Objective. There is a gap between theory and practice in treatment of acute schizophrenia. It could be visualized in relatively irrational treatment schemes and principles. In order to clarify the situation in Russia, we have analyzed antipsychotic treatment patterns of acute schizophrenia in two Moscow psychiatric hospitals. Materials and methods. Information was collected from the databases of two Moscow city psychiatric hospitals. Inclusion criteria were as follows: admission to hospital due to acute symptoms of schizophrenia in 2000-2010. We studied case histories of 108 patients, aged from 18 to 64 years (mean 36±12 years), 53% of men. Duration of illness was 7±7 years, duration of hospitalization was 77±45 days. Results. Most of the patients (77%) received traditional antipsychotics as a primary drug. Haloperidol was the most common primary antipsychotic drug prescribed (33% of patients). In 71% of cases, a combination of antipsychotics (typical and atypical) was used from the beginning of treatment. High values of average chlorpromazine equivalent were used at the first week of therapy as well as at the discharge from the hospital. Anticholinergic drugs were prescribed to 83.3% of the patients. Therapy had been changed at least 1 time during 2 month in 57.4% of cases. Conclusion. There was a significant discrepancy between the domestic routine practice and both treatment guidelines based on scientific data and antipsychotic treatment strategies used in other countries. To overcome these differences, reliable and biologically valid criteria for treatment selection in individual cases are needed. Pharmacokinetic data can serve as one of these criteria.