A woman accused of killing a seven-year-old girl in a park on Mother's Day had not been taking her anti-psychotic medication, a court heard.
Eltiona Skana, 30, allegedly grabbed Emily Jones and cut her throat with a craft knife as the child rode past on a scooter on 22 March.
Emily had gone to Queen's Park in Bolton with her father Mark Jones while her mother Sarah Burns was jogging nearby, the jury was told. She died in hospital two hours after the attack.
Minshull Street Crown Court in Manchester heard Skana was detained at a medium secure mental health unit following her arrest.
Dr Victoria Sullivan told jurors that Skana was heard "muttering" to herself on the unit in Manchester and turning her head abruptly as if to respond to visual stimuli.
Skana also reportedly claimed she could see "angels" that communicated to her through gesticulations.
Dr Sullivan said: "I suspected she had either not been taking medication in the community or it had for some reason stopped working."
Jurors also heard how Skana's sister Klestora turned up at the unit in a "distressed" state following the attack.
Dr Sullivan said: "She told us Miss Skana had been missing days in her medication ... she [Skana] had had mental health difficulties for a number of years, she intermittently did not take her medication and had been a risk to other people."
The court has heard Skana, originally from Albania, came to the UK in 2014 and had been taking anti-psychotic drugs by injection every month since 2017. She lived in a flat in Bolton but had no job or friends and spent her time having coffee with her mother, who lived nearby in Manchester.
Dr Suhanthini Farrell, an on-call psychiatrist who led a team which assessed Skana after her arrest, described Skana as "guarded and suspicious" with a "tone of hostility and increasing irritability".
Jurors heard Skana told them: "I know I'm a paranoid schizophrenic."
Dr Farrell added: "It did feel she was thinking carefully about the answers she was giving, rather than responding intuitively, naturally.
"She was composing her answers, then giving it. My impression was there was active psychotic symptoms. The symptoms were subtle. Objectively she did appear to be paranoid."
Skana admits manslaughter on the grounds of diminished responsibility but denies murder.
Michael Brady QC, prosecuting, told jurors the main issue was whether Skana's mental illness is the reason behind the killing or "a convenient excuse".
The trial continues.