"Madness" works have never failed to strike me as repetitive and mindnumbingly derivative.
You're free to depict what you want, but I feel you're wasting your man hours on things like this.
On a technical not, the enemy spawn doesn't stand out so much- more like some attempt at generic toothy monsters on a boardgame card than something meant to be expressive or cinematic.
The "hero" character also seems much more in the foreground than the monster he's supposed to be shooting- and if he's supposed to be that way and is firing more to his right instead of straight ahead, it's simply not comng across.
The composition of the whole piece is really stunted, with bits and pieces that just don't fit together. It seems like you started out with the characters and background divided up over multiple layers and as you went on developing the scene you realized how everything wasn't quite lining up. Furthermore, I feel that you tried to condense and edit things to fit- more like beat into place, honestly- and at some point threw up your hands. The end result is...confusing.
No hard feelings, love, but I feel like your hand has developed too far past your eye and it's beginning to really show.