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Melvin James, 36, was allowed to leave hospital in February and killed his sister Ann-Marie and himself at the family flat in Wolverhampton in March.
An inquest jury has said there were three missed opportunities.
These included hospital doctors not giving the family a face-to-face handover.
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Mr James was allowed to leave the Royal Edinburgh Hospital after treatment for what doctors suspected was a "drug-induced psychosis".
His mother, Lynette, had told the Oldbury inquest how she told her son "I love you" as he repeatedly stabbed her.
He was subdued using stun grenades and Tasers, but had inflicted multiple stab injuries on himself - one of which was fatal.
His 33-year-old sister, who died from a fatal stab wound to her heart, had 17 knife-related injuries.
The jury found there was a "lack of detail given in communication" between hospital staff and his family, communication had not been documented fully and there was "no follow-up (care) after discharge".
Senior coroner for the Black Country, Zafar Siddique, said he would write to the hospital with a report to prevent future deaths.
He added: "It does raise some concerns about the discharge procedure."
An internal hospital review is ongoing.
The jury heard Mr James spoke of "a clown that could brainwash him" into a choice of "kill or be killed".
Dr Norman Nuttall, consultant psychiatrist at Royal Edinburgh Hospital, said Mr James "appeared to be acutely medically unwell".
The doctor told the jury while he was assessed as a "risk to himself", he was not to others.
Blood tests revealed an opioid, possibly from a psychoactive substance, and his condition was diagnosed as "drug induced".
But Dr Nuttall said his admission may have "represented an exacerbation of an under-lying psychotic illness".
Mr James' condition improved and he was discharged.
Both Dr Nuttall and another doctor said it was "regrettable" no formal handover of care had taken place with the family.
There were "missed opportunities" in the handover care of a man who killed his sister and stabbed his mother, an inquest jury has found.