Better understanding of c-reactive protein and leukocytes in psychiatric inpatients with affective disorders:A biopsychosocial approach

BACKGROUND Affective disorders(AD)have been linked to inflammatory processes,although the underlying mechanisms of this relationship are still not fully elucidated.It is hypothesized that demographic,somatic,lifestyle,and personality variables predict inflammatory parameters in AD.AIM To identify biopsychosocial factors contributing to inflammation in AD measured with two parameters,C-reactive protein(CRP)and leukocytes.METHODS This observational study investigated 186 hospital inpatients diagnosed with AD using demographic parameters,serum inflammatory markers,somatic variables,psychological questionnaires,and lifestyle parameters.Hierarchical regression analyses were used to predict inflammatory markers from demographic,somatic,lifestyle,and personality variables.RESULTS Analyses showed that 33.8%of the variance of CRP was explained by body mass index and other somatic medication(e.g.anti-diabetics),age and education,and age of affective disorder diagnosis.For leukocytes,20.1%of the variance was explained by smoking,diet,metabolic syndrome(MetS),and anti-inflammatory medication(e.g.non-steroidal anti-inflammatory drugs).Other psychiatric or behavioural variables did not reach significance.CONCLUSION Metabolic components seem important,with mounting evidence for a metabolic affective disorder subtype.Lifestyle modifications and psychoeducation should be employed to prevent or treat MetS in AD.

Impaired implicit emotion regulation in patients with panic disorder:An event-related potential study on affect labeling

BACKGROUND Panic disorder(PD)involves emotion dysregulation,but its underlying mechanisms remain poorly understood.Previous research suggests that implicit emotion regulation may play a central role in PD-related emotion dysregulation and symptom maintenance.However,there is a lack of studies exploring the neural mechanisms of implicit emotion regulation in PD using neurophysiological indicators.AIM To study the neural mechanisms of implicit emotion regulation in PD with eventrelated potentials(ERP).METHODS A total of 25 PD patients and 20 healthy controls(HC)underwent clinical evaluations.The study utilized a case-control design with random sampling,selecting participants for the case group from March to December 2018.Participants performed an affect labeling task,using affect labeling as the experimental condition and gender labeling as the control condition.ERP and behavioral data were recorded to compare the late positive potential(LPP)within and between the groups.RESULTS Both PD and HC groups showed longer reaction times and decreased accuracy under the affect labeling.In the HC group,late LPP amplitudes exhibited a dynamic pattern of initial increase followed by decrease.Importantly,a significant group×condition interaction effect was observed.Simple effect analysis revealed a reduction in the differences of late LPP amplitudes between the affect labeling and gender labeling conditions in the PD group compared to the HC group.Furthermore,among PD patients under the affect labeling,the late LPP was negatively correlated with disease severity,symptom frequency,and intensity.CONCLUSION PD patients demonstrate abnormalities in implicit emotion regulation,hampering their ability to mobilize cognitive resources for downregulating negative emotions.The late LPP amplitude in response to affect labeling may serve as a potentially valuable clinical indicator of PD severity.

Glutamate transporters, EAAT1 and EAAT2, are potentially important in the pathophysiology and treatment of schizophrenia and affective disorders

Glutamate is the predominant excitatory neurotransmitter in the human brain and it has been shown that prolonged activation of the glutamatergic system leads to nerve damage and cell death. Following release from the pre-synaptic neuron and synaptic transmission, glutamate is either taken up into the presynaptic neuron or neighbouring glia by transmembrane glutamate transporters. Excitatory amino acid transporter(EAAT) 1 and EAAT2 are Na+-dependant glutamate transporters expressed predominantly in glia cells of the central nervous system. As the most abundant glutamate transporters, their primary role is to modulate levels of glutamatergic excitability and prevent spill over of glutamate beyond the synapse. This role is facilitated through the binding and transportation of glutamate into astrocytes and microglia. The function of EAAT1 and EAAT2 is heavily regulated at the levels of gene expression, post-transcriptional splicing, glycosylation states and cell-surface trafficking of the protein. Both glutamatergic dysfunction and glial dysfunction have been proposed to be involved in psychiatric disorder. This review will present an overview of the roles that EAAT1 and EAAT2 play in modulating glutamatergic activity in the human brain, and mount an argument that these two transporters could be involved in the aetiologies of schizophrenia and affective disorders as well as represent potential drug targets for novel therapies for those disorders.

Effect of Tongxinluo Capsule on Patients with Syndrome X and Affective Disorder

Background: To explore the therapeutic effect of Tongxinluo capsule (Tongxinluo) on patients with Syndrome X and Affective Disorder. Methods: Fifty-six patients with Syndrome X and Affective Disorder were randomly divided into a Tongxinluo capsule group and a placebo control group. The duration of treatment was 12 weeks. A 6-minute walking test, exercise load electrocardiogram and clinical symptom assessment were performed before and after treatment. After 12 weeks of treatment, the scores of the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were repeated. The levels of serum endothelin-1 (ET-1) and nitric oxide (NO) were measured before and after treatment. Results: Compared with the placebo control group, the Tongxinluo group SAS and SDS scores were lower than those before treatment (all P < 0.01), and the 6-minute walking distance increased significantly (P < 0.01). Clinical symptoms were significantly improved. The exercise test results suggested that, while improved, there was no significant difference (P > 0.05) when compared to before treatment. In the Tongxinluo treatment group, the levels of plasma endothelin-1 decreased significantly (P < 0.01) and nitric oxide levels were significantly increased (P < 0.01), with a significant difference when compared to the control group (P Conclusions: The Tongxinluo capsule can improve the Affective Disorder of Syndrome X, reduce the degree of anxiety and depression, increase exercise tolerance, reduce clinical symptoms, and improve vascular endothelial function.

Preferences for participation in shared decision making of psychiatric outpatients with affective disorders

Objective: To assess preferences for participation in shared decision making in a representative sample of psychiatric outpatients with affective disorders and to understand how clinical and socio-demographic variables influence patients’ preferences for participation. Method: A cross-sectional survey of 172 consecutive psychiatric outpatients with affective disorders attending at Community Mental Health Care setting was carried out. Patients expressed preferences on each of 3 aspects of decision making (seeking information, discussing options, making the final decision). The “CGI Severity and Improvement Scales” and the “Beck Depression Inventory” scale were used for severity assessment. Additionally the “Drug Attitude Inventory”, the “Beliefs about Medicine Questionnaire” and the “Leeds Attitude toward Concordance Scale” were applied to all participants. Effects of variables considered on preferences were assessed using proportional odds regression models. Results: We registered a high response rate of 85%. Nearly all patients (91%) preferred to leave final decisions to their treating psychiatrists and 87% preferred to rely on psychiatrists for medical knowledge rather than seeking their own information. In contrast, 81% of patients preferred to be offered options and to be asked their opinion by their doctors. Gender, age, educational level, number of psychotropics used and belief about psychiatric medication overuse were significant predictors in decision making dimensions considered. Conclusion: Shared decision making approach of patients with affective disorder must take into consideration a more doctor-directed approach preferred by the patients in which the desire to be offered options is not automatically linked with the willingness of taking decisions or getting more knowledge.

Transmission of NOTCH4 and GRIK2 in a population of Han Chinese with schizophrenia and affective disorder

BACKGROUND： Increasing evidence suggests overlapped genetic susceptibility across traditional classification systems that divided psychotic disorders into schizophrenia or affective disorder. OBJECTIVE： This study aimed to explore whether schizophrenia and affective disorder share genetic susceptibility in NOTCH4 and GRIK2 loci in a population of Han Chinese. DESIGN： Repetitive measurements. SETTING： The experiment was carried out at Shanghai Mental Health Center and Hongkou Mental Health Center of Shanghai between January 2001 and June 2004. PARTICIPANTS： Sixty-five mixed pedigrees （suffering from various diseases, in combination with schizophrenia and affective disorder）, composed of 45 completed trios and 20 single-parent families, were selected from Shanghai Mental Health Center and Hongkou Mental Health Center of Shanghai between January 2001 and June 2004. Probands received clinical diagnosis according to ICD-10; an independent clinician used identical criteria to review all diagnoses. All subjects were Han Chinese in origin and provided informed consent. There were 65 probands and 110 parents among the subjects. The probands comprised 30 males and 35 females： 33 with schizophrenia, 32 with affective disorder, mean age of （30.9 ± 9.8） years, mean age of onset （24.3 ± 8.8） years, mean duration （6.6 ± 7.0） years, and mean age of parents （58.8 ±10.9） years. METHODS： DNA samples from probands and their biological parents were extracted from peripheral blood according to standard methods. Four polymorphisms, -1725T/G and -25T/C in NOTCH4, rs6922753T/C and rs2227283G/A in GRIK2, were amplified and genotyped with PCR-RFLP techniques. MAIN OUTCOME MEASURES： Association between NOTCH4, GRIK2 polymorphism, and schizophrenia was analyzed by transmission disequilibrium test （TDT）. RESULTS： Sixty-five probands and 110 parents were included in the result analysis, with no dropouts. The results showed that the -25T/C polymorphism of NOTCH4 associated significantly with affective disorder and -1725G/-25T haplotype with schizophrenia. SNP rs6922753 of GRIK2 did not associate with the two diseases; SNP rs2227283 and haplotypes, TG and CA, were significantly associated with both diseases. CONCLUSION： Schizophrenia and affective disorder might share genetic susceptibility among mixed pedigrees of the Han Chinese population. NOTCH4 and GRIK2 might be two of the most common susceptibility genes for these psychoses.

Asthma history predicts the risk of affective disorders and anxiety disorders

Background: Positive associations between asthma and a range of mental disorders have been increasingly reported in cross-sectional studies. It is important to determine whether the association between asthma and mental disorders may be causal. Objectives: We conducted a retrospective cohort study using data collected from the 2007 Australia Mental Health and Wellbeing survey (MHW) to examine whether preexisting asthma may predict the likelihood of various types of anxiety disorders and affective disorders. Design, Settings and Subjects: The 2007 MHW survey was a nationally representative household survey. Its data included 8841 Australian adults aged 18 - 85 yrs. Age at first onset of asthma and mental disorders were used to reveal the order of occurrence of asthma and mental disorders, and to define time at risk and asthma exposure. Kaplan-Meier failure function and multivariate Poisson regression models were employed in analysis. Results: Participants who had a history of asthma that lasted six months or more were at higher risk of panic disorder, obsessive compulsive disorder, posttraumatic stress disorder, bipolar disorder, mania and hypomania. The association between asthma history and risk of mental disorder subtypes differed by gender. Conclusion: The findings of this study support the hypothesis that pre-existing asthma increases the risk of a number of anxiety disorders and affective disorders. Predisposition to carbon dioxide hypersensitivity and corticosteroid therapy may partly explain the observed associations.

The Theoretical Principles of the Body-Centered Therapy to Promote Affective Attunement in Children with Autism Spectrum Disorder

Background: The roots of autism spectrum disorders become evident in first attunement mechanisms between mother and child that allow a first level of mentalizing. Neurosciences and current developmental theories confirm the existence of defensive mechanisms related to body and affectivity that psychodynamic theories had already highlighted. Reading child’s behavior not only by administering tests but also through careful clinical observations allows a better understanding of the communication and social difficulties present in autistic children. The identification of the zone of proximal development can promote a therapeutic intervention that respects the individuality of the child and the specificity of his relational approach to the world. Conclusion: The paper presents the theoretical principles of a body-centered therapy to promote the attunement processes necessary to activate cognitive resources.

Reduced Risk of Cancer in Patients with Bipolar Affective Disorder

Background: research focusing on incidence of cancer amongst bipolar affective disorder (BAD) is sparse. Aim: to ex-amine the incidence of cancer in a cohort of BAD inpatients. Methods: the study sample was comprised of BAD patients who had been admitted to a tertiary care mental health center during the period: 1990 to 2006. The data for the sample was cross-referenced with the National Cancer Registry. Analyses of Standardized Incidence Rates (SIR) for all organ systems malignancies were performed. Results: of 1,638 BAD patients included in the present study, 72 (0.04%) were diagnosed as suffering from co-morbid malignancy. This reflects a significantly reduced risk;SIR of 0.27 (95% CI 0.21-0.34). Reduced risk of cancer held true for both males and females (0.20 and 0.34, respectively). Nineteen women developed breast cancer;SIR = 0.42 (95% CI 0.25-0.66). Conclusions: the present study demonstrates reduced rates of cancer amongst patients suffering from BAD - with special reduction in breast cancer.

White matter abnormalities:Insights into the pathophysiology of major affective disorders

The presence of white matter hyperintensities(WMHs) has been commonly associated with poor outcome in subjects with major affective disorders. Unfortunately, WMHs may be frequently confounded by the use of psychoactive medications and duration of illness. Al-though findings from the current literature are quite conflicting, we proposed that subjects with WMHs may be at higher suicidal risk when compared to other sub-groups without. Based on the Fazekas modified scale, the severity of WMHs may serve as a trait marker of disease. Interestingly, the presence of WMHs may rep-resent a neurobiological marker between the underlying vulnerability and clinical presentation of major affective disorders.

Lost Immune Markers for Major Affective Disorders: Could They Help Screen Airline Pilots?

In the 1980s it was discovered that quantitative IgG titers for antibodies directed against the hu-man-obligate DNA viruses were reliably and reproducibly correlated negatively with mood in in-dividuals with major affective disorders. This knowledge was lost to confirmation bias and uncontrolled studies that only looked at Epstein-Barr virus antibodies. The latter led to a long American fad of misdiagnosing major affective disorders as a “chronic Epstein-Barr virus syndrome.” This misdiagnosis even became part of the American popular culture during the 1980s. In light of fatal airline crashes intentionally caused by pilots, the antiviral IgG titers should be revisited as a means of screening pilots for current dysphoria or mania/hypomania due to major affective disorders.

Establishment and evaluation of a mouse model of affective disorder combined with atherosclerosis

Objective:To establish a mouse model of affective disorder complicated with atherosclerosis(AS)by high fat feeding and chronic mild unpredictable stimulation(CUMS),and to provide an animal model for the later study of the prevention and treatment of affective disorder complicated with atherosclerosis by traditional Chinese medicine.Methods:10 C57BL/6J mice were used as blank group,and 20 ApoE-/-mice were randomly divided into AS group and AS+CUMS group.After one week of adaptive feeding,except for the blank group,the other two groups were fed with high fat diet.Meanwhile,the AS+CUMS group was given chronic unpredictable mild stress.The model was evaluated after 16 weeks of modeling.During the experiment,the body weight,food intake,excitability,hair color and other general morphology of mice in each group were observed and recorded.Behavioral indexes(Sucrose preference tests and Open Field test)were detected in each group.The levels of 5-hydroxytryptamine(5-HT)and hypothalamic-pituitary-adrenal(HPA)axis hormones,including adrenocorticotropin(ACTH)and corticosterone(CORT),were detected by ELISA.Serum lipid levels,including total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)and high density lipoprotein cholesterol(HDL-C),were detected by ELISA.HE staining was used to observe the pathological condition of aorta.Results:Compared with blank group,the excitability and food intake of AS+CUMS group were significantly decreased.There were no significant differences in sugar water consumption and activity capacity of mice in AS group,while sugar water consumption and activity capacity of mice in AS+CUMS group were significantly decreased(P<0.01).The serum 5-HT levels in AS group and AS+CUMS group were decreased,and the levels of ACTH and CORT in AS+CUMS group were significantly decreased(P<0.01),and the levels of ACTH and CORT in AS+CUMS group were significantly increased(P<0.01).The serum TC,TG and LDL-C levels of mice in AS group and AS+CUMS group were significantly increased(P<0.01),while the HDL-C level of mice in both groups was significantly decreased(P<0.01).HE staining results showed that the area and degree of plaques in the active vascular lumen of AS group and AS+CUMS group were larger and heavier.Conclusion:High fat feeding combined with CUMS was successful in establishing a mouse model of emotional disorder combined with atherosclerosis.

Parkinson’s disease and affective disorder: The temporal relationship

In relationship between the affective disorders and Parkinson’s disease (PD) it was found that comorbidity was higher than expected in the majority of the studies. Patients with PD are at increased risk of developing depression and, conversely, recent studies have shown that patients with depressive disorders have increased risk of incident PD. However, the temporal associations between the disorders are not fully elucidated. From this review it could be learned that the temporal aspects strongly suggest that a neurobiological association exists between affective disorder and PD. This is illustrated with hitherto unpublished data. Some of these issues may be investigated in case register studies, e.g. by linkage of registers of somatic and psychiatric illness, and suggestions for future research are given. For GP’s, psychiatrists, geriatricians, and neurologists these new findings will lead to a better understanding and better treatment for patients with complicated comorbid conditions. Here timing is important!

Affect regulation in psychoanalytic treatments of patients with a borderline personality disorder–psychoanalysis and psychodynamic psychotherapy–a comparison

BACKGROUND A recent meta-analysis has confirmed that the effects of psychotherapy on patients with borderline personality disorders(BPD)are still insufficiently understood.Evidence of differences between different types of therapies has been questioned.AIM To study repetitive interaction patterns in patients with BPD undergoing either psychoanalysis or psychodynamic therapy.METHODS Psychoanalysis(PSA)or psychodynamic psychotherapy(PDT)was administered to 10 patients each,the two groups were matched.Therapy regimens were applied according to care as usual/manualized including quality control and supervision as usual.Randomization to one of the groups was done after baseline assessment.During classical PSA(n=10)and PDT(n=10),semiannually,recordings(audio or video)of five consecutive therapy sessions were taken over three years for an ex-post analysis.The patients'characteristics,such as affect parameters[Affect regulation and experience Q-sort(AREQ)],quality of object relations(quality of object relations scale)and personality traits[Shedler-Westen Assessment Procedure(SWAP-200)]were analyzed retrospectively by independent raters.Therapeutic action(psychotherapy process Q-sort)and affective(re)actions of the patients(AREQ)were then analyzed in relation to changes found in the patients'characteristics.RESULTS During the first year of therapy(PSA:n=10;PDT:n=9),the therapeutic method PSA was associated with significant improvements in the variable"SWAP Borderline",while in PDT change was not significantly different to baseline(PSA:P=0.04;PDT:P=0.33).Long-term results and follow up was available for seven participants in PSA and for five in PDT after three years;change in SWAP borderline for the whole sample was not significant at this time point when confronting to baseline(P=0.545).However,differences between PSA and PDT were significant when analyzing the“mean change”in the SWAP Borderline variable after one year of therapy(P=0.024):PSA led to slightly increased BPD symptoms,while PDT to a decrease;for the long run,variance of observed change was higher in PSA than in PDT(SDPSA±9.29 vs SDPDT±7.94).Our assumption that transference interpretations,closely followed by affective changes in the patient,could be useful modes of interaction was reproducible in our findings,especially when looking at the descriptive findings in the long-term data.The analysis of repetitive interaction structures demonstrated a very specific"time-lag"between therapeutic intervention and a corresponding increase in positive affect in successful therapy cases.CONCLUSION Exploring the change processes in the patients'characteristics and linking these changes to specific treatment strategies is of clinical importance when starting treatment and for its long-term progress.

Maternal Separation Affects Mothers’ Affective and Reproductive Behaviors as Well as Second Offspring’s Emotionality

Daily separation of rat pups from their mothers while the preweaning period has an impact on behavior and stress response of pups. We hypothesized that maternal separation may create a depression-like state in mother rats from which we separate the rat pups and decrease their reproductive function and fertility. Also, we aimed to evaluate the transmission degree of depression and anxiety across generations. Females aged 3 months were divided in two groups of 10 rats each. After a first mating and a first parturition, we conducted maternal separation 3 h during 22 days for the experienced group while the control group mothers kept their pups. At 4 months of age, females underwent behavioral tests and a second mating. Second generation’s pups were also subjected to behavioral tests. Behavioral tests showed that mothers which experienced separation were more depressive and anxious than control ones, also they had a lower litter size. Rats pups of the second generation whose mothers experienced maternal separation also revealed behavior changes akin to depression and anxiety. Thus, maternal separation causes depressive and anxious-likestates on mother rats which experienced separation and has an impact on their litter size. Also, consequences of maternal separation seem to last throughout generations.

Psychological impact of the COVID-19 pandemic on individuals with serious mental disorders: A systematic review of the literature

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic is having a great impact on individuals from all over the world,particularly on individuals with mental disorders.Several studies found more pronounced psychiatric symptoms,notably symptoms of depression and anxiety.AIM To assess the situation of patients with serious mental illness(SMI:Affective disorders and schizophrenia)regarding their mental health outcome during the pandemic.METHODS A systematic search using the databases PubMed and MEDLINE was conducted,employing the key words“COVID-19”,“SARS-CoV-2”,“psychiatric/mental disorder/illness”,“affective/mood disorder”,“bipolar disorder”,“(major)depression”,“schizoaffective disorder”,and“schizophrenia”.Studies that had been published up until January 9,2021 were included.Information of studies in languages other than English and German was mostly taken from their English abstracts.RESULTS The literature search concluded in the finding of 36 studies containing relevant clinical data.A general impairment of the mental health of individuals with SMI could be detected,particularly in individuals with affective disorders,as compared to those with schizophrenia.Compared to healthy controls,symptoms of anxiety,depression,and stress were more pronounced in individuals with SMI.Relevant factors found that impacted their mental health were age,resilience,and socioeconomic environment,especially the shortage of mental health services,lack of social support,and inadequate information about COVID-19.CONCLUSION In light of these results,mental health services should be reinforced,notably the use of telemental health services.Furthermore,supplying individuals with SMI with adequate information about the COVID-19 pandemic and increasing their resilience is important.When researching the impact of the COVID-19 pandemic on individuals with SMI,standardization as well as follow-up studies are needed to enable better comparability and understanding.

False dogmas in mood disorders research:Towards a nomothetic network approach

The current understanding of major depressive disorder(MDD)and bipolar disorder(BD)is plagued by a cacophony of controversies as evidenced by competing schools to understand MDD/BD.The DSM/ICD taxonomies have cemented their status as the gold standard for diagnosing MDD/BD.The aim of this review is to discuss the false dogmas that reign in current MDD/BD research with respect to the new,data-driven,machine learning method to model psychiatric illness,namely nomothetic network psychiatry(NNP).This review discusses many false dogmas including:MDD/BD are mind-brain disorders that are best conceptualized using a bio-psycho-social model or mind-brain interactions;mood disorders due to medical disease are attributable to psychosocial stress or chemical imbalances;DSM/ICD are the gold standards to make the MDD/BD diagnosis;severity of illness should be measured using rating scales;clinical remission should be defined using threshold values on rating scale scores;existing diagnostic BD boundaries are too restrictive;and mood disorder spectra are the rule.In contrast,our NNP models show that MDD/BD are not mind-brain or psycho-social but systemic medical disorders;the DSM/ICD taxonomies are counterproductive;a shared core,namely the reoccurrence of illness(ROI),underpins the intertwined recurrence of depressive and manic episodes and suicidal behaviors;mood disorders should be ROI-defined;ROI mediates the effects of nitro-oxidative stress pathways and early lifetime trauma on the phenome of mood disorders;severity of illness and treatment response should be delineated using the NNP-derived causome,pathway,ROI and integrated phenome scores;and MDD and BD are the same illness.

Genes in the serotonin pathway are associated with bipolar affective disorder in a Han Chinese population

Serotonin plays an important role in mood regulation, but the involvement of serotonin pathway genes in the development of bipolar I disorder. （BP-I）, a mood disorder, is not clear. We selected 21 single- nucleotide polymorphisms （SNPs） within the HTR2A gene, 8 within the SLC6A4 gene and 23 within the TPH2 gene for genotyping using the GoldenGate genotyping assay. A total of 375 patients with BP-I and 475 normal controls were recruited. Two out of 21 SNPs （rs1475196 and rs9567747） in the HTR2A gene and 1/23 SNPs （rs17110566） in the TPH2 gene were significantly associated with BP-I, both genotype-wise and allele-wise. Furthermore, a specific haplotype in the HTR2A gene showed a significant association with BP-I. Our results indicate that the HTR2A and TPH2 genes in the serotonin pathway play important roles in susceptibility to BP-I.

Chronotypes and affective disorders:A clock for mood?

Affective disorders are often accompanied by circadian rhythm disruption and the major symptoms of mental illness occur in a rhythmic manner.Chronotype,also known as circadian preference for rest or activity,is believed to exert a substantial influence on mental health.Here,we review the connection between chronotypes and affective disorders,and discuss the potential underlying mechanisms between these two phenomena.

SDI/seasonal affective disorder,etc

SDI abbr. Strategic Defense Initiative,a system of computer-controlled defense using lasersand nuclear ballistic missiles in outer space to intercept and destroy enemy missilesbefore they reach their targets。战略防御计划(一种在外层空间使用激光器和核弹道导弹的计算机控制的防御系统,用以拦截并摧毁尚未到达目标的敌方导弹):