Sexual offending is a public health concern and societal risk requiring a multi-disciplinary approach. While current data give an indication of the frequency of sexual victimization, these figures likely underestimate the severity of the concern as many of these incidents go unreported. And while sex offender research has increased over the past several decades, particular attention to those offenders with severe mental illness remains limited. In this descriptive review, literature describing sex offenders with psychotic disorders is explored with a focus on recent research. Important considerations are described, including theories surrounding psychosis and sexual offending, hospitalization rates, recidivism, not guilty by reason of insanity (NGRI), female offenders, and treatment considerations. By exploring these important aspects of sex offenders with psychosis, conclusions are drawn and future directions are proposed, with a particular emphasis on clinical application for the mental health treatment provider.