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benefit from therapy. “Adherence to treatment” refers of patients with schizophrenia or depression has
to the extent to which a patient’s behavior conforms been suggested. [22,23] Phillips and colleagues, [23] for
to the advice of health professionals. Although instance, considered adherence to treatment to be
[4]
dropout and adherence to treatment are related a factor that correlated with sleep disturbance and
issues, there are also important distinctions between depression. Their results showed that women with
these two concepts. [5] greater sleep disturbances also had a higher level of
depressive symptoms and poor adherence to their
Clinical psychologists have reported that, medication regimen. According to these findings, [23]
unfortunately, non-compliance with homework not only the severity of the disorder but also suffering
as part of cognitive-behavioral therapy is a from sleep disturbances might be related to treatment
common phenomenon in clinical practice. This non-adherence in patients with schizophrenia or
[6]
is problematic because research has shown that depression. A possible role for quality of sleep in
homework compliance is positively associated with treatment adherence is further supported by the fact
reduced symptom severity. [7]
that both schizophrenia and depression are co-morbid
with sleep disturbances. [24,25]
Treatment non-adherence is a common problem
in patients suffering from depression or However, to date, not much research has been conducted
schizophrenia. [8] In cases of schizophrenia, poor on the specific factors that can be related to the non-
adherence to medication and psychosocial treatment adherence to treatment in patients with schizophrenia
are prevalent and increase the probability of relapse or depression. As a result, more research is needed
and re-hospitalization. In their review of 39 studies on the possible factors suggested in the literature,
[9]
published in English since 1980 and specifically symptom severity and quality of sleep, as being
examining risk factors for medication non-adherence, related to treatment non-adherence. The aim of the
Lacro et al. pointed out that in those studies, present study was, therefore, to investigate the possible
[10]
the mean rate of non-adherence to medication for
patients with schizophrenia was 41%. Moreover, in relationships between symptom severities, quality of
their systematic review of 103 studies on adherence sleep, and treatment adherence further. Thereby, noting
to treatment by patients with psychosis, Nosé et al. that treatment non-adherence limits the improvements
[11]
reported a mean rate of failure to keep scheduled in independent living, employment, and quality of life
follow-up appointments of 24% in patients with to a large degree in patients with schizophrenia or
[26]
psychoses. Rates of treatment dropout are reported depression is important. First, patients with a more
less often; the figures for this range from 20% to severe depression were hypothesized to have worse
56% in patients with schizophrenia. [12-14] In patients treatment adherence than patients with a less severe
with depression, the severity of the disorder has depression. Secondly, patients with schizophrenia
been associated with treatment dropout in some who show more positive and negative symptoms were
studies, [15] but not in all. Agreeing with Last et al. [15] hypothesized to have worse treatment adherence than
[16]
Leserman [17] indicated that patients with depression patients with schizophrenia who show fewer positive
were less likely to adhere to a treatment program and negative symptoms. A final hypothesis was that
than patients without depression and experienced patients who have a poor quality of sleep have worse
worse outcomes in health. treatment adherence than patients who have a good
quality of sleep.
Schizophrenia and depression are both seemingly
dropout-prone disorders, [18,19] but which specific factors METHODS
can be related to the non-adherence to treatment
in patients with either condition is arguable. An Setting and participants
association between less severe psychiatric symptoms The participants in this study consisted of 17 female
[20]
and better treatment adherence was found, and both and 13 male adult patients with schizophrenia with
the severity of the disease and the patient’s attitude an average age of 41 (SD = 8.80) and 40 female
towards the prescribed medication were found to be and 18 male adult patients with depression with
related to adherence in patients with schizophrenia. an average age of 45 (SD = 12.14). All participants
[21]
In this case, the severity was found to correlate were outpatients of the LVR-Klinik Bedburg-Hau in
negatively with treatment adherence while the patient’s Germany and were diagnosed by their psychiatrist
attitude towards the prescribed medication was found according to the 10th revision of the International
to correlate positively with treatment adherence. Classification of Diseases and Related Health Problems
(ICD-10). [27] Note that in Germany, the ICD-10 [27] is
Also, a role for quality of sleep in treatment adherence used instead of the Diagnostic and Statistical Manual

110 Neuroimmunol Neuroinflammation | Volume 3 | May 20, 2016