SAN DIEGO » The man accused in the Arizona shooting rampage kept himself awake for 50 hours straight after an appeals court stopped forced medication. He walked in circles until he developed sores and then declined antibiotics to treat an infected foot. Already thin, he stopped eating and shed nine pounds.

U.S. District Judge Larry Burns described Jared Lee Loughner’s behavior to explain his refusal to overrule prison doctors who decided to resume forced medication July 18. The drugging, he said, "seems entirely appropriate and reasonable to me."

Loughner’s attorneys argued unsuccessfully that a court should review whether the forcible medications could resume.

The ruling came in a three-hour pretrial hearing Friday that offered insights into Loughner’s fragile condition at federal prison in Springfield, Mo., where he is on suicide watch.

Christina Pietz, a psychologist who is treating him at the prison, testified by phone that Loughner is "less psychotic" than in the past and that she is now more concerned about depression.

She worried that videotaping her sessions with him — as Loughner’s lawyers requested — would only exacerbate his ills. She said he turned "almost defeated" and withdrawn when she broached the idea on Wednesday.

"He feels as though he has no control about what’s going on around him, and this is just one more element," she said.

Pietz said Loughner sobs uncontrollably at times and steps aside during their meetings to cover his face.

Burns reaffirmed his earlier ruling to prohibit the videotaping, even after Loughner’s attorneys agreed to limit their request. He said it would add to Loughner’s stress and impair the psychological evaluation.

Loughner has pleaded not guilty to 49 charges in the Jan. 8 shooting that killed six people and wounded 13 others, including Rep. Gabrielle Giffords, at a meet-and-greet event held by the congresswoman outside a Tucson grocery store.

Loughner has been at the Missouri prison since late May after mental health experts determined he suffers from schizophrenia. Burns ruled him mentally unfit to stand trial.

He was forcibly medicated between June 21 and July 1 after prison doctors found he was a danger to others. The 9th Circuit Court of Appeals halted the medications while it considered an appeal of Burns’ decision to allow the drugs. The appeals court has scheduled a hearing in San Francisco on Tuesday.

The prison decided to resume the forced medications July 18 after doctors found Loughner’s condition has significantly worsened and that he was a danger to himself. Defense attorneys argued that the prison was violating the 9th Circuit’s order but the appeals court refused to step in.

Friday’s hearing was held in San Diego, where Burns is based. He was appointed to the case after all federal judges in Arizona recused themselves. John Roll, the chief federal judge for Arizona, died in the January rampage.