipolar. But now when it begins I can say to myself: this may be real or it may be psychosis. The only way to know is to take antipsychotic meds, check again in 48 hours. If it goes away, it was psychosis.

ETA, in my personal experience about the advice doctors give, I was advised to strongly consider not having a second child at all, because of the risk to me of having dangerous episodes and instability from discontinuing meds during pregnancy. I took that advice because I was concerned about a future where I couldn’t take care of another child. I don’t really mind having bipolar, it could be worse. But that’s the one thing I feel the illness took from me that was an unfair price to pay.

ETA: PPD/PPP we’re never explicitly mentioned. The concern was over bipolar episodes. But hormonal changes were mentioned.
 
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One thing I don’t think we’ve touched on is drug induced psychosis. I mainly associate this with methamphetamine, but I’ve read about other drugs causing it. Benzodiazepine withdrawal is rough. Could that have caused psychosis or psychotic symptoms?
 
One thing I don’t think we’ve touched on is drug induced psychosis. I mainly associate this with methamphetamine, but I’ve read about other drugs causing it. Benzodiazepine withdrawal is rough. Could that have caused psychosis or psychotic symptoms?
I think a lot of psych meds can cause it, particularly if stopped suddenly.

Source: My sister-in-law had to stop one of her meds cold turkey when she got pregnant. She was psychotic for ten days.
 

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