Let me reiterate.  James Holmes has Dysphoric Mania and Agitated Depression with Psychotic Ideation/Paranoid Delusions. Nowadays it is referred to as Psychotic Mania, but is not to be confused with typical Bipolar Disorder or simple manic depression.

He was diagnosed and treated too late. The University psychiatrist who saw him was partially fooled by his ability to maintain a facade of superficial social interaction and self-insight and mistook that to mean he still had a modicum of reality testing and borderline appropriate ego functioning/mental status. She only pushed the yellow caution button and she should have pushed the big red danger button. His worsening biochemical imbalance and psychiatric illness fused with his situational stress, anger, agitation, lack of sleep and mounting feelings of hopelessness, rejection, social/sexual/academic failure and estrangement from others and lit a dangerous mania fire in his head. He “flipped out” in a controlled, relatively quiet and secretive way over several months that allowed him to formulate his personal doomsday plans and violent form of rage-revenge against society, women, the University psychiatrists, the Medical school, his professors, and a world he progressively perceived as uncaring, dark, and depressing.  He still feels that way and that is why he smirks and sees the courtroom as a “joke”, himself as the “joker”, his victims as “collateral damage”, and his current “notoriety” as fair trade for losing his previous dreams of success (as a neuroscientist), fame, prestige, wealth, and social acceptance. He is definitely nuts but he knew exactly what he was doing. He gave signs and as usual nobody took it serious enough.