OBJECTIVE： To observe clinical efficacy and safety of paliperidone in the treatment of schizophrenia （Sz）. METHODS： 120 Sz patients were selected and randomly divided into control group and observation group， with 60 cases in each group. Control group was given conventional medicine Risperidone tablet 2-4 mg in the first week， increasing to 4-6 mg in the second week till the end of treatment course. Observation group was given Risperidone sustained-release tablet with initial dose of 3 mg， increasing to 6-12 mg according to disease condition， qd. Both group were treated for 12 weeks. Clinical efficacy of 2 groups were observed， and PANSS， SQLS and ADR were also observed before and after treatment. RESULTS： Total effective rate of observation group was 93.3％， which was significantly higher than 80.0％ of control group， with statistical significance （P＜0.05）. Before treatment， there was no statistical significance in PANSS and those scores between 2 groups （P＞0.05）， and those of 2 groups decreased significantly， the observation group was lower than the control group， with statistical significance （P＜0.05）. Before treatment， there was no statistical significance in SQLS and those score between 2 groups （P＞0.05）， and those of 2 groups increased  significantly after treatment， the observation group was higher than the control group， with statistical significance （P＜0.05）. There was no statistical significance in the incidence of ADR between 2 groups （P＞0.05）. CONCLUSIONS： Paliperidone is effective and safe in the treatment of Sz.