TUCSON, Ariz. >> The man accused of wounding U.S. Congresswoman Gabrielle Giffords and killing six is mentally incompetent to stand trial, a judge ruled Wednesday after U.S. Marshals dragged the man out of the courtroom because of an angry outburst.

As survivors of the deadly January attack looked on, Jared Lee Loughner lowered his head, raised it and said what sounded like "Thank you for the freak show. She died in front of me." His words were loud but mumbled, and it wasn’t clear who he was talking about. He wore a khaki prison suit and sported bushy, reddish sideburns.

U.S. District Judge Larry Burns’ decision means the 22-year-old will be sent to a federal facility for up to four months, to see if he can improve to the point where he understands the case against him.

The ruling came after two mental health professionals said they concluded Loughner suffers from schizophrenia and is mentally unfit for trial.

Loughner spent five weeks in March and April at a federal facility in Springfield, Mo., where he was examined by the professionals, psychologist Christina Pietz and psychiatrist Matthew Carroll. The two were asked to determine whether Loughner understands the consequences of the case against him.

Loughner has pleaded not guilty to 49 federal charges stemming from the Jan. 8 shooting at a meet-and-greet event that wounded Giffords and 12 others and killed six people, including a 9-year-old girl and a federal judge.

Following his outburst, two marshals standing behind Loughner’s chair grabbed him by each arm and led him from the courtroom. Loughner’s father, sitting a few rows behind his son, lowered his eyes and huddled with two women seated with him.

After a short recess, the marshals told the judge that Loughner had calmed down. They then brought Loughner back into the courtroom, and the judge told him he had a right to watch the hearing.

Burns asked Loughner if he wanted to stay in the courtroom and behave, or view the proceeding on a TV screen in another room.

"I want to watch the TV screen," Loughner responded.

At least three survivors of the Tucson attack attended the hearing: Giffords aide Pam Simon, who was shot in the chest and right wrist; Eric Fuller, who was shot in the knee and the back; and retired Army Col. Bill Badger, who is credited with helping subdue Loughner after a bullet grazed the back of Badger’s head.

Fuller said he is comfortable with the judge’s incompetency decision and wouldn’t be bothered if Loughner spends the rest of his life in a mental health facility.

"You don’t have to be a psychiatrist to know that the boy is disturbed," Fuller said.

Prosecutors had asked for the mental exam, citing a YouTube video in which they believe a hooded Loughner wore garbage bags and burned an American flag.

The judge gave the two mental health professionals access to Loughner’s health records from his pediatrician, a behavioral health hospital that treated him for extreme intoxication in May 2006 and an urgent care center where he was treated in 2004 for unknown reasons.

Prosecutor Wallace Kleindienst said that in the next few days, Loughner will be sent back to the Missouri facility where he underwent five weeks of mental competency testing. He will stay there for up to four months to see if his competency can be restored to where he understands the case against him.

If Loughner is later determined to be competent, the case against him will resume. If he isn’t deemed competent at the end of his treatment, his stay at the facility can be extended. There are no limits on the number of times such extensions can be granted.

Kleindienst said the Missouri facility will seek to medicate Loughner, but he didn’t know if Loughner would agree to taking medication.

If doctors conclude they can’t restore Loughner’s mental competency, the judge would have to make a decision. If the judge finds there’s no likelihood of Loughner being restored to competency, the judge can dismiss the charges against him. In that case, state and federal authorities can petition to have Loughner civilly committed and could seek to extend that commitment repeatedly, said Heather Williams, a federal public defender in Tucson who isn’t involved in the Loughner case.

The doctors who examined Loughner were ordered not to focus on his sanity at the time of the shooting.

Loughner’s lawyers haven’t said whether they intend to present an insanity defense. But they noted in court filings that his mental condition will likely be a central issue at trial and described him as a "gravely mentally ill man."

Giffords spokesman C.J. Karamargin declined to comment on Wednesday’s ruling and wasn’t sure whether Giffords would be notified. "We’ve never commented on Loughner’s legal case," Karamargin said. "There’s no reason to start now."

Giffords’ astronaut husband Mark Kelly is currently on NASA’s next-to-last space shuttle flight. Asked about whether Kelly would be told of the judge’s decision, Karamargin said: "I don’t know. My guess is he’s of course in constant communication with Earth, so I imagine he will be told. I don’t know the specifics."

___

Associated Press writer Mark Carlson in Phoenix contributed to this report.