First episode of schizophrenia is characterized by specific features of a response to the therapy and by adherence problems. The objectives of this study were to assess adherence to therapy in patients with the first episode of schizophrenia at the stage of remission, depending on the nature of the antipsychotic therapy. Material and methods. 50 patients diagnosed with F20.0 «Paranoid schizophrenia» with episodic course and progressive defect (26 women and 24 men, age 26.31 ± 5.50 years) were examined on the stage of remission. They were divided into two groups depending on the nature of antipsychotic therapy: 22 patients receiving first generation antipsychotics (FGA) and 28 patients receiving second generation antipsychotics (SGA) monotherapy. The validated RussianNlanguage version of the PANSS scale, the adverse event assessment scale of the therapy (UKU), the compliance assessment scale (DAI), the social and personal functioning scale (PSP) were used. The criteria for inclusion of patients were the duration of the disease not more than 5 years, the number of psychotic episodes not more than 3, the stage of remission. Results. Patients receiving FGA had more side effects, both mental, neurological and autonomic. The severity of side effects in patients receiving FGA was greater compared with patients receiving SGA as a whole (6.23 ± 1.5 and 2.01 ± 1.5 points, respectively, p < 0.05), and in terms of mental effects (3.43 ± 0.7 and 1.11 ± 0.7 points, respectively, p < 0.05). Attentional disorders were more pronounced in patients treated with FGA (0.81 ± 0.1 and 0.31 ± 0.1 points, p < 0.05), as well as fatigue (0.72 ± 0.1 and 0, 1 ± 0.1 points, respectively, p < 0.05), EPS ( p < 0.05), and constipation (0.5 ± 0.1 and 0.1 ± 0.1 points, respectively, p < 0.05). Patients who received SGA had a tendency to gain weight (0.4 ± 0.1 and 0.2 ± 0.1 points). The severity of side effects of antipsychotic therapy correlated with the level of compliance ( r = -0.53; p < 0.05). Compliance was higher in patients receiving SGA. Conclusion. The present naturalistic study showed that the tolerability of antipsychotic therapy was significantly higher in patients with the first episode of schizophrenia who received SGA, with the exception of an increase in body weight. They had a higher level of compliance as compared with patients treated with FGA.