The Relationship Between Early-Stage Maladaptive Schemas and Treatment Adherence in Patients Diagnosed with Bipolar Disorder in Remission

Background/Objectives: Treatment non-adherence in bipolar disorder remains a major clinical challenge. Although demographic and clinical predictors have been widely studied, enduring cognitive vulnerability patterns such as early maladaptive schemas have received limited attention in relation to adherence behavior. Methods: This cross-sectional study included a total of 156 euthymic patients with bipolar disorder (HAM-D ≤ 7; YMRS ≤ 12) who were assessed using the Young Schema Questionnaire–Short Form 3, the Morisky Medication Adherence Scale, and a clinician-rated insight measure. Group differences across adherence levels were examined using ANOVA and chi-square tests. Ordinal logistic regression was conducted to identify independent factors associated with poorer adherence. Multicollinearity was evaluated, and proportional odds assumptions were tested. Results: Several schema domains differed significantly across adherence groups, with the Punishment schema demonstrating the largest effect size. In ordinal regression analysis controlling for age and insight, higher Punishment schema scores were independently associated with poorer adherence (OR = 1.14, 95% CI = 1.09–1.20, p < 0.001). Younger age and partial insight were also associated with lower adherence. Conclusions: Early maladaptive schemas—particularly punitive self-evaluative patterns—may represent cognitive correlates of treatment non-adherence in euthymic bipolar disorder. Interventions targeting self-critical schema processes may be relevant for adherence-focused strategies; however, due to the cross-sectional design, the observed relationships reflect associations only and do not allow for causal inferences.