Moors murderer Ian Brady has been denied the use of a pen because of fears he will use it as a weapon against other patients at the psychiatric hospital where he is being kept.
On the second day of a mental health tribunal being held in public, a lawyer representing Ashworth Hospital said the 75-year-old has "chronic levels" of anger and launches "verbal tirades" against medical staff.
The serial killer, who has been at the maximum security hospital for 26 years, wants to be transferred to a prison to spend the rest of his life behind bars.
Eleanor Grey QC, the hospital's lawyer, said Brady's anger "can erupt on the smallest provocation".
Dr Adrian Grounds, a forensic psychiatrist called to give evidence by Brady's legal team, said he has been known to target staff with "intense ill-feeling and aggression".
He said Brady remains aloof to most of those around him and does not form close relationships but argued there was insufficient evidence to support the conclusion that he is mentally ill.
Miss Grey QC said: "(Brady) is extremely socially withdrawn or isolated, at least since the withdrawal of his pen.
"He's got a nocturnal existence really, only coming out at night time when other patients are not there.
"At present he's currently sleeping under the covers but with his clothes on."
Dr Grounds described Brady as a "very opinionated man" who occasionally shouts at the television.
Brady left the hearing at Ashworth after around an hour, leaving doctors and lawyers to continue without him.
The tribunal is being relayed by video link to Manchester Civil Justice Centre, where journalists and victims' relatives have been watching on TV screens.
The hearing, which is expected to last about a week, was postponed last July because Brady suffered a seizure.
Brady and his partner Myra Hindley were responsible for the murders of five youngsters in the 1960s.
Some of their victims were sexually tortured before being buried on Saddleworth Moor above Manchester.
Pauline Reade, 16, John Kilbride, aged 12, Keith Bennett, also 12, Lesley Ann Downey, 10 and 17-year-old Edward Evans were all victims of the pair.
Keith Bennett's remains were never found, despite extensive searches and police taking the killers back to the Moor in 1987.
Hindley died in jail in November 2002, aged 60.
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