Jared Lee Loughner's attorneys and doctors worried his mental condition could deteriorate during a lengthy trial, prompting the decision to work out a plea agreement, according to a forensic report released Thursday by the U.S. District Court.

Forensic psychologist Christina Pietz told U.S. District Judge Larry Burns in an April report that the mass shooter was competent to stand trial. However, she informed the judge that even when they are doing well, people with schizophrenia have problems "remaining lucid during lengthy interviews and stressful situations."

She said his attorneys may notice times he's moody and less talkative.

If Loughner were to go to trial, Pietz suggested the judge schedule shorter days to give Loughner a break, and so his attorneys could make sure he was keeping up with the proceedings. She also urged the judge to hold the trial as soon as possible, noting there was no guarantee Loughner would remain competent for an extended period.

The psychologist also said it was imperative Loughner's medication not be changed "without a compelling reason" and suggested his current treating psychologist and psychiatrist be allowed to monitor him via teleconferencing throughout a trial.

Loughner, who killed six people and wounded 13 at a "Congress on Your Corner" event last year in Tucson, pleaded guilty Tuesday in U.S. District Court. The 23-year-old is facing seven consecutive no-parole life terms plus another 140 years when sentenced Nov. 15.

Loughner's guilty plea came immediately after Burns declared him competent, based in part on Pietz's report and following an hour-long discussion about Loughner's extended stay in a U.S. Bureau of Prisons medical unit in Missouri.

In her report and in her testimony, Pietz spoke about the measures taken to keep Loughner safe from himself and others. She also discussed the progress he made once his involuntary medication began, both in terms of his behavior and his lucidity.

In March 2011, officials were forced to put Loughner in belly chains, handcuffs and leg irons after he spat on and lunged at his attorney, but they began slowly removing the restraints for attorney visits this February, Pietz wrote.

Pietz wrote she was originally concerned because Loughner kept insisting his main target in the shooting, U.S. Rep. Gabrielle Giffords, was dead and that 10 seconds of shooting footage had been faked. She now believes Loughner sometimes contends Giffords is dead to help him cope with thoughts of being a failure. As for the footage, the differences between the footage and his memory of the event are probably a matter of perspective.

On Jan. 24, 2012, Loughner said, "I saw her on TV last night. ... I saw her walk into her office for the last time. She's going to the State of the Union address. I swear to you that's not the woman I shot. The woman I shot in the head died instantly. No one could survive that gunshot wound to the head."

At times Loughner now concedes Giffords is alive, but at other times he doesn't want to talk about it, Pietz wrote.

When asked what it would mean if Giffords is alive, Loughner told her, "That I failed. I'm not an assassin. That I ruined my life for nothing."

He also said, "It's another failure if she's alive. Jared Loughner failed again. He's a failure. So all of this would be for nothing."

Pietz wrote, "In my opinion, Mr. Loughner maintains this belief to vindicate himself and not because he's delusional."

Pietz testified she met with Loughner nearly every day of his Missouri stay and reviewed thousands of pages of his journal, police reports and interviews with friends, family and school mates.

Loughner was an average student who appeared normal up until he was 16 or so, Pietz told Burns.

When Loughner began saying odd things and becoming disruptive, it appears his friends stuck by him for a while. Pietz said they went so far as to initiate a suicide watch over him at one point.

Later, however, the friends began to ostracize him, Pietz said. They weren't afraid he would become violent, she stressed. They were young and they were afraid because he was different, she said.

Despite his behavior, Loughner was not diagnosed with a serious mental illness until after the shooting, Pietz said.

Doctors began medicating Loughner in June 2011, and by the next month he began expressing regret for his actions, Pietz testified.

Loughner asked to be assigned a job in March and now has two jobs that he "loves," Pietz said. He rolls up inmates' T-shirts and underwear in towels for distribution, and stamps outgoing envelopes with return addresses.

"It's a big deal to him. He's doing something he's successful at," Pietz said.

Pietz believes Loughner will stay stable if medicated but gave two caveats.

Sometimes patients will become acclimated to their medications and adjustments have to be made, Pietz testified. In addition, medications will not address the depression Loughner will likely suffer the rest of his life.

"He will have to learn to live with what he did" and the fact it put him behind bars forever, Pietz testified.

On StarNet: Read the forensic report filed by psychologist Christina Pietz on Jared Lee Loughner at azstarnet.com/pdf

"Jared Loughner failed again. He's a failure. So all of this would be for nothing."

Jared Lee Loughner, When asked what it would mean if Gabrielle Giffords is alive

Contact reporter Kim Smith at kimsmith@azstarnet.com or 573-4241.