Objective. To assess the clinical efficacy, tolerability and safety of prolonged treatment with paliperidone in adolescents with the exacerbation of psychotic schizophrenia spectrum disorders. Material and methods. Thirty-six adolescents at the age from 14 to 18 years with ICD-10 diagnosis F20—21, F25 were examined by clinical/psychopathological method (PANSS and CGI scale). The duration of the disease was from 1 to 3 years. The duration of the study was 12 months. Results and conclusion. The efficacy and safety of prolonged use of paliperidone in a dose of 3 to 12 mg/day in adolescents with schizophrenia spectrum disorders were identified.