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Stine Holmstul Olsen

PhD Candidate

Email s.h.olsen@ous-research.no

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Academic interests

Bipolar disorder, sleep, substance use, affect, self-medication.

The PhD Project

Bipolar disorder is considered a severe mental disorder, affecting approximately 1 % of the general population worldwide. Use of substances like cannabis and alcohol is common in people with bipolar disorder. Even though this initially can ameliorate symptoms, the long-term consequences seem to be increased symptom severity and poorer functioning. In this project, we want to investigate whether affective symptoms (depression and mania) look any different in persons with bipolar disorder and current substance use disorders, and to try to answer the question of “the chicken and the egg”: do people with bipolar disorder use substances to regulate their symptoms (self-medication), or does the substance use trigger these symptoms, and do we see signs of a “spiral”? We will try to answer these questions by having the participants self-monitor their symptoms and substance use in an app over time, as well as wear an actigraph that registers activity (acceleration). The goal is to get a better understanding of substance use in bipolar disorder, which in turn can contribute to better prevention and treatment.

Title of the project: Self-medication in bipolar disorder: the temporal relationship between mood, sleep and substance use.

Background

Clinical Psychologist.

Funding and collaboration

Empolyee at NORMENT (Norwegain Centre for Mental Disorders Research), Oslo University Hospital.

This project is financed by the Norwegian Research Council.

Research Team

This project is a part of the research group Mechanisms of psychopathology at NORMENT. Main supervisor is Trine Vik Lagerberg (OUS/NORMENT). Co-supervisors are Sofie Ragnhild Aminoff (OUS/NORMENT) and Roger Hagen (UIO).

Tags: Bipolar Disorder, Substance abuse

Publications

Scientific articles and book chapters

Glastad, Stine Holmstul; Klungsøyr, Ole; Aminoff, Sofie Ragnhild; Hagen, Roger; Bjella, Thomas & Engen, Magnus Johan [Show all 11 contributors for this article] (2026). Frequency analysis of mood, sleep, and alcohol and nicotine use: investigating instability in bipolar I and II disorder. Frontiers in Psychiatry. 17, p. 1–12. doi: 10.3389/fpsyt.2026.1810743.
Høegh, Margrethe Collier; Glastad, Stine Holmstul; Lyngstad, Siv Hege; Engen, Magnus Johan; Aminoff, Sofie Ragnhild & Melle, Ingrid [Show all 8 contributors for this article] (2025). The MinDag app for symptom monitoring and feedback to patients and clinicians during the initial treatment of bipolar disorder – a feasibility study. International journal of bipolar disorders. 13(1). doi: 10.1186/s40345-025-00382-x. Full text in Research Archive Show summary
Background The app “MinDag” (MyDay) was developed as a tool for monitoring mood, symptoms and illness-relevant behaviour in the initial treatment of bipolar disorder. Digital self-monitoring may provide patients and clinicians with valuable data for tailoring treatment interventions. This study aims to evaluate the practical use and clinical implications of integrating MinDag in the early treatment of bipolar disorder from the perspectives of both patients and clinicians. Methods The MinDag app includes six content modules covering mood, sleep, functioning/activities, substance use, emotional reactivity, and psychotic symptoms. Patients were asked to use the app for six months, and automated feedback based on the app registrations was delivered to the patients’ clinicians biweekly. The study involved quantitative evaluations completed by patients (n = 20), as well as interviews with patients (n = 7) and clinicians (n = 2). Results Overall, the patients reported that they felt that MinDag was safe, relevant and easy to use, although technical difficulties such as too many automated reminders and need for reinstallations were reported. The patients appreciated the potential for increased awareness of their mental health, but expressed a desire for direct access to their data. Clinicians found the visual reports and feedback useful for tailoring treatment, even though the alert system for high-risk variables needed refinement. The quantitative evaluations indicated a positive general reception, with suggestions for improvement in usability and accessibility. Conclusion The MinDag app shows promise as a tool for enhancing the treatment of bipolar disorder by facilitating self-monitoring and providing actionable data to clinicians. However, technical issues and the need for direct patient access to data must be addressed. Development of digital tools to support the treatment of bipolar disorder and other mental health conditions is resource demanding, and there is a need to clarify criteria to establish proof of concept to guide the selection of tools for upscaling and implementation.
Grimstad, Kristoffer; Sørensen, Håkon; Vaskinn, Anja; Mohn, Hanne Christine; Glastad, Stine Holmstul & Andreassen, Ole [Show all 11 contributors for this article] (2025). Subjective cognition in schizophrenia and bipolar disorder: Investigation of group differences and associations with objective cognition and clinical characteristics using a novel measure of subjective cognition. Schizophrenia Research: Cognition. 40. doi: 10.1016/j.scog.2025.100345. Full text in Research Archive
Glastad, Stine Holmstul; Klungsøyr, Ole; Aminoff, Sofie Ragnhild; Hagen, Roger; Bjella, Thomas & Engen, Magnus Johan [Show all 14 contributors for this article] (2025). Exploring the temporal relationship between mood, alcohol- and nicotine use in bipolar disorder using time-series analyses. International journal of bipolar disorders. 13(1). doi: 10.1186/s40345-025-00388-5. Full text in Research Archive Show summary
Background The prevalence of substance use disorders in bipolar disorder (BD) is high. Exploring potential interactions between mood and the use of common substances such as alcohol and nicotine may contribute to a better understanding of the mechanisms underlying such comorbidities. Digital tools now allow for continuous monitoring and data collection of both symptoms and behavior. This enables time-series analyses to explore such associations with greater precision. Methods Thirty-two individuals in the early phases of BD registered their mood daily and their use of substances weekly in the MinDag (MyDay) app for up to 6 months. We explored temporal relationships between the use of alcohol and nicotine and the levels of depressed, elevated, irritable, and anxious mood using Vector Autoregressive Models and Granger causality tests. Results We found indications that mood influenced alcohol- and nicotine use, and vice versa. Significant temporal relationships (Granger causality) were found in 55% (11 out of 20) of the participants for alcohol and 70% (7 out of 10) for nicotine use, and with high proportions of the variance explained by the one time-series on the other. The associations were consistent with causal effects in one or both directions, but with no adjustment for confounding. Conclusion Our findings indicate that mood influences alcohol- and nicotine use and vice versa in individuals with BD, although caution should be taken due to the exploratory approach. Larger samples are needed to further disentangle these relationships to provide insight for better prevention and treatment of BD and comorbid substance use disorders.
Glastad, Stine Holmstul; Aminoff, Sofie Ragnhild; Hagen, Roger; Høegh, Margrethe Collier; Büchmann, Camilla Bakkalia & Barrett, Elizabeth Ann [Show all 9 contributors for this article] (2023). Nicotine use and non-pathological alcohol use and their relationship to affective symptoms and sleep disturbances in bipolar disorder. Journal of Affective Disorders. ISSN 0165-0327. 327, p. 236–243. doi: 10.1016/j.jad.2023.02.003. Full text in Research Archive Show summary
Background The use of alcohol and nicotine can negatively impact the course of bipolar disorder (BD), but there is limited knowledge about how symptoms and sleep disturbances are related to concurrent nicotine use and non-pathological use of alcohol. Methods We investigated how nicotine use and non-pathological use of alcohol relates to affective symptoms and sleep disturbances in 453 participants with BD without substance use disorders. Manic symptoms were assessed with the Young Mania Rating Scale, and depressive symptoms with The Inventory of Depressive Symptomatology, Clinician-Rated (IDS-C). Sleep-related questions from IDS-C were used to create proxy variables for sleep disturbances, including Insomnia and Hypersomnia. Multinomial regression analysis was conducted to investigate the associations between nicotine use and sleep disturbances, controlling for possible confounders such as current use of illicit drugs and psychopharmacological treatment. Results Depressive and manic symptoms were not associated with the concurrent level of alcohol or nicotine use. Individuals with medium and high levels of daily nicotine use had higher risk of insomnia than those without. Non-pathological alcohol use was not associated with sleep disturbances. Limitations Sleep disturbances were based on items from the IDS-C questionnaire. Conclusion We found an elevated risk for insomnia in individuals with BD and medium or high levels of daily nicotine use. We found no association between the level of affective symptoms and the level of use of alcohol or nicotine. The direction of the relationship between nicotine use and insomnia needs clarification, as it is highly relevant for treatment planning.
Bjella, Thomas; Høegh, Margrethe Collier; Olsen, Stine Holmstul; Aminoff, Sofie Ragnhild; Barrett, Elizabeth Ann & Ueland, Torill [Show all 14 contributors for this article] (2022). Developing "MinDag" - an app to capture symptom variation and illness mechanisms in bipolar disorder. Frontiers in Medical Technology. 4. doi: 10.3389/fmedt.2022.910533. Full text in Research Archive Show summary
Introduction: The illness course of bipolar disorder (BD) is highly heterogeneous with substantial variation between individuals with the same BD subtype and within individuals over time. This heterogeneity is not well-delineated and hampers the development of more targeted treatment. Furthermore, although lifestyle-related behaviors are believed to play a role in the illness course, such mechanisms are poorly understood. To address some of these knowledge gaps, we aimed to develop an app for collection of multi-dimensional longitudinal data on BD-relevant symptoms and lifestyle-related behaviors. Methods: An app named MinDag was developed at the Norwegian Center for Mental Disorders Research in Oslo, Norway. The app was designed to tap into selected areas: mood, sleep, functioning/activities (social, occupational, physical exercise, leisure), substance use, emotional reactivity, and psychotic experiences. Ethical, security and usability issues were highly prioritized throughout the development and for the final app solution. We conducted beta- and pilot testing to eliminate technical problems and enhance usability and acceptability. Results: The final version of MinDag comprises six modules; three which are presented for the user once daily (the Sleep module in the morning and the Mood and Functoning/Activities modules in the evening) and three which are presented once weekly (Substance Use, Emotional Reactivity, and Psychotic Experiences modules). In general, MinDag was well received in both in the beta-testing and the pilot study, and the participants provided valuable feedback that was taken into account in the final development. MinDag is now in use as part of the research protocol at the NORMENT center and in a specialized treatment unit for BD at Oslo University Hospital in Norway. Discussion: We believe that MinDag will generate unique longitudinal data well suited for capturing the heterogeneity of BD and clarifying important unresolved issues such as how life-style related behavior may influence BD symptoms. Also, the experiences and knowledge derived from the development of MinDag may contribute to improving the security, acceptability, and benefit of digital tools in mental health.
Høegh, Margrethe Collier; Melle, Ingrid; Aminoff, Sofie Ragnhild; Olsen, Stine Holmstul; Lunding, Synve Hoffart & Ueland, Torill [Show all 7 contributors for this article] (2022). Affective lability and social functioning in severe mental disorders. European Archives of Psychiatry and Clinical Neuroscience. ISSN 0940-1334. 272, p. 873–885. doi: 10.1007/s00406-022-01380-1. Full text in Research Archive Show summary
Abstract Social functioning is impaired in severe mental disorders despite clinical remission, illustrating the need to identify other mechanisms that hinder psychosocial recovery. Affective lability is elevated and associated with an increased clinical burden in psychosis spectrum disorders. We aimed to investigate putative associations between affective lability and social functioning in 293 participants with severe mental disorders (schizophrenia- and bipolar spectrum), and if such an association was independent of well-established predictors of social impairments. The Affective Lability Scale (ALS-SF) was used to measure affective lability covering the dimensions of anxiety-depression, depression-elation and anger. The interpersonal domain of the Social Functioning Scale (SFS) was used to measure social functioning. Correlation analyses were conducted to investigate associations between affective lability and social functioning, followed by a hierarchical multiple regression and follow-up analyses in diagnostic subgroups. Features related to premorbid and clinical characteristics were entered as independent variables together with the ALS-SF scores. We found that higher scores on all ALS-SF subdimensions were significantly associated with lower social functioning ( p < 0.005) in the total sample. For the anxiety-depression dimension of the ALS-SF, this association persisted after controlling for potential confounders such as premorbid social functioning, duration of untreated illness and current symptoms ( p = 0.019). Our results indicate that elevated affective lability may have a negative impact on social functioning in severe mental disorders, which warrants further investigation. Clinically, it might be fruitful to target affective lability in severe mental disorders to improve psychosocial outcomes.
Høegh, Margrethe Collier; Melle, Ingrid; Aminoff, Sofie Ragnhild; Haatveit, Beathe; Olsen, Stine Holmstul & Huflåtten, Idun Bernadotte [Show all 8 contributors for this article] (2021). Characterization of affective lability across subgroups of psychosis spectrum disorders. International journal of bipolar disorders. 9.34, p. 1–10. doi: 10.1186/s40345-021-00238-0. Full text in Research Archive Show summary
Background Affective lability is elevated and associated with increased clinical burden in psychosis spectrum disorders. The extent to which the level, structure and dispersion of affective lability varies between the specific disorders included in the psychosis spectrum is however unclear. To have potential value as a treatment target, further characterization of affective lability in these populations is necessary. The main aim of our study was to investigate differences in the architecture of affective lability in different psychosis spectrum disorders, and if putative differences remained when we controlled for current symptom status. Methods Affective lability was measured with The Affective Lability Scale Short Form (ALS-SF) in participants with schizophrenia (SZ, n = 76), bipolar I disorder (BD-I, n = 105), bipolar II disorder (BD-II, n = 68) and a mixed psychosis-affective group (MP, n = 48). Multiple analyses of covariance were conducted to compare the ALS-SF total and subdimension scores of the diagnostic groups, correcting for current psychotic, affective and anxiety symptoms, substance use and sex. Double generalized linear models were performed to compare the dispersion of affective lability in the different groups. Results Overall group differences in affective lability remained significant after adjusting for covariates (p = .001). BD-II had higher affective lability compared to SZ and BD-I (p = .004), with no significant differences between SZ and BD-I. There were no significant differences in the contributions of ALS-SF dimensions to the total affective lability or in dispersion of affective lability between the groups. Conclusions This study provides the construct of affective lability in psychosis spectrum disorders with more granular details that may have implications for research and clinical care. It demonstrates that despite overlap in core symptom profiles, BD-I is more similar to SZ than it is to BD-II concerning affective lability and the BD groups should consequently be studied apart. Further, affective lability appears to be characterized by fluctuations between depressive- and other affective states across different psychosis spectrum disorders, indicating that affective lability may be related to internalizing problems in these disorders. Finally, although the level varies between groups, affective lability is evenly spread and not driven by extremes across psychosis spectrum disorders and should be assessed irrespective of diagnosis.
Lagerberg, Trine Vik; Icick, Romain; Aminoff, Sofie Ragnhild; Nerhus, Mari; Barrett, Elizabeth Ann & Bjella, Thomas [Show all 9 contributors for this article] (2021). Substance Misuse Trajectories and Risk of Relapse in the Early Course of Bipolar Disorder. Frontiers in Psychiatry. 12, p. 1–9. doi: 10.3389/fpsyt.2021.656912. Full text in Research Archive Show summary
Substance misuse is highly prevalent in bipolar disorder even in the early illness phases. However, the trajectories of misuse of different substances after treatment initiation is not well-studied. Also, knowledge on how substance misuse trajectories influence the early course of bipolar disorder is limited. We recruited 220 individuals in first treatment of bipolar disorder of which 112 participated in a 1-year follow-up study at the NORMENT center in Oslo, Norway. Misuse was defined as having scores above cut-off for harmful use on the Alcohol or Drug Use Disorders Identification Tests (AUDIT or DUDIT). We investigated rates of stopping and continuing misuse of alcohol, cannabis and other illicit substances and daily nicotine use over the follow-up period, and whether such misuse trajectories predicted the risk for affective relapse. The prevalence of cannabis misuse was reduced from 29 to 15% and alcohol misuse was reduced from 39 to 21% during follow-up. Continuing alcohol misuse significantly and independently predicted affective relapse, whereas there was no difference in relapse risk between individuals stopping alcohol misuse and never misusing alcohol. Cannabis misuse trajectories did not significantly predict relapse risk although we cannot exclude interactions with alcohol misuse. In conclusion, substance misuse decreased in the early phase of bipolar disorder treatment but should be further reduced with interventions specifically addressing substance misuse. Stopping alcohol misuse is likely to yield substantial benefit on the clinical course of bipolar disorder.

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Published Dec. 6, 2021 3:39 PM - Last modified Nov. 29, 2024 9:08 AM