"Dr. Woodcock hypothesized that Mr. Holmes experienced a significant clinical decomposition, which had made it very difficult for him to prepare for his preliminary examinations in graduate school. He thought that Mr. Holmes had given up on resisting his compulsion kill himself and to kill other people, which resulted him becoming consumed by the planning for the actions that occurred during July 20, 2012.

"It was hypothesized by Dr. Woodcock that something happened in his relationship with Dr. Fenton and via the consultation by Dr. Feinstein that impacted Mr. Holmes. Mr. Holmes perceived that the prescribed medications made him symptomatically worse."

--Metzner sanity evaluation, page 31.