Defendant James Holmes appears in a video presented to a darkened courtroom in Centennial, Colo., Thursday, June 4, 2015. Holmes, also seated at defense table below screen, spoke in the video to a psychiatrist who evaluated him for the trial on charges that he killed 12 people and wounded 70 others during the midnight premiere of a Batman film. (Colorado Judicial Department via AP, Pool)

CENTENNIAL | Another state-appointed psychiatrist testified Monday that Aurora theater shooter James Holmes was sane at the time of the attack almost three years ago.

Jeffrey Metzner examined Holmes after he killed 12 people and injured 70 more in the packed Aurora Century 16 theater, prosecutors said.

“Despite having a mental disorder or defect, Mr. Holmes had the capacity to tell the difference between right and wrong,” Metzner said. Metzner later said he was “extremely confident” in his finding that Holmes knew right from wrong and that he had the capacity to be culpable for his actions.

But under questioning from public defender Daniel King, Metzner said he was confident in that diagnosis but that he couldn’t be 100-percent certain about it.

Also under questioning from King, Metzner said that without Holmes’ mental illness, the shootings would never have occurred.

Metzner’s testimony was similar to testimony from Dr. William Reid last week. Both said Holmes was sane at the time of the killings but had a serious illness that caused the shootings.

Metzner testified that he interviewed Holmes and wrote a 128-page report on his findings.

Holmes was failing a University of Colorado Anschutz Medical Campus neuroscience program in the months before the attack, and Metzner said that failure, combined with Holmes’ only romantic relationship falling apart, contributed to serious depression.

In the months before the shooting, Holmes had “lost his purpose in life” and was floundering, Metzner said.

“I think he was struggling with who he was and what was going to happen to him,” he said.

Metzner said the fact that Holmes planned for his escape — he brought road stars with him to the theater in case he was in a car chase with police — and Holmes’ statements about not wanting to kill children demonstrate that he knew his actions were morally wrong, Metzner said.

Metzner was the first doctor to examine Holmes after he pleaded not guilty by reason of insanity to the July 2012 attack. Holmes’ attorneys say he suffers schizophrenia and couldn’t tell right from wrong during the attack.

Prosecutors are presenting evidence indicating Homes was sane at the time.

Judge Carlos A. Samour Jr. later ordered a second evaluation, agreeing with prosecutors that Metzner’s examination was incomplete. The other court-appointed psychiatrist, Reid, testified last week.

If jurors find in favor of Holmes, he would be committed indefinitely to a state mental hospital. Prosecutors want them to convict Holmes and sentence him to death.

Holmes told Metzner and Reid that he still had homicidal urges more than a year after the shootings.

In a hearing before Metzner took the stand, Samour agreed with defense attorneys that jurors should not hear about Holmes’ “continuing, chronic, homicidal thoughts” because it might improperly influence their judgment.

Samour noted, however, that the statements could come up during Holmes’ sentencing phase.

Reid previously testified that Holmes still believes that killing people will increase his self-worth.

— The Associated Press contributed to this report.