TUCSON, Ariz. — The man accused of wounding Rep. Gabrielle Giffords in the deadly shooting rampage in Tucson was quiet and emotionless and mostly sat still during a federal court hearing on his mental health.

During that hearing, on May 25, Loughner had to be removed from the courtroom by federal marshals because of an angry outburst.

Dr. Christina Pietz, a psychologist who has been treating Loughner at Springfield, Mo. prison facility, testified Wednesday that his improved demeanor is a sign he can be made competent to stand trial within the next eight months.

U.S. District Judge Larry Burns also cited Loughner’s behavior in ruling there’s a substantial probability Loughner’s mental health can be restored. Burns noted at the end of Wednesday’s hearing that Loughner had, for once, paid attention to the proceedings.

“There’s reason to be optimistic he will recover and be able to assist in his case,” the judge said. “The court finds that measurable progress has been made.”

Earlier in the hearing, Loughner looked thin and pale and was wearing a white T-shirt and khaki-colored prison pants. He had closely cropped hair and sideburns, and his wrists and ankles were shackled.

As the hearing dragged on, Loughner swiveled back and forth in his chair at times, and sighed as the talk turned to video surveillance of the shooting and later his delusions. But for the most part, he sat still and expressionless.

Experts have concluded Loughner suffers from schizophrenia, and prosecutors contend he can be made competent with more treatment. But Loughner’s attorneys argue prosecutors have failed to prove that it’s probable his condition will improve enough.

Pietz said that when Loughner first arrived at the Missouri facility, he was convinced Giffords was dead, even though he was shown a video of the shooting.

“He believed it had been edited” by law enforcement, Pietz said.

Now that the 23-year-old is being forcibly medicated with psychotropic drugs, “he knows that she (Giffords) is alive.”

“He is less obsessed with that,” Pietz testified. “He understands that he has murdered people. He talks about it. He talks about how remorseful he is.”

Pietz added Loughner now makes eye contact with people and no longer has the inappropriate smirk seen at previous court hearings, which she described as a symptom of his mental illness. Burns also noted the absence of a smirk in issuing his ruling.

Loughner has pleaded not guilty to 49 charges stemming from the Jan. 8 shooting that killed six and injured 13, including Giffords.

Pietz noted Loughner remains on suicide watch but is no longer having auditory hallucinations. Extending his stay at the Missouri facility by eight months will give him enough time to become mentally fit for trial, she told the judge.

“He has already made improvements, and he has only been on medication for 60 days,” she said. “Given the progress he has made today, I have no reason to think he wouldn’t continue to make progress.”

Less than an hour into the May 25 hearing, Loughner lowered his head to within inches of the courtroom table and then lifted his head and began a rant. “Thank you for the free kill. She died in front of me. Your cheesiness,” he said, according to court transcripts.

Federal marshals whisked him from the courtroom, and he watched the rest of the hearing on closed-circuit TV from a separate room.

The judge required Loughner’s presence at Wednesday’s hearing, even though his lawyers objected and argued traveling would be disruptive for their mentally ill client.

Loughner wanted to attend so he could see his parents, who live in Tucson and were at the hearing.

Burns on Wednesday decided to extend Loughner’s stay at the Missouri facility for four months, adding that he would have to see more “measureable progress” before he could add more time. Burns also ruled that officials can continue medicating Loughner based on the prison’s finding that he’s a danger to himself.

Prison officials began forcibly medicating Loughner after concluding at an administrative hearing that he posed a danger at the prison. Loughner’s lawyers have been seeking to have the judge, rather than the prison, decide whether Loughner should be medicated.

Loughner was first forcibly medicated between June 21 and July 1, but an appeals court temporarily halted the medications after defense lawyers objected.

The forced medication resumed July 19 after prison officials concluded Loughner’s psychological condition was deteriorating, noting he had been pacing in circles near his cell door, screaming and crying for hours at a time.

Defense lawyers have repeatedly asked Burns and a federal appeals court to halt the forced medications.

Loughner’s medications include the sedative Lorazepam, the antidepressant Wellbutrin and Risperidone, a drug used for people with schizophrenia, bipolar disorder and severe behavior problems.

If Loughner is later determined to be competent enough to understand the case against him, the court proceedings will resume. If he isn’t deemed mentally fit at the end of his treatment, Loughner’s stay at the facility can be extended. There are no limits on the number of times such extensions can be granted.

If doctors conclude they can’t restore Loughner’s mental competency, the judge must make another decision. If he finds there’s no likelihood of Loughner being restored to competency, he can dismiss the charges.

In that case, state and federal authorities can petition to have Loughner civilly committed and could seek to extend that commitment repeatedly.