How can psychosis lead to death? MCG doctor explains after fatal stabbing of baby at fort

Recently filed court documents reveals new details about the mental health of a military spouse accused of killing her 11-month-old baby with a knife at Fort Eisenhower on Nov. 15 and a list of discovery materials potentially outline the Attorney General's case against her.

April Evalyn Short, 30, pleaded not guilty on May 6 to premeditated murder and felony murder in relation to the death of her 11-month-old baby.

On the morning of Nov. 15, Short allegedly sent a text to her husband, who is a staff sergeant in the U.S. Army, while he was at work, according to previous reporting. The message made numerous religious references, including "the days of darkness are upon us."

After failing to get in contact with her, Short's husband drove home and found their 11-month-old baby wrapped in a shower curtain with cuts to the neck, authorities noted in previous reports. The baby was pronounced dead at Dwight D. Eisenhower Army Medical Center at Fort Eisenhower.

FBI agents interviewed Short's other two children, who were present during the incident, and they said Short got two knives and told them she "was going to help get [the baby] to God and Jesus," according to previous reporting.

The U.S. Attorney General's Office has not yet decided if they will seek the death penalty, which is authorized given the charges, according to court documents.

Psychiatric reports reveal new information

At Short's initial court appearance on Nov. 16, the prosecution and defense jointly requested she undergo a psychiatric evaluation.

Short was admitted to Federal Medical Center Carswell in Fort Worth, Texas on Dec. 11 and "exhibited worrisome symptoms of psychosis upon her arrival," according to court documents.

"When you're talking about psychosis, those [symptoms] are typically going to be things like hallucinations, hearing voices, or seeing things that other people don't see," said Megan Porter Staats, an assistant professor in the Department of Psychiatry and Health Behavior at the Medical College of Georgia. "You also can have delusions where it's this fixed belief that may make you act a certain way. Sometimes individuals can have religious beliefs and fixations that God wants them to do something or act a certain way. If they don't follow these set of rules by some voice telling them to do it, something bad is going to happen."

Court documents note Short stabilized once she began regularly taking psychiatric medications.

Timeline of alleged murder: Deposition: Baby was stabbed in bathtub, wrapped in shower curtain during Fort Eisenhower murder

Staats said retaining memory from time in psychosis can vary from person to person.

"There are people who have a lot of insight into their mental illness when they're stable and on medication, and they have some memory of what happened when they were not medicated," she said. "There are some people who do not have that insight or awareness, or who don't have great memory of the incidences."

Staats said, traditionally, psychosis usually goes along with a number of different mental disorder diagnoses, one of the most well known being schizophrenia.

"With schizophrenia, the popular thought is that there is some type of major life stressor that happens in a certain window of time, oftentimes that is in young adulthood, and psychosis can start to emerge," she said. "There is often what we call a 'first break' where these symptoms come out for the first time and there is this moment of severe psychosis. There could be symptoms that lead up to that point that people in their lives didn't notice or didn't see because they were operating normally until that point. But that is going to be dependent person to person."

Other diagnoses, such as schizoaffective disorder, can have a mood component including mania or depression, according to Staats.

In looking at the relationship between mental disorder diagnoses and pregnancy, Staats said it is uncommon for schizophrenia to be tied directly to postpartum depression or anxiety.

"I know that there does exist the possibility of the postpartum period leading to psychosis, but I believe it's very rare," she said.

Dr. Macy Wilson observed Short for two months and ultimately found her competent to stand trial, according to court documents.

Two psychiatric reports were filed on Feb. 20 and March 27, but are exempt from public disclosure.

"Ms. Short articulated an understanding of the 'not guilty by reason of insanity' defense and what would be associated with such a finding," Wilson wrote in a report. "She expressed trust in her attorney, though she said they have not spent much time together. ... There was no evidence of cognitive impairment during this interview."

The legal test for competency is whether the defendant is able to consult with their lawyer with a reasonable degree of rational understanding and whether they have a rational and factual understanding of the proceedings against them, according to court documents.

Wilson did, however, express concern about a potential for relapse, according to the documents. Short's attorneys also expressed concerns about a potential relapse and stated their intention to notify the court if competency concerns resurface.

Staats said relapses are typically caused by a medication not working for that specific person or people completely going off of their medication.

"Sometimes it can take time trying different types of medications, trying different dosages and trying different combinations," she said. "There's some trial and error, but once you find it and they're able to stabilize, they could have some symptoms come back while they're still taking medication, but it's unlikely that it will be to a level that it was before. Oftentimes, their treatment provider can address that with their medications and make little tweaks as needed."

Government releases discovery materials

On May 6, the U.S. Attorney's office provided the defense with evidence they gathered during discovery, according to a certificate of disclosure filed on May 7.

While the evidence is not available to view by the public, a file name and a brief description are listed in court documents.

Some of the files appear to be call logs from the day of the alleged murder, Short's husband's 911 call on the day of the alleged murder, Short's medical records and prescription history, nearly half a dozen statements from emergency room staff, 130 ER photos, and more than 200 crime scene photos.

This article originally appeared on Augusta Chronicle: Fort Eisenhower spouse accused of killing baby found mentally competent