Matthew Tvrdon, 32, drove his van on a "journey of mayhem" for eight miles over 30 minutes on 19 October 2012.
Karina Menzies, 31, died and 17 others were hurt at five locations in Cardiff.
Tvrdon, who has paranoid schizophrenia, has admitted manslaughter on the grounds of diminished responsibility and seven counts of attempted murder.
The Welsh government says it will consider ordering an independent review into the case.
Karina Menzies was killed during the hit-and-run incidents in Cardiff on 19 October last year During the start of two days of sentencing, the court heard seven children were among those hurt as Tvrdon drove his white three-tonne Iveco van into them.
Tvrdon had deliberately tried to kill at least one adult in each of the five family groups he targeted, the court was told.
Witnesses saw the van veer off the road and straight into the Menzies family. Ms Menzies pushed her children out of the way before the van hit her. Tvrdon, the court was told, turned around and ran over her again.
Another witness described how Ms Menzies was semi-conscious and her two young children were calling out for their mother.
The map shows the route Matthew Tvrdon took on his 'journey of mayhem'A video was played of Tvrdon driving a Renault Clio car along another main road in Cardiff. It showed him speeding through red lights and into oncoming traffic. He also mounted grass verges.
He then stopped at a social club car park and got into the van, while his ex-girlfriend Lisa Davies tried in vain to stop him.
The court was shown CCTV footage which showed each of the attacks in detail:
Crossways Road, Ely. A woman, 29, and two children - a boy, nine, and girl, eight, were injured. One child dragged under the vanCowbridge Road West, a man, 24, and woman, 22 walking two-year-old daughter in a buggy near Ely Reptile Centre. Child was catapulted out of the pushchair. Karina Menzies and two children, eight and 23 months, at near Ely fire station in Cowbridge Road WestGrand Avenue in Ely, Renee Selio and two daughters, 10 and 12, hit on zebra crossing Tvrdon attacked three people with a steering lock at Asda petrol station at LeckwithGill White, 49, remonstrated with him before he ran her over and then her daughter Rebecca, 27, and they were dragged under the van as he drove out of the forecourtThe court was told that Tvrdon was chased by police before being dramatically stopped near the Baron's Court restaurant in Penarth Road.
He tried to assault a police officer with a crook lock before being sprayed with CS gas.
Artist impression of Matthew Trvdon appearing in court at an earlier appearance Later, Tvrdon, who tested negative for drink and drugs, told police he was under stress at work and had split up from his girlfriend.
He told police what he had done was a "horrendous" thing and said he felt "hazy".
Tvrdon said he had not been feeling "right about himself or his mind and this was not a feeling he had before in his previous mental health episodes".
The court heard Tvrdon had been sleeping rough for a few days in the run up to the incidents and said he got into the van that day intending to drive to a local industrial estate and go to sleep in it.
But instead he began to drive erratically and targeted pedestrians.
During police interviews, he said experienced a "fit of fury" during the incident at the fire station where Ms Menzies was fatally injured.
Tvrdon, who has no previous convictions, told police: "It felt like what I wanted to do was kill these people but in actually doing it, it felt really wrong."
Continue reading the main storyThe man responsible for the death of a mother of three after he deliberately drove his van at her and her children, had a long history of mental health problems which were to prove lethal.
Tvrdon, from Cardiff, came from a stable family and had no record of trouble with the police as a young person.
However there was a history of mental illness on both sides of his family, which was later to manifest itself in him.
In July 2003, Tvrdon had his first spell at a psychiatric hospital after being diagnosed with paranoid schizophrenia.
He was back in hospital four years later in 2007, and was apprehended by police carrying an airgun at one stage.
Tvrdon was treated for his schizophrenia over the years, but in 2011 he was discharged from psychiatric services because he was not considered to be a danger to the public or himself.
Doctors told him he could gradually reduce his medication before stopping it entirely.
But his condition gradually deteriorated and by the time of the fatal hit-and-run journey he believed everyone was trying to drive him out of his mind.
In the days leading up to the attacks, he was said to be behaving "strangely and bizarrely".
He was sleeping rough and had not been feeling right about himself or his mind, and had been in a different state to previous mental health episodes.
In a blur, looking dreadful, he took his car to Ely, got out of it and into his van, and despite the desperate efforts of his former girlfriend, set off on his journey of destruction.
Following his arrest, Tvrdon found to be in the grip of a severe psychotic illness.
The court heard he "behaved strangely and bizarrely in the days before the offences".One expert said after the Cardiff attacks Tvrdon was "in the grip of a severe psychotic illness".
Paul Keleher QC, defending, said Tvrdon was diagnosed as a paranoid schizophrenic in July 2003.
But in October 2011, he was discharged from psychiatric services because he was not considered a danger to himself or anyone else and was told to gradually cut his medication down before stopping it entirely.
Mr Keleher said Tvrdon's recollection of the hit-and-run incidents was a "blur" and he was said to have told police: "I couldn't believe what I had done... I just went for them, went for all of them".
The court heard that Tvrdon believed himself to be sane at the time but was convinced everyone was trying to drive him out of his mind.
The court was told in February this year he was still considered delusional by mental health experts.
By March he was considered to be improving and was coming to a "realisation about what he had done" but this was causing him to be depressed.
His lawyer said that when Tvrdon was not ill he was a "thoroughly pleasant, kind, thoughtful, even timid man".
A statement from his ex-girlfriend Lisa Davies said that while intervening, she noticed Tvrdon looked "dreadful". He got into the van and did not seem to notice her and she had to jump out of the way.
"I know that person that did this wasn't the person I lived with for the last 17 months," she said.
And part of a letter from Tvrdon's parents was read out in court in which they said he was now "profoundly conscious" of what he had done and would have to live with his "terrible guilt" for the rest of his life.
Karina Menzies' sister Samantha, Det Chief Insp Ceri Hughes and Grenville Barker of the Crown Prosecution Service speak after the hearingDr John Crosby, a consultant forensic psychiatrist who was responsible for Tvrdon at Ashworth Hospital, Merseyside agreed he was suffering from diminished responsibility at the time.
He said Tvrdon had accepted medication and his symptoms had eased.
He told the hearing that Tvrdon should be the subject of an order that would "protect the public from serious harm" rather than a prison term.
Tvrdon, of no fixed address, admitted manslaughter on the grounds of diminished responsibility and seven counts of attempted murder.
He has also admitted two counts of grievous bodily harm, five counts of actual bodily harm, two of attempted grievous bodily harm, one count of assault by beating and one charge of dangerous driving.
Sentencing was adjourned until Thursday afternoon.
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