OBJECTIVES:  To describe medication use patterns and adherence rates for schizophrenia patients after initiating antipsychotic treatment in Tianjin, China. METHODS:  Data were extracted from the Tianjin Urban Employee Basic Medical Insurance database (2008-2010). Adult patients with a schizophrenia diagnosis, newly initiating or restarting antipsychotics (no antipsychotics during previous 90 days) with 12-month continuous enrollment after their first observed antipsychotic prescription were included. Patients’ medication prescribing patterns and antipsychotic adherence are described. RESULTS:  A total of 1216 patients were identified, with a mean (SD) age of 51.43 (12.48) years, 54.11% female. 83.14% of patients initiated with one antipsychotic and 16.86% with ≥ 2 antipsychotics. 37.99% of patients were initiated on typical antipsychotics, 52.06% on atypicals, and 9.95% on both. A higher portion of typical initiators were co-prescribed antianxiety and anticholinergic medications than atypical starters (both p<0.001). During the following 12 months, the majority of patients remained on medications from their initial antipsychotic class (80.74% of typical initiators vs. 86.41% of atypical initiators) or the same medication (66.45% of typical initiators vs. 70.93% of atypical initiators). More typical initiators switched to, or augmented with, atypical antipsychotics than atypical initiators to/with typical antipsychotics (19.26% vs. 13.59%, P=0.011). During the following 3, 6 and 12 months, antipsychotic continuation rates (≤ 30 days gap) were 50.33%, 23.60%, and 8.88%, respectively. Medication Possession Ratios were low, with means (SD) of 0.58 (0.32), 0.44 (0.30), and 0.34 (0.27) for the 3, 6 and 12 months, respectively. CONCLUSIONS:  More individuals with schizophrenia were treated with atypicals rather than typical antipsychotics. The majority of patients tended to stay with one antipsychotic drug class or the same medication. Patients’ adherence to prescribed antipsychotics was low. This study highlights the importance of selecting an effective medication when starting antipsychotic therapy in China. However much could be done to improve treatment adherence.