OBJECTIVES: Clinical guidelines for schizophrenia recommend monotherapy of second-generation antipsychotics (SGAs) for treating patients suffering from schizophrenia, but do not address the issue of how to treat patients with inadequate first-line treatment. The aim of this study is to describe real-word prescription patterns for patients suffering from schizophrenia in Japan. METHODS: Using data from the Japan Medical Data Center (JMDC) database, a retrospective longitudinal cohort study was conducted, including adults aged from 18 to 65 years with a first prescription of antipsychotic (index date) between January 2009 and September 2013, and diagnosed with schizophrenia around index date. The treatments prescribed in first and second lines were described and treatment duration was estimated using the Kaplan-Meier method. Proportions of patients receiving an add-on treatment, switching or not treated after discontinuation of first-line treatment were estimated. RESULTS: