Ms Ofori-Akuffo, also known as ‘Racquel’, was a qualified nurse while her mother Ms Hill had worked as a housekeeping assistant at Guy’s and St Thomas’s hospital in Westminster for 21 years before retiring in 2018.

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Jacques, emerged naked and prostrated himself in a praying position, shouting: ‘Allah, take me!,’ ‘Kill me now,’ ‘Get rid of me,’ and ‘God please forgive me.’

‘This, we say, led to a transient psychotic disorder which does not meet the requirements for the defendant to make out a partial defence of diminished responsibility.’

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He said: ‘My opinion is that on balance the abnormality of mental function arising from bipolar disorder would have been a significant factor in the killings.’

Dr Blackwood said he believed drug use was also the cause of Jacques’ behaviour in 2018 and that he did not have bipolar disorder.

He told the court: ’The defence psychiatrists maintain there was a serious mental illness which recurs in the context of cannabis use.’

Mr Little had told jurors there was ‘no dispute or issue other than that it was the defendant that killed all four of the victims and that he did so by attacking them.

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After killing the family Jacques made a FaceTime call to his mother in the locked bathroom and said: ‘I’m ending it, I’m gonna make a sacrifice.’

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Ms Ofori-Akuffo died after suffering from a 12.5cm stab wound to the left side of her chest which had gone through her heart, as well as cut injuries to her chest, neck, back and left thigh.

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‘We say that the defendant killed his victims with murderous intent and there’s no dispute about that, and that when he did so his ability to form a rational judgment and to exercise self-control were not substantially impaired by any psychiatric condition.

‘And indeed that his conduct on that night was brought about by self-induced intoxication, here taking drugs and drinking alcohol.

Dr Nigel Blackwood, a forensic psychiatrist for the prosecution, said the symptoms of manic behaviour displayed were caused by the large amount of cannabis he had consumed.

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He said it was his view that the symptoms ‘could be entirely produced by the cannabis use he was using at that time’ without an underlying condition.

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‘He was not breathing, and was unresponsive.  He was removed from the property by police. A large cut to his throat was noted.

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Samantha Drummonds, 27, her mother Tanysha Ofori-Akuffo, 45, her grandmother Dolet Hill, 64, and Ms Hill’s husband, chef Denton Burke, 58, were all stabbed to death by Joshua Jacques, 29.

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The ‘bloodbath’ took place at Mr Burke’s and Ms Hill’s home on Delaford Road, Bermondsey, southeast London, in the early hours of 25 April last year.

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‘He could not open it fully initially because it was blocked. The reason why it was blocked was on the other side of the door was Denton Burke’s body.

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Ms Drummonds died after sustaining multiple stab wounds to her back, side and neck, which caused internal injuries to her lungs, liver and right kidney.

Ms Hill was found to have sustained multiple stab wounds to her shoulder and chest, with the fatal injury being a 21cm-deep stab wound to the left side of her chest that had gone through her heart.

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Jacques, of Minard Road, Lewisham, admitted four counts of manslaughter but denied four counts of murder on the grounds of diminished responsibility.

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Jacques had been smoking pot from the age of 12 and hours before the killings Ms Drummond had phoned her best friend several times to raise concerns about his mental state.

In a voice note she said: ‘Josh is basically getting to the point where he could basically have an episode, like I don’t know what’s triggered him.’

Mr Burke had suffered multiple injuries to his face, mouth and body, including a large cut to his neck, as well as a significant head injury and fractures to his face and jaw.

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‘A paramedic and police officers moved Tanysha Ofori-Akuffo away from the wall of the kitchen. Wounds were seen on her upper chest, neck, and upper back.’

‘The officer saw a stab wound to the right side of her abdomen, with her intestines protruding, and noted that she had no pulse.

‘A paramedic and a police officer brought Dolet Hill, from the kitchen out into the hallway.  She was wearing a pink nightdress and underwear.

‘The kitchen area was cramped and so her body was moved outside. Further wounds to her neck and back were noted, and there had been severe blood loss.