Sydney siege gunman Man Monis was diagnosed with chronic schizophrenia four-and-a-half years before the Lindt cafe attack after telling a psychiatrist that he was under 24-hour surveillance from ASIO and Iranian intelligence, including in the bathroom.
As the inquest into last December's siege continues to examine Monis' background, south-west Sydney psychiatrist Dr Kristen Barrett described seeing the self-styled sheikh in May 2010 after he had been referred from Canterbury Hospital.
"I [first] saw him in the waiting room, wearing a cap and sunglasses and looking down at the floor … I thought that it was likely that wearing the cap and sunnies may have been because he was paranoid," Dr Barrett said.
When the appointment began, Monis was "extremely guarded" Dr Barrett said, refusing to provide detailed information about how he was feeling or his previous visit to a psychiatrist.
However he did tell Dr Barrett that he was being constantly watched, saying he didn't want to use his Medicare card for the appointment, and asking whether she was recording him.
"He felt that he was being watched by groups in Iran and Australia and that this had been going on for 14 years," Dr Barrett said.
"He felt he was being watched all the time including in the bathroom …He said even in his bathroom he was being recorded."
"My impression was chronic schizophrenia … that was my provisional diagnosis … I wanted to start him on one milligram of the anti-psychotic medication Risperdal."
"I felt that his ideas were delusional , and that they'd been going on for a considerable period of time making me think it was a chronic illness."
Dr Barrett said Monis agreed to take the medication and appeared to improve as she saw him at regular appointments in the coming months.
Rather than talking about being under surveillance, Monis expressed concerns about accidentally giving offence to people because of his poor English and general manner.
Believing that this may have been a symptom of anxiety, Dr Barrett prescribed the anti-anxiety medication Sertraline.
The inquest heard that over the course of around six months Monis decided to reduce the amount of medication he was taking and then stop taking it completely.
This contradicted the advice of Dr Barrett.
"I strongly recommended that he continue taking the dose that got him well," Dr Barrett said.
"I usually explain that the dose that got you well is likely to keep you well and that there's a likelihood of relapse."
The psychiatrist said Monis may have been suffering from a psychotic episode at the time of the siege.
"It seemed to me that some of the things he was doing before [the siege] suggested that some paranoid delusions were possible," she said.
"When I read in the papers that he'd been complaining to [the television program] Sunrise that they were sending hidden messages about things - that sounded like a psychotic phenomenon," she said.
"That was one of the things that made me think it was quite possible [he was having a psychotic episode]."
The inquest continues.
