Individuals with schizophrenia face significantly higher mortality rates than the general population, with a typical reduction in life expectancy of 15–20 years. This study investigated 10-year all-cause mortality and its clinical correlates in a Romanian cohort of patients with schizophrenia, using real-world clinical and hospital and forensic records. A total of 635 individuals hospitalized between 2010 and 2013 were followed for 10 years. Mortality rates, causes of death, and risk factors were assessed using Cox regression models and standardized mortality ratios (SMRs). During the follow-up, 123 patients (19.37%) died, corresponding to a mortality rate of 21.3 per 1000 person-years. The SMR was 1.58 compared to the Romanian general population. Non-violent causes predominated, with cardiovascular disease (27.64%) and infections (17.07%) being the most frequent. Violent deaths, including suicides and accidents, accounted for 17.07% of all mortality. The mean age at death was 58.97 years, reflecting a 17-year reduction in life expectancy. Age was the strongest independent predictor of mortality (HR = 1.07, p < 0.001). Use of second-generation antipsychotics (HR = 0.37, p < 0.001) and low frequency hospitalization (HR = 0.09, p < 0.001) were significantly associated with reduced all-cause and cause-specific mortality. Schizophrenia is associated with significantly increased premature mortality, primarily due to preventable physical illnesses and violent deaths. Early intervention, sustained treatment adherence, and integrated medical care are essential to improve survival outcomes.

Background and Objectives: Schizophrenia is associated with a 15–20-year reduction in life expectancy, with cardiovascular disease as the leading cause. Sudden unexpected death is common in this population, often linked to structural heart disease, antipsychotic use, and overlapping cardiometabolic, autonomic, and drug-related factors. This study aimed to determine the incidence and causes of sudden unexpected death among schizophrenia inpatients between 2014 and 2024 and compare these findings with historical data from the same institution. Materials and Methods: We conducted a retrospective cohort study of schizophrenia inpatients admitted from January 2014 to December 2024. Hospital records were reviewed to identify sudden and unexpected deaths, verified by the Forensic Medicine Service Brașov. Sudden death was defined as death in an asymptomatic patient or within one hour of new symptom onset, excluding suicide, homicide, or accidental overdose. In accordance with Romanian legislation, an autopsy was performed in every case. Results: Over the 10-year period, six schizophrenia inpatients (mean age 53.2 ± 17.8 years) died suddenly. All had long-standing schizophrenia (mean illness duration 28.7 ± 17.7 years) and were receiving second-generation antipsychotics. Cardiovascular comorbidity was present in three cases. All patients received antipsychotic treatment within 24 h before death. No deaths occurred within the first 24 h of admission; one occurred within 48 h. Compared with the 1989–2013 cohort, which included 57 sudden deaths, the incidence during 2014–2024 declined substantially (0.27% vs. 0.79%). Conclusions: The incidence of sudden unexpected death among schizophrenia inpatients declined significantly over the past decade compared with the 1989–2013 cohort, reflecting improved multidisciplinary care, prompt transfer to general hospitals, and wider use of second-generation antipsychotics. Autopsy findings emphasize the continuing importance of cardiovascular disease and airway obstruction as preventable causes of sudden death in this population.