Determining Guatemalan national Diego Novella's mental state and his fitness to stand trial may delay his case in the Western Cape High Court for an "indeterminate amount of time", Judge Vincent Saldanha said on Monday.
A week ago, Novella was declared a suicide risk after being rushed to the district surgeon.
This, after he told the court he had lied when testifying about how his girlfriend, Gabriela Kabrins Alban, died in 2015 and that he was feeling unwell.
He was found to have suffered from a panic attack and his medication was increased.
Novella is accused of murdering the US sales executive at an upmarket hotel in Camps Bay on July 29, 2015.
When Saldanha asked how he was when the trial resumed for closing arguments on Monday, he shook his head and said he was not "feeling so well".
Episode triggered by Novella's 'own conduct'
His lawyer William Booth explained how both he and mental health professionals visited his client last week due to concerns about his state of mind.
"I have not been able to get a clear, coherent account from my client," he said, adding that this was supported by a private psychiatrist who had seen Novella.
He recommended his client be held in the hospital section of Pollsmoor Prison, so he could be monitored.
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Saldanha responded: "As I understand in these reports, this entire episode was precipitated by your client not taking his medication (for anxiety) since last Monday morning."
Booth said his client was in a "fairly serious mental state", to which Saldanha replied: "Precipitated by his own conduct."
The court heard that Novella suffered from derealisation (feeling that surroundings are unreal) and depersonalisation (feeling numb, detached or unreal).
No psychiatrist's testimony
Saldanha said Novella's consulting psychiatrist should explain in court what this meant and what the implications were for the trial.
"It is completely speaking in tongues. What is it? I don't know what it means?"
Saldanha also felt Novella had to be properly assessed and wondered whether he should not be sent back to Valkenberg psychiatric hospital.
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Prosecutor Louise Friester-Sampson said she had been advised that Novella was taking his medication daily and that the "matter should resolve in a day or two".
Saldanha instructed Booth to get his psychiatrist to testify so he could get clarity.
"He ought to have been here in any event to testify in court. The trial effectively comes to a halt for an indeterminate amount of time. That is my concern."
Tranquilliser recommended
The trial was briefly adjourned so that Booth could check the psychiatrist's availability.
When he returned, he said he could not get hold of the psychiatrist because he was apparently off work for a personal matter.
Friester-Sampson said that in the break, Valkenberg psychiatrist Professor Sean Kaliski advised in a cellphone message that the reports he had seen were not enough for a referral and that it seemed as though Novella would respond well to a tranquilliser.
She said he advised that the medication was ready for him at Pollsmoor Prison and that it would take effect in 48 hours.
Saldanha postponed the trial until Tuesday for Novella's psychiatrist to testify.