The woman found not guilty by reason of insanity of last year's fatal stabbing attack in Wellington hadn't taken her medication for three months and attacked her GP on the same day because she thought he was trying to poison her.
The 26-year-old, who suffers from a schizoaffective disorder, will be kept as a special patient in hospital following her appearance in the High Court at Wellington today.
In July last year, a 67-year-old man died after what was described as a "rampage" in the suburb of Johnsonville. The other four victims were a nine-year-old boy and three women.
The woman faced one charge of murder, three of wounding with intent to cause grievous bodily harm and one of assault with a weapon.
Following submissions by lawyers and psychiatrists, Justice David Collins found her not guilty by reason of insanity on all five charges.
A number of suppression orders surround the case, including a restriction on naming the woman.
"It's hard to think of a greater tragedy," forensic psychiatrist Philip Brinded told the court.
The woman had first become unwell in Australia in 2008 and had spent time in hospital.
She suffered from paranoid delusions, believed people were trying to hurt or poison her, heard voices criticising her and telling her to do things, Prof Brinded said.
However, she had a history of not taking her medication because she didn't like the side effects.
At the time of the attack she was in a psychotic state and her hallucinations were terrifying her.
"She was in such a psychotic state that she did not know what she was doing was morally wrong."
Another forensic psychologist Justin Barry-Walsh told the court the woman had stopped taking her medicine about three months earlier.
On the day of the attacks, she had been taken to see her GP, who tried to get her to take her medication.
"She actually assaulted the GP believing he was evil and trying to poison her."
She was then sent to the emergency department at Wellington Hospital and released from there - just hours before the attack - because they believed she had taken her pills.
However, her blood test showed no result for the medicine.
As a special patient she would receive careful treatment, which would go well beyond the prescription of medication, Dr Barry-Walsh said.