Jumpy Dewani 'freaks' over cleaner moving a bed

British honeymoon murder accused Shrien Dewani was rushed from his Valkenberg Psychiatric Hospital ward on Friday after experiencing what officials suspected was an attack related to his psychological condition.

The Briton "freaked" when a cleaner moved the steel bed in his private ward, making a screeching sound.

He was taken away for treatment and only returned to his ward five hours later.

"He closed his eyes and ears and then the police and nurses took him somewhere inside the hospital and only brought him back hours later," said a hospital employee.

The police and medical staff have been monitoring Dewani day and night through a one-way glass window in his ward. Hospital sources said he had been seen browsing on his iPad, despite hospital rules forbidding computers for patients.

Dewani's reaction to the noise suggests he is suffering from either depression or post-traumatic stress disorder, or possibly both, according to psychologists.

Sensitivity to noise is commonly associated with depression and an abnormal "startled response" is a hallmark of post-traumatic stress disorder, for which Dewani is being treated.

However, the family of the woman he is accused of killing, his wife Anni Dewani, believe he did not take his medication while in London to prolong his illness in the hope of delaying and even avoiding a trial.

The first public signs of Dewani's medical problems came on Tuesday when he became jumpy during his first appearance in the High Court in Cape Town.

His eyes went wild and he appeared to become bewildered by coughs from the public gallery.

He was brought to South Africa on a private jet costing the taxpayer about R2.9-million.

He was on Tuesday charged with murder, conspiracy to commit murder, kidnapping, robbery with aggravating circumstances and obstructing the administration of justice after losing a drawn-out battle to avoid extradition to South Africa for allegedly arranging the killing of his new bride in a staged hijacking in 2010.

The case was postponed to May 12 and Dewani is being held at Valkenberg, a state institution for psychiatric evaluation and treatment.

Anni's father, Vinod Hindocha, said this week that they were happy he was under constant monitoring and treatment.

"We now know that he will be taking his medication, which I believe he avoided in England," he said.

Unlike other patients undergoing observation, Dewani has his own bedding, a pile of books and he enjoys specially prepared meals.

Two hospital officials said Dewani spent most of the week indoors under a pink floral duvet.

"He has got his iPad and books, [although] they are not allowed in the hospital," said one of the staff members. "He has got a desk in his room and is always reading."

The hospital employee said Dewani tucked into four boiled eggs every morning, followed by a special vegetarian meal in the afternoon, and that he spent most of the time in shorts and a T-shirt.

"He eats different food from other patients ... it is being made in the kitchen in a different pot."

He said two police officers and two nurses watch Dewani "every minute of the day".

"They follow him everywhere he goes - even when he goes to the toilet."

He uses a standard steel bed like other patients. His room was given a touch of paint ahead of his arrival and a new closet was also placed there.

Six members of the Dewani family, including his father and brother, visited him on Thursday afternoon and spent two hours with him.

They then drove in two metered taxis to the Crystal Towers Hotel & Spa in Century City, where they are believed to be staying. - Additional reporting by Bobby Jordan

• ndabenik@sundaytimes.co.za, nombembep@sundaytimes.co.za

Another set of experts for 'fragile' Shrien to convince

Is he faking it? Shrien Dewani's fragile mental condition - disclosed soon after he was named as the prime suspect in his bride's murder - is a subject that has turned polite dinner table conversations into raging disagreements.

Now the question is a step closer to being answered at Valkenberg Psychiatric Hospital in Cape Town.

Post-traumatic stress disorder delayed Dewani's extradition to South Africa for three-and-a-half years while he was treated in the UK.

Psychologists say that although it is not impossible to fake the illness, rigorous scrutiny by professionals will eventually trip up a patient who is feigning his symptoms.

"The treatment is quite rigorous and quite stressful sometimes, so if you are malingering, the stress of the treatment is not going to be worth it," said clinical psychologist Gerrit van Wyk, director of the Trauma Clinic in Cape Town.

Durban clinical psychologist Francois de Marigny said it was medically possible to replicate the physical symptoms of post-traumatic stress disorder. The drug ephedrine, for example, would elevate the heart rate.

But in a controlled environment such as Valkenberg the condition would be difficult to fake.

Post-traumatic stress affects many people exposed to trauma such as violent crime.

Van Wyk said symptoms included reliving the experience through nightmares or flashbacks, being in a constant state of enhanced alertness or feeling threatened, and avoiding situations similar to those encountered during the trauma.

These are natural reactions that fade with time for most people. But depending on the intensity of the event, symptoms that persist for more than a month and include a sense of numbness or angry outbursts are regarded as post-traumatic stress disorder.

Dewani's legal team fought to block his extradition on the grounds of his mental health. Eleven days after his wife, Anni, was shot, Dewani's brother, Preyen, issued a statement through publicist Max Clifford saying he was "severely traumatised". Two months later his solicitor said he had an acute stress disorder.

Judge Howard Riddle touched on the question in August 2010 during an extradition ruling at the Belmarsh Magistrate's Court when he said: "Although Mr Dewani has not undertaken the so-called malingering test, the experts have all considered this question. Their conclusion is that this is highly improbable ... The reasoning is convincing and on the evidence before me I am satisfied that the symptoms and the illnesses are genuine."

Psychologist Ian Meyer said Dewani would be closely monitored at Valkenberg. "Your behaviour is being observed day and night, such that if you are trying to feign mental illness, you have to do a pretty competent job and keep it up for 30 days," he said this week.

"The only question the team has to answer is whether Dewani is fit to stand trial," said Meyer.

Johannesburg website editor TJ de Klerk was diagnosed with post-traumatic stress disorder two years ago. He had blocked traumatic combat experiences from the past from his mind and they resurfaced.

He was referred for treatment by chance, after a psychologist viewed bizarre posts he made on Facebook that concerned his family and friends.

De Klerk's advice for people suffering in silence after a traumatic event is to seek treatment sooner rather than later. - Andre Jurgens