Schizophrenia elevates the risk for aggressive behavior and violent crime; however, aggression in schizophrenia is heterogeneous in origin. The different pathways leading to aggressive behavior in this special subgroup of violent offenders have to be taken into account in treatment planning and risk management. To treat schizophrenic delinquents in the same way as schizophrenics in general psychiatry is only effective in a small group of forensic patients. The majority of schizophrenic offenders show additional problems, such as neurocognitive impairment, high rates of side effects of psychopharmacological treatment, persistent positive symptoms, substance abuse, conduct disorder, comorbid antisocial personality disorder, psychopathy and stressful experiences in adult life. The interaction of all these factors results in a general lack of adherence to therapy as one of the most important risk factors for relapse into psychosis and recidivism. Effective treatment of psychotic offenders takes all these problems into account while accepting them as severe obstacles for positive treatment outcomes; therefore, modern forensic therapy of schizophrenia is designed to address these problems in order to improve overall treatment motivation.