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accurate measurement of “real” treatment adherence. In fact, it is unclear whether sleep disturbance, a
major comorbid condition of schizophrenia and depression, directly affects treatment adherence. According
to previous reviews of patients with schizophrenia, sleep disturbances are not predisposing factors for
[7,8]
medication nonadherence . Therefore, the study’s findings might only imply that schizophrenic patients
with severe negative symptoms or better quality of sleep tend to complete the sleep log form and to submit
it to their physicians.

In spite of the challenges in acquiring valid measurements of treatment adherence, the study illustrates key
steps that are needed for the evidence-based intervention. It gives us a better understanding of the possible
difference of the reasons related to nonadherence between schizophrenia and depression observed in
this study, which may elicit a clue to elucidate the possible differences of underlying mechanisms of sleep
disturbance among psychiatric disorders. Studies examining factors to maintain the treatment adherence
has always been extensively conducted as one of the important topics to prevent the relapse of various
psychiatric disorders since effective psychopharmacological treatments were established in the 1950s.
However, the relative importance of these factors contributing to treatment adherence varies depending
on the psychiatric disorders. Thus, further research is needed to identify specific risk factors in treatment
nonadherence for each psychiatric disorder.

DECLARATIONS
Authors’ contributions
Drafted the manuscript text, developed the intellectual ideas, made the suggested revisions, and approved
the final version to be published: Ishizuka K, Inada T

Financial support and sponsorship
None.

Conflicts of interest
There are no conflicts of interest.

Patient consent
Not applicable.

Ethics approval
Not applicable.

Copyright
© The Author(s) 2018.

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