Wearing a maroon prison jumpsuit and sporting dyed reddish orange hair, James Holmes stared wide-eyed at the judge in his first court appearance since Friday morning's movie theater rampage in Colorado.
"He definitely seems out of it. He's not fully cognizant," said Dr. Justin D'Arienzo, a clinical psychologist in Jacksonville.
When Channel 4 showed him footage of the 24-year-old in court, he was quick to point out his erratic blinking, eyes cast downward and inability to focus.
"They're often given medication to calm their nerves, so I'm wondering if he's probably medicated right now on some type of anti-anxiety-type medication," D'Arienzo said.
While D'Arienzo has never treated Holmes, he said the mass murder suspect shows signs of being a high-functioning paranoid schizophrenic and believes a psychotic break could have been the reason why he recently dropped out of the graduate program at the University of Colorado.
"If it does turn out to be that he is a paranoid schizophrenic or has some time of psychotic break, there will be some pretty clear indicators that were likely going downhill sometime in adolescence," D'Arienzo said.
One of those indicators, according to D'Arienzo, could be that Holmes appeared to be a loner and didn't have much of a digital footprint -- no Twitter or Facebook accounts -- but instead had a profile on the sex site AdultFriendFinder.com with the tagline: "Will you come visit me in prison?"
"What that tells me is that he was headed down a path to being very withdrawn from society and being very secluded, and that is a symptom of someone having a lot of problems," D'Arienzo said.
With Holmes' first court appearance sparking more questions than answers, D'Arienzo said only a full psychological autopsy will reveal his true mental state and how this case will move forward.
"What it does tell me with the red hair and playing the part and being at the Batman premiere is that there was a lot of planning that led up to this horrific event," D'Arienzo said.
Channel 4 Crime Analyst on Holmes
Channel 4 crime analyst Ken Jefferson said while Holmes is being kept in solitary confinement, it’s unlikely that his dazed expression is due to sedatives he’s been given in jail.
"They generally don’t unless they’re on medication coming in. They generally don’t provide any type of medication. Who know the ins and outs of this guy," said Jefferson.
Jefferson said unless Holmes is being talked to by detectives, he is most likely sitting alone in a cell under constant guard.
"He’s there alone with a urinal and a cot. Space is not very big, he’s monitored every 10 to 15 minutes just to see what’s going on inside with him because he is a threat to himself," said Jefferson.
Jefferson said the threat of suicide is very real. He said Holmes may receive visits in jail from immediate family or psychiatrists, but even that’s in question. Jefferson added that each time viewers see Holmes in court, it’s likely it will be under heavy security because of the number of people out there who would want revenge.
"If you notice, he’s dress in jail clothes, but underneath there’s a bullet proof vest. They don’t want anything to happen to this person before justice is actually served," said Jefferson.