Was it drug-induced psychosis triggered by taking LSD, or the first episode of an underlying chronic schizophrenia?
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The jury in the murder trial of Jordan Brodie Miller are being asked to determine what caused the then 20-year-old university student to lose touch with reality and, in a psychotic state, strangle his 18-year-old girlfriend to death at a home at Metford in 2020.
Mr Miller had formed the belief his girlfriend, Emerald Wardle, was a "demon" who was "sucking the life out of him", the jury heard on Monday.
Mr Miller also thought he was trapped in a "coma or matrix" and the only way to save himself was to kill himself or kill Ms Wardle.
Mr Miller on Monday pleaded not guilty to murder and faced the first day of an estimated two-week trial in Newcastle Supreme Court.
There is no dispute that he killed Ms Wardle in the early hours of June 20, 2020; he confessed the next day at his first court appearance.
Instead, the trial will focus on his mental state around the time of the killing and what caused him to be in a "psychotic state", Crown prosecutor Lee Carr, SC, said during his opening address.
Jordan Miller had formed the belief that his girlfriend was a demon and she was sucking the life out of him.
- Public Defender Peter Krisenthal.
The prosecution case is that Mr Miller's mental state was a result of drug induced psychosis, linked back to an amount of LSD he had ingested 11 days before Ms Wardle was killed.
But the defence, led by Public Defender Peter Krisenthal, say Mr Miller was suffering from his first episode of psychosis, in the form of an underlying chronic schizophrenia, and he has available to him a defence of mental health impairment.
The trial will focus on the evidence of a number of medical experts, including forensic psychiatrists and a psychopharmacologist.