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explanation for these findings, the researchers stated sleeping patterns for a period of two weeks. Patients
that patients might associate reduction of negative without sleeping problems might not understand the
symptoms with a return to normal functioning and, therapeutic use of registering their sleeping patterns
therefore, might decide that they no longer need and, therefore, might be more likely to not complete
medication. This assumption is supported by the the sleep log.
finding of Quach et al. [40] whose study indicated that
a high level of functioning after one year of treatment In sum, treatment adherence appears to be a complex
was associated with non-adherence at year two. phenomenon and can only partly be associated with
symptom severity and quality of sleep in patients
However, opposing findings have also been reported with schizophrenia and patients with depression.
in the treatment adherence literature on patients Some studies indicate, for instance, that a weak
with schizophrenia. A study by Tattan and Creed [41] therapeutic alliance and low insight might be related
regarding negative symptoms of schizophrenia and to poor adherence in patients with schizophrenia. [42]
compliance with medication, for instance, found Another study by Spiekermann et al. [43] stated that
that patients with schizophrenia who had a poor patients with schizophrenia who had stronger
medication compliance experienced a significantly cognitive impairments showed lower adherence
greater severity of negative symptoms. Especially behavior compared to those without cognitive
avolition, apathy, and alogia were related to poor impairments.
compliance. The researchers presumed that patients
who suffered from avolition and apathy would lack The present study has several limitations that should
the motivation to regularly go to a satellite clinic. be discussed in order to correctly interpret its results.
They also suggested that these patients might One limitation of our study is the fact that all data
question the beneficial effects that the medication were derived from self-report inventories, which
[44]
given at such clinics had had on their positive have their strengths and weaknesses. However,
symptoms and might have instead focused on the the disadvantages, for instance, self-report measures
[45]
limited effect that the medication had had on the being potentially biased by social desirability, might
negative symptoms from which they still suffer. have negatively affected the reliability of the results.
Another point considered was that patients with Moreover, future studies might vary in their means to
alogia could possibly lack insight into their illness measure treatment adherence. For instance, attendance
and, therefore, might not understand the importance at a psycho-education group for patients with
[46]
of taking medication regularly. In sum, hitherto, as for schizophrenia could be additionally used to measure
depression, not much research has been conducted treatment adherence. Another limitation of our study
on the relationship between symptom severity and is that a mixed sample of subjects, e.g., outpatients
treatment adherence in patients with schizophrenia, with schizophrenia and outpatients with depression,
and the results are conflicting. [39-41] Clearly, negative was used. Although we have presented our treatment-
symptoms can be related to adherence, but further adherence results for the depression group and the
research is needed to gain a better understanding of schizophrenia group separately, having a larger sample
this relationship. of one patient group in order to investigate the possible
relationships between symptom severity, quality of
An interesting new finding of our study is the fact sleep, and treatment adherence would have been better
that poor quality of sleep significantly predicted because the main reasons related to non-adherence in
better treatment adherence in the group of patients patients with schizophrenia and those with depression
with schizophrenia. This finding contradicts the may differ significantly. This is an important issue for
finding in the study by Ong et al. who reported that future research. Finally, the exploratory nature of the
[2]
insomnia might be a risk factor for poor treatment analyses, as well as the cross-sectional study design, [47,48]
adherence. To the authors’ knowledge, this study was used in the present study should be mentioned as
among the first to investigate a possible relationship further limitations, making it impossible to generalisze
between quality of sleep and treatment adherence in the results.
patients with schizophrenia; therefore, comparing
this group of patients to another that has sleep In conclusion, the current exploratory study revealed
disorders such as obstructive sleep apnoea and a significant positive relationship between symptom
insomnia might be difficult. Possibly, the patients severity and treatment adherence, as well as a significant
with a worse subjective quality of sleep were more negative relationship between quality of sleep and
treatment adherent because they could benefit from treatment adherence in patients with schizophrenia,
completing the sleep log and, hence, register their own but no significant relationships between symptom

114 Neuroimmunol Neuroinflammation | Volume 3 | May 20, 2016