Posted on 07/07/2006 6:26:30 PM PDT by Extremely Extreme Extremist
(AP) HOUSTON A psychiatrist testified Friday that she warned Andrea Yates not to have any more children after she tried to commit suicide twice within months of having her fourth child in 1999.
"I could pretty much predict that Mrs. Yates would have another episode of psychosis," Dr. Eileen Starbranch told jurors in Yates' second murder retrial.
Starbranch said Yates suffered from postpartum psychosis, which she said causes a mother to have delusions and lose touch with reality, making it much more severe than postpartum depression.
Yates drowned her five young children in a bathtub in June 2001, 6 months after the birth of her fifth child, Mary. She is being tried again because an appeals court overturned her 2002 murder conviction based on erroneous testimony that might have influenced the jury. She has again pleaded innocent by reason of insanity.
Yates' attorneys have never disputed she killed the youngsters but say she didn't know that the drownings were wrong.
Prosecutors say Yates may be mentally ill but does not meet the state's definition of insanity.
They say Yates planned to drown the children when she was alone with them, after her husband went to work and before her mother-in-law arrived. Then Yates called 911 and later told a detective she killed them because she was a bad mother and wanted to be punished, according to witnesses.
Along with Mary, Yates drowned 2-year-old Luke, 3-year-old Paul, 5-year-old John and 7-year-old Noah.
Starbranch said she treated Yates after she tried to kill herself by overdosing on sleeping pills in June 1999.
About a month later, Starbranch said, Yates' then-husband, Rusty, told her that Yates had held a knife to her own throat the previous day.
Starbranch said Yates had a bald spot on her head from scratching it, had not been taking her antipsychotic medication, had filthy hair and could not function. Starbranch said she sent the couple immediately to a mental hospital so Andrea Yates could be admitted.
Under cross-examination, Starbranch acknowledged that the words "filthy" and "catatonic" were not in her notes and said that Yates' nervousness and anxiety may have been a sign that she simply did not want to be at a psychiatrist's office. But Starbranch maintained that Yates was psychotic and not lethargic or exhausted from caring for four young children.
Over the next two weeks or so while hospitalized, Yates steadily improved while on antipsychotic drugs, Starbranch said.
But then in March 2001, Rusty Yates called Starbranch's office trying to make an appointment, saying his wife was getting worse since having the couple's fifth child in November, Starbranch testified.
"I knew that was a very ominous sign ... that lives were at stake, so I asked that she be brought in immediately," Starbranch said.
The couple never showed up, but Starbranch later learned that Yates was admitted to another mental hospital, the psychiatrist testified.
Yates, being tried in only three of the children's deaths, will be sentenced to life in prison if convicted. After the first jury rejected execution, prosecutors could not seek the death penalty again because they found no new evidence.
Why are you refusing to look at the facts? Do you prefer to believe she is crazy because she committed a horrific act?
A head like a busted radio?
She is a valedictorian - i.e. highly intelligent.
She is a trained nurse.
She hid her intent from her husband, friends and family.
She siezed a brief opportunity when she was left alone with
the kids to carry out her plan.
Why are you refusing to look at the facts? Do you prefer to believe she is crazy because she committed a horrific act?
In this case I think the act pretty much speaks to state of mind. Also, I've seen crazy people in a variety of forms, from lunatics yelling on the street in absolute terror at nothing to highly accomplished and highly educated individuals speaking very calmly and with 100% conviction of realities that simply don't exist. The brain is a very, very delicate and complicated instrument, a lot can go wrong with it.
The rules of motivation, logic, etc. don't apply to these folks. And again, that's why they're terrifying.
As a means of suicide, how effective is an "overdose of forty ot fifty trazodone 50 mg tablets"?
You know what they say: neurotics build castles in the sky, and psychotics live in them.
So that is a dosage of between 2,000 to 2,500 mg.
About 6 times a maximum daily dose of 400 mg/day.
A modified cyclic antidepressant used to relieve depression.
I agree with you. She waited for an opportunity. What she did was evil.
Animosity towards one's child is a projection of animosity towards the other parent. She hated her husband, so she killed his children. When men do this, they often kill themselves too, or are killed by the police.
Some people do not wish to believe that such evil exists, so they attribute evil acts to mental illness, and feel that every murderer should continue to live. Evil people rely on such morally confused people to go to bat for them.
Interesting. It is also used to help people sleep.
Agreed.
The only reason she wanted to wait until she was alone was so that she could ensure that she could kill all of them. If another adult was present she could only kill one or two of the kids. She started from youngest to oldest also for that reason.
Apparently it is not a good drug to try to commit suicide with - very ineffective for that purpose.
http://www.jatox.com/abstracts/1996/jan-feb/59-esposito.htm
Trazodone and Dothiepin Poisoning
G. Esposito
Dear Editor:
This letter is in reference to an article by Lambert et al. (1), which dealt with the topic of trazodone poisoning.
Because we are the manufacturer of trazodone, we would like to make some comments on the conclusions of the article. We believe the trazodone profile may be misunderstood by some readers.
Although suicides by overdose of antidepressant drugs are very common, the data in the literature of the past 10 years have shown that the new generation of antidepressants like trazodone appear to be much safer in overdose than tricyclics. Tricyclics can cause cardiovascular complications due to the combination of direct cardiotoxicity and anticholinergic effects, central nervous system sedation, and respiratory suppression.
Tricyclic antidepressant-related deaths have occurred even at doses of 2000 mg, and serious intoxication may be expected at doses greater than 1000 mg.
However, death due to overdose of trazodone administered alone is rare, and attribution to the drug is uncertain (2).
In 1984, Root and Ohlson (3) reported the case of a patient with trazodone blood concentrations of 25.7 mg/L (thus comparable with those found in the case in question and corresponding to the ingestion of approximately 8 g of the drug); the patient was lethargic and had mild hypotension upon admission to the hospital. Two days later, the patient was discharged from the hospital after a complete recovery. In another case, the ingestion of 6 g trazodone produced only drowsiness. Plasma concentrations of 15 and 19 mg/L (corresponding to the ingestion of approximately 4–5 g trazodone) produced toxic manifestations consisting only of drowsiness and ataxia (4).
The absence of direct cardiotoxicity and the absence of the affinity for muscarinic acetylcholine receptors (5) explain the often unsuccessful suicide attempts by trazodone overdose. The greater safety and minor incidence of lethal effects of trazodone in overdose, as compared with tricyclics, have been reported in the literature (6).
Nevertheless, trazodone should be used with caution in patients with cardiovascular disease (7) or when associated with other substances, including alcohol (4,8,9).
We are partially in agreement with the authors of the article in question; in fact, we would like to note that the blood concentrations of the tricyclic dothiepin found in the patient postmortem (approximately 40 times higher than therapeutic doses) could warrant the death of the patient.
In a study by the American Association of Poison Control Centers in 1989–90, desipramine, nortriptyline, amitriptyline, and imipramine have a relative risk of death from overdose of 16.88, 8.63, 6.06, and 7.53%, respectively, whereas the risk for trazodone is indicated as being only 1.00% (6).
In light of these facts, the final statement, “This case confirms the increased toxicity and the high mortality rate of a trazodone overdose, especially when concomitant administration of alcohol and other drugs is involved” (1) appears to penalize a drug that has been proven to be one of the safest in cases of overdose.
We think the words “high” and “especially” in particular may induce some misunderstanding.
Gaetano Esposito
Post Marketing Surveillance Department
Aziende Chimiche Riunite
Angelini Francesco A.C.R.A.F. S.p.A.
Viale Amelia, 70
00181 Roma
Italy
References
1. W. Lambert, J. Van Bocxlaer, M. Piette, and A. De Leenheer. A fatal case of trazodone and dothiepin poisoning: toxicological findings. J. Anal. Toxicol. 18: 176–79 (1994).
2. E. Hassan and D.D. Miller. Toxicity and elimination of trazodone after overdose. Clin Pharmacol. 4: 97–100 (1985).
3. I. Root and G.B. Ohlson. Trazodone and overdose: report of two cases. J. Anal. Toxicol. 8: 91–94 (1984).
4. J.A. Henry, C.J. Ali, R. Caldwell, and R.J. Flanagan. Acute trazodone poisoning: clinical signs and plasma concentrations. Psychopathology 17(suppl. 2): 77–81 (1984).
5. D.M. Gallant. Antidepressant overdose: symptoms and treatment. Psychopathology 20(suppl. 1): 75–81 (1987)
6. S. Kapur, T. Mieczkowski, and J.J. Mann. Antidepressant medications and the relative risk of suicide attempt and suicide. J. Am. Med. Assoc. 268(24): 3441–45 (1992).
7. W.L. Augenstein, S.C. Smolinske, K.W. Kulig, and B.H. Rumack. Trazodone overdose and severe cardiac toxicity. Vet. Hum. Toxicol. 29(6): 478 (1987).
8. C.J. Ali and J.A. Henry. Trazodone overdosage: experience over 5 years. Neuropsychobiology 15(suppl. 1): 44–45 (1986).
9. D.E. Gamble and L.G. Peterson. Trazodone overdose: four years of experience from voluntary reports. J. Clin. Psychiatry 47: 11 (1986).
The Authors Reply:
We are fully aware of the greater safety and the minor incidence of fatalities in trazodone overdose cases as compared with intoxications with the established tricyclics. This is already stated in the Introduction of our original paper. We are also convinced that concomitant administration of other drugs seriously increases the risk of mortality in a trazodone intoxication case.
The respondent has a valid point in stating that the reported concentration of dothiepin in the postmortem sample (2.1 µg/mL) is very high. However, dothiepin overdose patients have recovered from much higher dothiepin concentrations in the blood (up to 3.8 µg/mL) (1). The contribution of each compound (dothiepin and trazodone) in terms of percentage to the fatal outcome in this particular patient is difficult—if not impossible—to evaluate.
Willy Lambert1, Jan Van Bocxlaer1, Michel Piette1, and André De Leenheer1,2
1Laboratorium voor Toxicologie and 2Laboratorium voor Gerechtelijke Geneeskunde
Universiteit Gent
B-9000 Gent
Belgium
Reference
K.F. Ilett, L.P. Hackett, L.J. Dusci, and J.W. Paterson. Disposition of dothiepin after overdose: effects of repeated-dose activated charcoal. Ther. Drug Monit. 13: 485–89 (1991).
Reproduction of editorial content of this journal is prohibited without publisher’s permission.
Trazodone is an antidepressant agent used in Spain since 1975. There are few documented reports of fatalities solely attributed to trazodone and none in which the main metabolite is analyzed....
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15975258
The second one - a month later is:
About a month later, Starbranch said, Yates' then-husband, Rusty, told her that Yates had held a knife to her own throat the previous day.
So in neither case did she significantly harm herself.
The first attempt was with a drug that has hardly ever resulted in a fatalty by itself. She is a trained nurse so she would know how to figure out what she should take. The second atttempt was dramatic but was only a threat as she did not cut herself.
But like you, I’d like to know the husband’s contribution, role and accountability for this. He knew her problems after the 4th child and yet impregnated her a 5th time (bad judgment on his part)
________________________________
That's right, when a man does something terrible its his fault and lets fry him, when a woman does something terrible its what was the MANS role in this? Just put the victim tag on her. I would suggest that her getting pregnant was wrong, however he didn't rape her. Perhaps living with the fact that his 5 kids are dead is enough. There is no evidence that he ignored her problems, in fact she was committed several times, his mother had to come over and sit with her, however he had to go to work to support his family. While not a smart move on his part, forcing her to get pregnant (sarcasm on), She murdered his kids. Some guys would have left her when she was found to have a gopher loose in her garden. His role, he did the best he could do. Quit looking to blame him for something he didn't do. If the shoe was on the other foot, no one would ask what she did to cause her husband to kill the kids.
Amen. Rusty Yates left an unstable woman alone to raise and homeschool four children -- living in a school bus for a while, IIRC -- and then brought a fifth into the picture. He should have wrapped the rascal or gotten himself snipped. It was nice that he supported her during the trial, but it was far too little and far too late.
Mental illness is real. It's an illness as real as any physical malady, not a sin or a failure of character. Andrea Yates is a sick person who requires treatment and deserves sympathy. That said, she's also a dangerous person who shouldn't be allowed to walk in the fresh air and sunshine outside high walls ever again.
I'm less interested in avenging the Yates children than I am in doing everything possible to avert another tragedy like this one. I hope Andrea Yates lives a long life with electrodes glued to her head, daily therapy sessions, and frequent CAT scans. If that can help spot the next Andrea Yates ahead of time, it's worth the effort and expense,
You're isolating one factor. If someone who is normally well-groomed becomes habitually unkempt, that's a sign of a deteriorating mental state. If you've known me for years as someone who's always clean-shaven and wearing tailored suits, and one day I show up for a meeting with a three-day stubble wearing a bathrobe, that should send up red flags.
Rusty Yates is just as culpable -- he just doesn't get the focus. In my opinion, he ought to be tried, as well.
The pshrinks can give advice and prescribe medication. They cannot follow the patient home to ensure that the patient takes the advice or the meds.
I don't believe that Rusty Yates is criminally liable. But if I were in his position, I don't think I'd ever have a decent night's sleep again. He was duly warned by professionals, saw the signs for himself, and failed to act responsibly. He not only failed to be part of the solution, he was part of the precipitate.
That's why we call it a difference of opinion. You think I am wrong and I think you are.
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