During the hearing, Ocampo mumbled to himself and at times appeared to smirk. His own defense attorney said his client is mentally ill.
"He's cracked. He's ill. He's got a mind that is wounded. His mind is so fractured that I think it's hard for him to understand not only the gravity, but even where he is right now," said defense attorney Randall Longwith.
The 23-year-old is charged with stabbing four homeless men to death. The murders took place in Orange County over a three-week period starting in December. It ended with Ocampo's arrest as he ran from the scene of the fourth murder in Anaheim.
Ocampo is also charged with stabbing to death a mother and son in Yorba Linda last October. Unlike the homeless victims, authorities allege Ocampo knew 53-year-old Raquel Estrada and her 34-year-old son Juan Herrera through Estrada's younger son.
Family members of one of Ocampo's homeless victims, 42-year-old Lloyd Middaugh, came to court to see the suspect. Middaugh was found stabbed more than 40 times along the Santa Ana River Trail in Anaheim.
"I'm kind of sick to my stomach," said Marie Middaugh, the victim's mother. "I can't wrap my head around it. It just doesn't seem possible."
Longwith said he has not yet decided whether to use an insanity defense, but stressed that Ocampo was affected by his eight months in Iraq. While he did not see combat, his attorney said Ocampo drove a truck and would have to deal with wounded and deceased people.
Prosecutors have not yet said whether they will seek the death penalty. Ocampo is due back in court on March 9.