Psychiatric and criminal backgrounds of 111 forensic patients suffering from Axis-I psychotic disorders were compared with those of 197 non-psychotic offenders residing in the same forensic psychiatric hospitals in Germany and the Netherlands. When compared with non-psychotic offenders, psychotic offenders were more often first-time offenders who had committed severe physical assaults. Often these assaults were targeted at intimates. Sexual crimes were relatively rare among psychotic offenders. Of the 111 index offences committed by psychotic patients, 33 (30%) had fatal consequences. In all these cases, the psychotic offender had known the victim beforehand. Remarkably, the 33 psychotic patients who committed crimes with fatal consequences had fewer previous arrest records, had a late onset of criminal activity, and were less often addicted than psychotic patients whose offences did not cause someone's death. It is concluded that, although psychotic forensic patients commit severe crimes, the probability of their committing a serious sexual offence appears to be low (compared with non-psychotic forensic patients). Also, it was found to be highly unlikely for psychotic offenders to murder complete strangers. The subgroup of psychotic offenders committing crimes with fatal consequences may be hard to identify and to make timely intervention in, precisely because such offenders often lack a history of criminally deviant behavior.