OBJECTIVE： To observe the clinical efficacy and safety of paliperidone and risperidone in the treatment of schizophrenia. METHODS： 98 patients with schizophrenia were randomly divided into paliperidone group and risperidone group， with 49 cases in each group. Paliperidone group was treated with initial dose of paliperidone with initial dose of 6 mg， qd， and then given 3-12 mg，qd， according to patient’s condition within 1 week. Risperidone group was given risperidone with initial dose of 1 mg， qd， and then given 4-6 mg， qd， according to patient’s condition within 1 week. Clinical efficacy， positive and negative PANSS， PSP， PRL and lipid metabolism level before and after treatment were observed in 2 groups. RSESE and TESS were adopted to evaluate ADR. RESULTS： There was no statistical significance in clinical efficacy between 2 groups （P＞0.05）. There was no statistical significance in total PANSS score， positive symptoms， negative symptoms and general pathological score between 2 groups before treatment and after 8 weeks treatment （P＞0.05）. Total PANSS score， positive symptoms， negative symptoms and general pathological score were reduced significantly in paliperidone group 12 weeks after treatment， and were significantly lower than risperidone group， with statistical significance （P＜0.05）. There was no statistical significance in PSP score between 2 groups before and 8 weeks after treatment （P＞0.05）； 12 weeks later， PSP score of paliperidone group increased significantly， which was significantly higher than risperidone group， with statistical significance （P＜0.05）. 12 weeks later， PRL， TC， HDL-C and LDL-C levels increased in 2 groups， and those in risperidone group were significantly higher than paliperidone group， with statistical significance （P＜0.05）； TG of 2 groups were increased significantly after treatment compared to before treatment， with statistical significance （P＜0.05）， but no statistical significance between 2 groups （P＞0.05）. The scores of RSESE and TESS of the incidence of ADR in the paliperidone group were lower than those in risperidone group， with statistical significance （P＜0.05）. CONCLUSIONS： Therapeutic efficacy of paliperidone is similar to risperidone in the treatment of schizophrenia， and both can improve mental symptom. Paliperidone has worked faster and more safely.