The man accused of wounding Rep. Gabrielle Giffords in a deadly shooting rampage has improved to where he understands that he killed people and feels remorse about it, and will be competent to stand trial within eight months, a psychologist testified Wednesday in federal court.

Jared Lee Loughner is still delusion but has made strides during the past four months at a Springfield, Mo., prison facility, Dr. Christina Pietz said.

When he first arrived at the facility, Loughner 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's testimony came at a hearing before U.S. District Judge Larry Burns, who must decide whether it's likely Loughner can be made competent to stand trial, and whether to grant prosecutors' request to extend his stay at the Missouri facility by eight months.

Loughner's attorneys argue prosecutors have failed to prove it is probable that Loughner's mental condition can be improved so that he can go to trial.

Pietz also said 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."

During the hearing, Loughner sat expressionless with his attorneys and listened quietly. He looked thin and pale and was wearing a white T-shirt and khakis. He was sporting a short haircut and sideburns, and his wrists and ankles were shackled.

Two federal marshals stood behind him.

The court appearance was Loughner's first since an angry, loud outburst got him kicked out of a May 25 competency hearing.

According to court transcripts, Loughner interrupted that hearing by saying: "Thank you for the free kill. She died in front of me. Your cheesiness."

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. They sat in a back corner of the courtroom, holding hands and whispering to each other.

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

Several survivors of the shooting spree also were at Wednesday's hearing, including Giffords staffer Pam Simon and Daniel Hernandez, the intern who helped Giffords at the scene. Also in the courtroom was Giffords spokesman Mark Kimble, who stood only a few feet from the congresswoman when she was shot.

If Burns decides to extend Loughner's stay in Missouri, the judge likely will also discuss whether to hold another hearing to determine if Loughner should continue to be forcibly medicated in a bid to make him mentally fit for trial.

Prison officials have forcibly medicated Loughner with psychotropic drugs 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.