A pensioner badly hurt himself in the weeks before he was found stabbed to death near his niece who suffered similar fatal injuries.
Richard Thompson's self-harm was mentioned at a hearing to prepare an inquest on the pair, who were found dead inside a caravan on Old Mill Lane, Forest Town.
It was conducted by Mairin Casey, Nottinghamshire senior coroner, who will also run the full inquest in the autumn.
Sitting at Nottingham Council House, she said that it was important to examine the care given to Mr Thompson, aged 66, after he had been released from hospital. The woman who died was Lisa Butler, aged 48 of Newport Cresent, Mansfield.
She said that the two deaths had caused "great distress" among the family who found it "incredibly painful."
Miss Casey said that Mr Thompson was prescribed medication to control his condition and told the hearing: "I would like to know how this is managed.
"If he is not compliant with the medication, what steps should or may be taken with that eventuality?
"Clearly someone who has psychosis may feel well and stop taking medications.
"Before he was admitted to hospital, Mr Thompson acted with violence against himself, life-threatening and impulsive."
The coroner said she needed to know whether he could have been returned to hospital or given the medications by injection.
"That is the nub of it as far as I can see. It is only right to flag it up before the hearing," she added.
The couple were found dead just after 10pm on August 28 last year. Police officers say they had no involvement with the pair before their deaths and that they sought nobody else for the deaths.
Nottinghamshire Healthcare Trust has provided statements for the inquest, which is likely to last for a day.
Mr Thompson was admitted to hospital in December 2017 and released the following March, five months before the deaths.
The coroner said she would also look at the work of two psychiatrists who treated Mr Thompson, studying how care changed when he was allowed out.
Miss Casey added that she needed "to check how the community team were liaising with the hospital team."
The case is also subject to a domestic homicide review, which has been set up under advice from the Home Office.
In the aftermath of the death, the family described Mrs Butler as "a much-loved wife and mother".