Moors murderer Ian Brady remains "chronically psychotic" and should stay in a hospital for treatment, his mental health tribunal has heard.
The child killer suffers from long-term paranoid schizophrenia which does not "just fade away and die", according to the clinician in charge of his care at high security Ashworth Hospital in Merseyside.
The 75-year-old was constantly paranoid about the Home Office and the Prison Officers' Association and believed hospital staff were acting as their agents.
His wish that he could "send cancer in an envelope" to one doctor was one example of anger which was the driving force behind his paranoia.
Giving evidence, Dr James Collins said Brady also had paranoid beliefs about fellow patients he thought were spying on him.
He believed others were "out to get at him" and he responded by spilling shredded oats cereal outside one man's door and smearing the chair of another with jam and honey.
Dr Collins said he was not aware Brady was paranoid before he was jailed for life in 1966 for murdering five youngsters in the 1960s, burying their bodies on Saddleworth Moor near Manchester.
Brady and Myra Hindley became known as the Moors Murderers He said he had managed to hold down a relationship with his partner in crime, Myra Hindley, a job and "sideline work" as a pornography dealer when he was a young man.
He was transferred to Ashworth Hospital in 1985 after displaying psychotic symptoms since 1967.
Dr Collins said he believed his illness is "clearly still active".
He told the panel: "He is better, much better and able to control it (the illness) but his life is still severely handicapped by his disorder, his mental illness.
"He is acting like someone who is chronically psychotic."
An expert witness called by Brady's legal team had previously told the panel Brady was not suffering from schizophrenia but from a severe personality disorder which could be handled in prison.
The murderer, who has been on hunger strike since 1999 and is force-fed through a tube, claims he has faked psychotic episodes in the past.
Brady has said he wants to end his life in prison where he could not be force-fed.
The pair killed five children and buried their bodies on Saddleworth Moor Since 2012 there had been 11 noted references in hospital records of him talking to himself.
The hearing was told Brady was still smoking after 60 years and had chronic obstructive airways disease but his health was better after last year when he suffered from a recurrent chest infection, had an epileptic fit and suffered two broken bones in his spine.
Brady was not present at the hearing, which is being relayed to the press and public at Manchester Civil Justice Centre.
He walked out on Tuesday after complaining that he had heard evidence "ad nauseam" cited by Ashworth Hospital and did not want to sit in when Dr Collins was speaking.
Brady and Hindley lured children and teenagers to their deaths, with their victims sexually tortured before being buried on Saddleworth Moor.
Pauline Reade, 16, disappeared on her way to a disco on July 12, 1963 and John Kilbride, 12, was snatched in November the same year.
Keith Bennett was taken on June 16, 1964 after he left home to visit his grandmother; Lesley Ann Downey, 10, was lured away from a funfair on Boxing Day 1964; and Edward Evans, 17, was killed in October 1965.
Brady was given life at Chester Assizes in 1966 for the murders of John, Lesley Ann and Edward.
Hindley was convicted of killing Lesley Ann and Edward and shielding Brady after John's murder, and jailed for life. She died in jail in November 2002 at the age of 60.
The hearing continues on Thursday.
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