The objective of this study was to examine a sample (n = 55) of filicidal mothers to compare those with and without psychotic symptoms at the time of the filicide. Clinical data were gathered through retrospective chart review of filicidal women referred for criminal responsibility/competence to stand trial evaluations from 1974 to 1996 at Michigan's Center for Forensic Psychiatry. Most (52.7%) women had psychotic symptoms at the time of filicide. Women with psychosis were more likely than those without to have a history of substance abuse; to have past and ongoing psychiatric treatment; and to be older, unemployed, more educated, and divorced or separated. They were less likely to be first time mothers or to have had prior contact with Children's Protective Services. The psychotic mothers more often confessed, attempted suicide at the time of the filicide, used weapons, killed multiple children, and expressed homicidal thoughts and/or concerns about their children to psychiatrists and family before the filicide. Psychotic women were as likely as nonpsychotic women to have used alcohol or illegal drugs at the time of the filicide.