Objective — to study a psychopathological structure of the acute paraphrenic syndrome in different variants of schizophrenia course. Material and methods. Sixty patients were examined. Results and conclusion. Three variants of acute paraphrenic syndrome with the domination of sensitive delusions, Kandinsky—Clerambault’s syndrome or confabulatory disorders were singled out. Acute paraphrenic syndrome with sensitive delusions was characteristic of recurrent schizophrenia. Slow-progressive attack-like schizophrenia was characterized by the acute paraphrenic syndrome with sensitive delusions in the combination with interpretative delusions. Juvenile malignant schizophrenia was characterized by the acute paraphrenic syndrome with the domination of Kandinsky—Clerambault’s syndrome and sensitive delusions. Acute paraphrenic syndrome with the domination of Kandinsky—Clerambault’s syndrome and acute paraphrenic syndrome with confabulatory disorders were identified in patients with paranoid attack-like schizophrenia similar to chronic schizophrenia. The nosologic specificity of the acute paraphrenic syndrome for attack-like schizophrenia was confirmed.