Suicide is a leading cause of death in patients with schizophrenia. Previous studies have mostly investigated the association between suicide and sociodemographics, positive and negative symptoms, and depressive symptoms. This study evaluated psychache and alexithymia in patients with schizophrenia, which have both been associated with suicide attempts and thoughts in patients with other psychiatric disorders. Positive and Negative Syndrome Scale (PANSS), Psychache Scale (PAS), Beck Scale for Suicidal Ideation (BSSI), Calgary Depression Scale for Schizophrenia (CDSS), and Toronto Alexithymia Scale (TAS) scores were obtained in 113 patients with schizophrenia, including 50 with suicide attempts. PANSS positive symptoms and general psychopathology subscale, CDSS, BSSI, TAS, and PAS scores were significantly higher in patients with suicide attempts. In multivariate logistic regression analysis, only the PAS score was an independent predictor of attempted suicide. Mediation analysis demonstrated that psychache (both directly and indirectly) and alexithymia (indirectly) might be associated with the risk of suicide in these patients.