Dewani has been treated for post-traumatic stress and depression since the killing of his Swedish wife, Anni, but Pretoria has not let up in its fight to bring him to trial, mindful of the damage to crime-ridden South Africa's reputation after its successful hosting of the 2010 soccer World Cup.
The 34-year-old arrived at Cape Town airport from Britain early in the morning but was whisked away out of sight of a throng of waiting reporters and taken to the Cape High Court, which was cordoned off with yellow police ticker tape.
Top Cape Town judge, John Hlophe, postponed the case to May 12 and ruled that Dewani would remain in custody at state-run Valkenberg psychiatric hospital.
"The state and defence agree that Mr Dewani requires further care and treatment and will be admitted voluntarily," said prosecutor Rodney de Kock.
Dressed in a black suit and tie with white shirt, Dewani was supported by his family and appeared confused at times, struggling to hear the judge, who asked him twice if he understood the court's ruling.
"Do you hear me?" asked the judge, before Dewani eventually whispered: "yes".
Dewani faces five charges, including murder, kidnapping, robbery with aggravating circumstances and obstructing the administration of justice. If found guilty, he faces up to 25 years in prison.
Anni Dewani was shot dead in November 2010 in a taxi in the Khayelitsha township on the outskirts of Cape Town after being kidnapped in Gugulethu. Shrien Dewani denies any wrongdoing but prosecutors have accused him of conspiring to kill his wife.
Dewani says he and the driver, Zola Tongo, were forced out of the car unharmed before Anni was driven away and killed. She was found dead in the back of the abandoned vehicle with a bullet in the neck. However, Tongo turned state witness and, in return for a reduced sentence, alleged Dewani had paid 15,000 rand ($1,500) for his wife to be killed. He was jailed for 18 years.
Accomplices Mziwamadoda Qwabe and Xolile Mngeni were also found guilty of murder and were jailed for life.
Outside court, a large crowd of women protested, singing songs and holding up placards which read: "Real men protect women and children".