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Nearly four months into his imprisonment, the Aurora theater shooter began to act in a peculiar fashion: he licked walls, sat naked on top of his clothes, was verbally non-communicative, refused to eat or drink, ate a sandwich of meat and paper cups and defecated throughout his cell.

Arapahoe County Jail nurse Sandra Paggan monitored and documented inmate behavior every shift she worked. She testified Tuesday that the shooter acted “normally” from late July — when he was jailed — until early November 2012. Paggan said he spent most of his time sleeping, reading, exercising, eating meals regularly, using the bathroom appropriately, watching television and occasionally speaking with the jail’s deputies and staff.

But the shooter’s described normalcy took a sharp turn in early November.

“He had a blank stare. It was like he was looking at you but straight through you,” Paggan said.

The defendant, James Holmes, is pleading not guilting by reason of insanity to killing 12 people and injuring 70 in an Aurora movie theater on July 20, 2012.

He was put on suicide watch and moved to a special cell for surveillance on Nov. 11 but moved to another one after a couple of days, because “the (first) cell and he were covered in feces,” Paggan said.

Paggan said he was unable to stand on his own and his body was “tensed up,” so the deputies moved the inmate across the hall on a blanket.

Soon after, the defendant was transported by ambulance to Denver Health, where he received psychiatric and medical attention. When the paramedics arrived he was able to stand up on his own and, with some assistance, get himself onto the medical gurney.

“(This) surprised me,” Paggan said, since he was non-ambulatory just minutes before.

The two paramedics who transported the shooter said he was responsive to some questions but not all, and he smiled “widely, with teeth.”

“He didn’t seem reliable in discussing what was wrong (with him),” said one of the paramedics, Jeremiah Leadem. “Interaction irritated him.”

As part of a normal diagnostic check, Leadem asked the shooter to say the phrase: “You can’t teach old dogs new tricks.” The shooter repeated the phrase without signs of slurred speech or confusion, but he then continued to repeat it over again during the hour-long drive to Denver Health.

The team of psychiatrists that treated the shooter agreed he exhibited symptoms of delusion. The prosecution asked one of these psychiatrists, Dr. Elizabeth Lowdermilk, if the stress of being imprisoned and possibly facing the death penalty, plus not eating or drinking, could trigger a state of delusion.

“Significant stress can cause a psychotic break,” Lowdermilk said, adding that a person would have to have a latent mental illness leading up to the kind of break she diagnosed as psychotic and delusional.

Another psychiatrist who treated the shooter testified Monday that his refusal to eat or drink may have been prompted by psychosis, which then caused a state of delusion. Causation of the delusion is not officially determined, but the shooter was treated with medication for both psychosis and delusion.

The defendant’s attorneys insisted he displayed similar psychotic signs directly following the shooting. They played an 11-minute video that showed their client in court the morning of July 23, 2012; he looked sleepy, solemn and scrunched his eyes tightly closed from time to time.

The prosecution suggested these behaviors could be due to sleep deprivation, or an emotional response to committing mass murder. The defense continues to present witnesses and evidence aimed at proving their client suffered from an untreated, severe mental illness in 2012.

“We’re offering this up to show his state of mind to rebut the prosecution’s claim he was making this up,” said defense attorney Rebecca Higgs. “His mental state was vulnerable and he had a psychotic break.”

Editor’s note: CU News Corps will honor the victims of this tragedy with every post via this graphic.