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with schizophrenia. adherence; however, in general, the patients with
schizophrenia who reported a worse quality of
Variables predicting degree of treatment adherence in the sleep were more treatment-adherent than those who
depression group
For the group of patients with depression, a multiple reported a better quality of sleep and not vice versa.
regression analysis with “Degree of Treatment The surprising findings that no relationships were
Adherence” as the dependent variable and the found between quality of sleep and treatment
scores on the BDI-II and the PSQI as predictors adherence and between symptom severity and
was conducted. Note that the adherent depression treatment adherence in the depression group are
group had a mean of 13.44 days (SD = 2.02 days). opposed to the findings by Ong et al. who investigated
[2]
Table 3 shows the results of the multiple regression the risk factors associated with dropping out of group
analysis using the enter method for predicting cognitive-behavior therapy for insomnia and found
“Degree of Treatment Adherence”. The scores on the that short sleep duration and elevated symptoms of
BDI-II and the PSQI were insignificant predictors.
depression at baseline could be especially associated
Variables predicting degree of treatment adherence in with an increased risk of early therapy dropout.
the schizophrenia group Also, in their study, Phillips et al. [23] reported that
For the group of patients with schizophrenia, a women with greater sleep disturbances had a higher
multiple regression analysis was conducted with level of depressive symptoms and poor adherence to
“Degree of Treatment Adherence” as the dependent their medication regimen. Noticeably, research that
variable and the scores on the PANSS-total (also targets adherence to medication dominates research
split into PANSS-positive, PANSS-negative, and that targets adherence to treatment. Possibly,
PANSS-general psychopathology) and on the PSQI different risk factors may be related to these two
as predictors. Note that the adherent schizophrenia forms of adherence, which might make a direct
group had a mean of 12.82 days (SD = 2.43 days). comparison between studies that target adherence
Table 4 shows the results of the multiple regression to medication and studies that target adherence to
analysis using the enter method for predicting treatment difficult. This suggestion remains to be
“Degree of Treatment Adherence”. The scores on the verified. Overall, to date, only a few studies have
PANSS-total, PANSS-positive, PANSS-negative, and been conducted on treatment non-adherence by
PANSS-general psychopathology were insignificant patients with depression and its predictors, [38] so
predictors while the score on the PSQI was a further research is warranted.
significant predictor. Moreover, the score on the
PANSS-negative and the score on the PSQI correlated Nevertheless, in the group of patients with
significantly with “Degree of Treatment Adherence” schizophrenia in the present study, symptom
(PANSS-negative: r = 0.31, P < 0.05; PSQI: r = 0.39, severity and quality of sleep may be related to better
P < 0.05). treatment adherence. Steger et al. [39] reported similar
findings. The researchers assessed medication
DISCUSSION adherence in a sample of 216 patients with a first
episode of psychosis; the assessments were done
The general results of our study showed that for at program entry and three and six months later.
the group of patients with depression, in contrast They found an association between early resolution
to our hypotheses, symptom severity and quality of negative symptoms and poor adherence. Patients
of sleep did not significantly predict whether a whose positive symptoms had been resolved
patient would be adherent to treatment or not; the after three months of treatment did not show a
severity of depression and the quality of sleep did change in adherence behavior compared to those
not differ significantly between treatment adherent whose symptoms persisted. On the contrary, early
and non-adherent patients. For the group of patients resolution of negative symptoms was significantly
with schizophrenia, in line with our hypotheses, a associated with less medication adherence compared
relationship was found between symptom severity to the patients whose negative symptoms persisted.
and treatment adherence, as well as between quality Unfortunately, patients whose negative symptoms
of sleep and treatment adherence; however, the had been resolved but who were non-adherent
directions of those relationships were contrary to experienced a worsening of both positive and negative
our expectations. Experiencing more severe negative symptoms at six month. Steger et al. [39] concluded
symptoms was found to be significantly related to that patients who experience a rapid reduction of
better treatment adherence. Moreover, quality of negative symptoms must be closely followed, as they
sleep did serve as a significant predictor of treatment are at high risk for non-adherence. As a possible

Neuroimmunol Neuroinflammation | Volume 3 | May 20, 2016 113