The study will assess the use of paliperidone palmitate compared with oral risperidone in delaying time to relapse in patients recently diagnosed with schizophrenia who are at high risk of relapse.

This is a Prospective, Randomized, Active-controlled, Rater-blinded Study to to assess the efficacy of paliperidone palmitate compared with oral risperidone in delaying time to relapse in patients recently diagnosed with schizophrenia who are at high risk of relapse. Recently diagnosed is defined as first diagnosis of any psychotic disorder within 5 years prior to screening. High risk of relapse is defined as having documented occurrence of 3 periods of breakthrough symptoms that required a change in patient care per the investigator's judgment (e.g., increase in dose, addition of a new drug, increase in the level of psychiatric care, notable increases in the frequency or intensity of patient contact required to maintain outpatient status, psychiatric hospitalization, etc.) within the previous 24 months, including 1 such period within the previous 6 months. Safety evaluations will include AE reporting, labs, vital signs, ECG, and evaluations of suicidality and sexual functioning. Patients will receive either paliperidone palmitate 50, 75, 100, or 150 mg eq. monthly by injection for two years or oral risperidone 2, 4, 6, or 8 mg tabs once daily for two years.

• Drug: paliperidone palmitate
  50, 75, 100, or 150 mg eq. monthly injection for 2 years
• Drug: oral risperidone
  2, 4, 6, or 8 mg tabs once daily for two years

• 001: Experimental
  Intervention: Drug: paliperidone palmitate
• 002: Active Comparator
  Intervention: Drug: oral risperidone

Inclusion Criteria:

• Patients must be, in the opinion of the investigator, able to understand the informed consent form approved by the Institutional Review Board (IRB) or Independent Ethics Committee (IEC), as appropriate
• All patients must sign the study informed consent document indicating that they understand the purpose of and procedures required for the study and are willing to participate in the study
• Must have a current diagnosis of schizophrenia
• must have had 3 periods of breakthrough symptoms that required a change in patient care as determined by the investigator (e.g. increase in dose, addition of a new drug, hospitalization, increase in the level of psychiatric care, notable increases in the frequency or intensity of patient contact required to maintain outpatient status, etc.) within the previous 24 months, including 1 such period within the previous 6 months
• Women must be postmenopausal, surgically sterile, or otherwise be incapable of pregnancy, abstinent, or if sexually active, be practicing a highly effective method of birth control before entry, and must agree to continue to use the same method of contraception throughout the study
• Women of childbearing potential must have a negative urine pregnancy test at screening
• Patients must be cooperative and reliable, agree to receive regular injections, and be willing/able to adhere to the prohibitions and restrictions specified in this protocol

Exclusion Criteria:

• Patients who are unable to provide their own consent or are involuntarily committed to psychiatric hospitalization
• Have attempted suicide within 12 months before screening or are at imminent risk of suicide or violent behavior
• Have a positive urine drug screen test for barbiturates, cocaine, amphetamines, or opiates at screening
• Patients who are in their first episode of psychosis
• Patients currently meeting criteria for any other Axis I diagnosis except substance abuse or an Axis II diagnosis of Mental Retardation or Borderline Personality Disorder
• Meet the DSM-IV definition of substance dependence (except for nicotine and caffeine dependence) within 6-months prior to entry
• Patients with known allergies, hypersensitivity (anaphylaxis-type reaction), or intolerance to paliperidone palmitate, risperidone, Risperdal®, Risperdal® Consta®, or INVEGA® or its excipients
• Patients who received Long Acting Therapy (LAT) treatment within 2 injection cycles prior to screening
• Women who are pregnant or breast-feeding, or planning to become pregnant