Top BT boss Leslie Winnister "lost touch with reality" when he attacked his wife Suzanne at their home in Bexley, southeast London, on September 8.
He had grown paranoid after believing his wife was having an affair with a handyman after she had reportedly put a kiss at the end of a text to him, prosecutors told the Old Bailey.
Telecoms director Winnister, 69, was spotted covered in blood wandering around a churchyard before telling police "I've had a terrible day".
BT Group took steps to distance itself from Treasury Manager Leslie Winnister in the days immediately following his arrest for the murder of his wife.
A longstanding member of the treasury team, Winnister held dozens of directorships linked to BT financial vehicles over the past two decades, including Esat and Interkom.
The court was told Mrs Winnister had become so concerned at her husband's increasingly paranoid behaviour, he had seen a nurse just six days before he killed her.
Mrs Winnister, 66, was found in a pool of blood in the kitchen of their £1.6m detached home with a blood-stained marble chopping block nearby, My London reports.
A post-mortem examination found she had died from head and neck injuries.
Yesterday Winnister was handed a hospital order without a limit of time after pleading guilty to manslaughter by diminished responsibility.
Judge Wendy Joseph QC told him: "The events that led to her death were an unmitigated tragedy for her, for you and for family and friends of you both who can barely bring themselves to believe what has happened."
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She outlined Winnister's contact with health services in the weeks before the killing, culminating in an assessment by a nurse on September 2, in which he appeared anxious and paranoid.
Judge Joseph said: "A further review was planned for one week's time. Too late. Six days later he killed his wife.
Earlier, prosecutor Bill Emlyn Jones QC told how the couple's relationship had deteriorated in late 2019 after Mrs Winnister sent a text to her husband meant for the handyman.
Mr Emlyn Jones said: "The defendant questioned her about the 'x' with which she had signed off, which she explained was a casual gesture which she in fact routinely used in text messages to all and sundry."
During the lockdown last spring and summer, their relationship became "intolerable", with "paranoid" Winnister again wrongly accusing his wife of cheating on him, trying to poison his food and swapping his Rolex watches for fakes, the court heard.
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On August 4 last year, Winnister attacked the handyman with a crowbar.
No further action was taken after the handyman declined to make a statement and the defendant moved into a hotel for five weeks.
During that time, a number of attempts were made to have the defendant assessed, and on August 19 his GP requested an urgent psychiatric review, the court heard.
On September 6, Mrs Winnister allowed her husband to come back home after she became concerned he was not eating or looking after himself.
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On the morning of September 8, Mrs Winnister told her best friend Beverley Johnson that he had been "awful" and was behaving strangely.
That night, family members became concerned.
Mrs Winnister was later found dead with injuries to her head and throat.
The defendant had gone to the nearby King's Head pub and was found walking through a churchyard with blood on his clothes.
As he was arrested, he told officers: "I've just had a terrible day."
Giving evidence, psychiatrist Dr Nigel Blackwood assessed the defendant as suffering from a delusional disorder with depression.
"Not only was this man palpably ill, everyone knew it. It was apparent before and during the time he killed."
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