A man accused of killing six members of his ex-wife's family, including four children, has collapsed in court as a prosecutor read out the charges against him.
Ronald Lee Haskell was standing shackled before a state district judge when he fell to the ground. Deputies lifted him to his feet and the 33-year-old stood for about another minute before collapsing again.
He was lifted into a chair and wheeled from the courtroom. His court-appointed lawyer, Doug Durham, said it appeared that he fainted. He added that Haskell is being treated at Harris County jail in Texas.
Mr Durham said the defence case will focus on Haskell's mental health.
Earlier, authorities said Haskell was the subject of a restraining order obtained by his own mother less than a week before the attack and faced previous allegations of domestic violence.
He is accused of killing his ex-wife's sister Katie Stay, her husband and the children, ranging in age from four to 14, after tying them and laying them face-down on the floor of their suburban home in Houston.
They were shot in the back of the head after the family refused to tell Haskell where he could find his ex-wife, officials said.
The lone survivor of the attack, the murdered couple's 15-year-old daughter, suffered a fractured skull when a bullet grazed her head.
Police in San Diego, California, said Haskell's mother had reported an argument with her son on July 2 at her home, during which Haskell physically restrained her when she tried to leave the house to call for help. He finally left after a few hours, and his mother contacted police, a statement said.
She later obtained a restraining order against her son and the case remains under investigation, according to the statement.
Haskell had a handful of previous run-ins with law enforcement in Utah, where he had lived with his wife. Neighbours said his marriage was so rocky that Ms Stay arrived last year to help her sister escape the relationship and start a new life in Texas.