We used to say, "cold blooded murder"--wouldn't be at all surprised if he had planned this longer than even what they're saying. If there was any "snapping" at all, I think it was when he realized he was going to get caught.
I think you're right about the pre-planning. I'll bet he had some "accident" planned when he went to North Carolina. Then he could pretend to "withdraw" from medical school, and that would be the end of that.
Lori stumbled on the truth a few weeks too early.
I do think he decided the best/easiest way to kill her and he followed through with the plan. Cold blooded.