Modulação Autonômica Cardíaca é Fator Chave para Pressão Alta em Adolescentes / Cardiac Autonomic Modulation is a Key Factor for High Blood Pressure in Adolescentes

Resumo Fundamento O interesse pela hipertensão em crianças e adolescentes aumentou desde a atualização do sistema de classificação da pressão arterial para comparar com o sistema de classificação dos adultos, alterando a terminologia de "normal alta" para "pré-hipertensão". Objetivo O objetivo deste estudo foi analisar a associação da modulação autonômica cardíaca com os níveis pressóricos dos adolescentes. Métodos 203 adolescentes foram agrupados de acordo com a pressão arterial sistólica (PAS) e a pressão arterial diastólica (PAD). Um grupo foi caracterizado como pré-hipertensão, e o outro como normotenso. Foram coletadas características antropométricas, cardiovasculares e de qualidade do sono. Inicialmente, os dados foram submetidos ao teste de normalidade Kolmogorov-Smirnov . As variáveis quantitativas contínuas foram analisadas por meio do teste T de Student não pareado. Para análise das variáveis categóricas, foi utilizado o teste qui-quadrado. Um modelo de regressão logística foi realizado. O nível de significância estabelecido foi p<0,05. Os dados foram expressos como média ± desvio padrão e intervalo de confiança. O software R foi utilizado para análise dos dados. O tamanho do efeito foi calculado com a fórmula de Cohen. Resultados O grupo pré-hipertensão apresentou aumento da entropia de Shannon e diminuição da variância total. Além disso, no modelo de regressão logística, os adolescentes deste grupo tiveram 1,03 mais chances de ter a entropia de Shannon afetada quando a PAS foi ajustada ao gênero, maturação sexual, tempo escolar, idade, circunferência da cintura e qualidade do sono. Conclusão Nossos dados mostram que a modulação autonômica pode desempenhar um papel importante no desenvolvimento da pressão arterial elevada em adolescentes ao controlar fatores como tempo escolar e qualidade do sono.

Abstract Background The interest regarding hypertension among children and adolescents has increased since the blood pressure rating system was updated to be compared with the adult rating system, changing the terminology from "normal high" to "prehypertension". Objective This study aimed to analyze the association between cardiac autonomic modulation and pressure levels of adolescents. Methods 203 adolescents were grouped according to systolic blood pressure (SBP) and diastolic blood pressure (DBP). One group was characterized as prehypertension, and the other as normotensive. Anthropometric, cardiovascular and sleep quality characteristics were collected. Initially, the data were submitted to the Kolmogorov-Smirnov normality test. Continuous quantitative variables were analyzed using the unpaired Student t-test. For the analysis of categorical variables, a chi-square test was used. A logistic regression model was performed. The level of significance was set at p<0.05. The data were expressed as mean ± standard deviation and confidence interval. The R software was used for data analysis. The effect size was calculated using the Cohen's formula. Results The prehypertension group showed an increase in Shannon entropy and a decrease in total variance. Also, in the logistic regression model, adolescents in this group were 1.03 times more likely to have Shannon entropy's affected when SBP was adjusted for gender, sexual maturation, school time, age, waist circumference, and sleep quality. Conclusion Our data show that autonomic modulation may play an important role in the development of elevated blood pressure in adolescents, when controlling for other factors, such as school time and sleep quality.

Cardiac Autonomic Modulation is a Key Factor for High Blood Pressure in Adolescentes. / Modulação Autonômica Cardíaca é Fator Chave para Pressão Alta em Adolescentes.

BACKGROUND: The interest regarding hypertension among children and adolescents has increased since the blood pressure rating system was updated to be compared with the adult rating system, changing the terminology from "normal high" to "prehypertension". OBJECTIVE: This study aimed to analyze the association between cardiac autonomic modulation and pressure levels of adolescents. METHODS: 203 adolescents were grouped according to systolic blood pressure (SBP) and diastolic blood pressure (DBP). One group was characterized as prehypertension, and the other as normotensive. Anthropometric, cardiovascular and sleep quality characteristics were collected. Initially, the data were submitted to the Kolmogorov-Smirnov normality test. Continuous quantitative variables were analyzed using the unpaired Student t-test. For the analysis of categorical variables, a chi-square test was used. A logistic regression model was performed. The level of significance was set at p<0.05. The data were expressed as mean ± standard deviation and confidence interval. The R software was used for data analysis. The effect size was calculated using the Cohen's formula. RESULTS: The prehypertension group showed an increase in Shannon entropy and a decrease in total variance. Also, in the logistic regression model, adolescents in this group were 1.03 times more likely to have Shannon entropy's affected when SBP was adjusted for gender, sexual maturation, school time, age, waist circumference, and sleep quality. CONCLUSION: Our data show that autonomic modulation may play an important role in the development of elevated blood pressure in adolescents, when controlling for other factors, such as school time and sleep quality.

FUNDAMENTO: O interesse pela hipertensão em crianças e adolescentes aumentou desde a atualização do sistema de classificação da pressão arterial para comparar com o sistema de classificação dos adultos, alterando a terminologia de "normal alta" para "pré-hipertensão". OBJETIVO: O objetivo deste estudo foi analisar a associação da modulação autonômica cardíaca com os níveis pressóricos dos adolescentes. MÉTODOS: 203 adolescentes foram agrupados de acordo com a pressão arterial sistólica (PAS) e a pressão arterial diastólica (PAD). Um grupo foi caracterizado como pré-hipertensão, e o outro como normotenso. Foram coletadas características antropométricas, cardiovasculares e de qualidade do sono. Inicialmente, os dados foram submetidos ao teste de normalidade Kolmogorov-Smirnov . As variáveis quantitativas contínuas foram analisadas por meio do teste T de Student não pareado. Para análise das variáveis categóricas, foi utilizado o teste qui-quadrado. Um modelo de regressão logística foi realizado. O nível de significância estabelecido foi p<0,05. Os dados foram expressos como média ± desvio padrão e intervalo de confiança. O software R foi utilizado para análise dos dados. O tamanho do efeito foi calculado com a fórmula de Cohen. RESULTADOS: O grupo pré-hipertensão apresentou aumento da entropia de Shannon e diminuição da variância total. Além disso, no modelo de regressão logística, os adolescentes deste grupo tiveram 1,03 mais chances de ter a entropia de Shannon afetada quando a PAS foi ajustada ao gênero, maturação sexual, tempo escolar, idade, circunferência da cintura e qualidade do sono. CONCLUSÃO: Nossos dados mostram que a modulação autonômica pode desempenhar um papel importante no desenvolvimento da pressão arterial elevada em adolescentes ao controlar fatores como tempo escolar e qualidade do sono.

Obesity as an additional factor for autonomic imbalance and poor sleep behavior in chronic obstructive pulmonary disease: a case-control study.

OBJECTIVES: We compared the autonomic modulation and sleep behavior of eutrophic and overweight patients with chronic obstructive pulmonary disease (COPD). METHODS: COPD participants were divided into the overweight and eutrophic groups. Pulmonary function, blood pressure, body composition, autonomic modulation, and the Pittsburgh Sleep Quality Index score were assessed. Participants performed the six-minute walk test for functional assessment. RESULTS: Spirometric variables obtained in eutrophic and overweight individuals with COPD showed no statistically different results. We observed that the SDNN index indicated lower overall variability (p=0.003), and root mean square of successive differences between normal heart beats (RMSSD) (p=0.04) indicated lower parasympathetic modulation in the overweight group than observed in the eutrophic group. The indexes of the frequency domain presented lower values of total variability (p<0.01), low frequency bands (p<0.01), and high frequency (p=0.02), suggesting a higher sympathetic modulation and reduced parasympathetic modulation of the overweight group compared to eutrophic group. The overweight group also showed reduced sleep quality than the eutrophic group. CONCLUSION: Overweight COPD patients showed lower autonomic modulation and impaired sleep quality, latency, and efficiency as compared eutrophic subjects. These results reinforce the importance of weight control and the acquisition of healthy habits in this population.

Obesity as an additional factor for autonomic imbalance and poor sleep behavior in chronic obstructive pulmonary disease: a case-control study

OBJECTIVES: We compared the autonomic modulation and sleep behavior of eutrophic and overweight patients with chronic obstructive pulmonary disease (COPD). METHODS: COPD participants were divided into the overweight and eutrophic groups. Pulmonary function, blood pressure, body composition, autonomic modulation, and the Pittsburgh Sleep Quality Index score were assessed. Participants performed the six-minute walk test for functional assessment. RESULTS: Spirometric variables obtained in eutrophic and overweight individuals with COPD showed no statistically different results. We observed that the SDNN index indicated lower overall variability (p=0.003), and root mean square of successive differences between normal heart beats (RMSSD) (p=0.04) indicated lower parasympathetic modulation in the overweight group than observed in the eutrophic group. The indexes of the frequency domain presented lower values of total variability (p<0.01), low frequency bands (p<0.01), and high frequency (p=0.02), suggesting a higher sympathetic modulation and reduced parasympathetic modulation of the overweight group compared to eutrophic group. The overweight group also showed reduced sleep quality than the eutrophic group. CONCLUSION: Overweight COPD patients showed lower autonomic modulation and impaired sleep quality, latency, and efficiency as compared eutrophic subjects. These results reinforce the importance of weight control and the acquisition of healthy habits in this population.

Cardiac autonomic modulation of adolescents with different levels of sleep quality.

Evaluate the cardiac autonomic modulation of adolescents with different levels of sleep quality. METHODS: Adolescents aged 11 to 17 years who presented themselves an explanation of the project with consent form signed by participated in the study. Anthropometric and hemodynamic data collected, and questionnaires. RESULTS: Analysis of the variables, age, systolic blood pressure, diastolic blood pressure, waist circumference, body fat and body mass index among the groups with good and poor sleep quality did not present a significant difference (p>0.05) in any paired characteristics. Time domain analysis indicated lower values in the vagal modulation with poor sleep quality. In the frequency domain, LF component increased and HF component decreased significantly in the group with poor sleep quality. There was also a statistical difference in the LF/HF analysis, the group with poor sleep quality presented an increase in this variable. CONCLUSION: The subjects with poor sleep quality present lower cardiac autonomic modulation.

Inspiratory muscle training improves autonomic modulation and exercise tolerance in chronic obstructive pulmonary disease subjects: A randomized-controlled trial.

OBJECTIVES: We aimed to evaluate the effect a regular inspiratory muscle training program on autonomic modulation measured by heart rate variability, exercise capacity and respiratory function in chronic obstructive pulmonary disease subjects (COPD). DESIGN: Single-center controlled study, with balanced randomization (1:1 for two arms). SETTING: A COPD reference hospital localized in Sao Luís, Brazil. PARTICIPANTS: 22 COPD subjects joined the study. INTERVENTIONS: Three times a week for four weeks inspiratory muscle training (IMT) at 30% of PImax. MAIN OUTCOME MEASURES: Pulmonary capacities and inspiratory pressure, total six-minute walk test and, cardiac autonomic modulation. RESULTS: The intervention group showed improvements in the cardiac autonomic modulation, with increased vagal modulation (total variability and HF [ms2; adjusted p < 0.05]); increased expiratory and inspiratory capacities and, increased distance in the 6-min walk test. CONCLUSION: 12 weeks of IMT at 30% of the maximal inspiratory pressure increased cardiac autonomic modulation, expiratory and inspiratory and exercise capacity in COPD subjects.

Estimated intensity and acute cardiovascular response to a single exercise session guided by the fitness app Sworkit® Personal Trainer

Aim: The aim of the present study was to evaluate the effect of an exercise session prescribed by the Sworkit® Personal Trainer application on hemodynamic and autonomic responses. Methods: The sample consisted of 11 men classified as sedentary according to IPAQ. The exercises were randomly selected by the app Sworkit® Personal Trainer, using the pre-built program "Light Warm-Up Cardio" (see supplementary material). Heart rate and perceived exertion data were collected every minute during an exercise session. Blood pressure and heart rate variability were measured Pre, Post, 30 min, 12h, 24 h, and 48h after exercise. Heart rate and rate of perceived exertion were collected during the 30 minutes exercise. Results: Hemodynamic responses showed differences in heart rate and systolic blood pressure: Post, 12 h and 24 h compared to Pre. We also found significant statistical differences in the heart rate variability indexes when comparing Post, 30min to 48h versus Pre, indicating modifications in the autonomic modulation post-exercise. The perceived exertions scale remained between 13-14 during the exercise. Heart rate was 149 ± 5.26 (80 ± 5% of HRmax) during the 30min exercise, indicating a moderate to vigorous intensity. Conclusion: We concluded that a single exercise session guided by the Sworkit® Personal Trainer application could generate autonomic changes in up to 12 hours, presenting a moderate to vigorous intensity in 30 minutes of exercise for sedentary men.(AU)

Impacts of low or vigorous levels of physical activity on body composition, hemodynamics and autonomic modulation in Down syndrome subjects

Aim: We aimed to evaluate the effect of low and vigorous levels of physical activity in body composition, hemodynamics and autonomic modulation in subjects with Down syndrome (DS). METHODS: We evaluated 13 healthy subjects without DS (control group), 15 sedentary subjects with DS, (SED DS group), nine with DS with low intensity levels of physical activity (LIDS) and 12 with DS with vigorous levels of physical activity (VIDS). The physical activity level was measured using the IPAQ questionnaire. Body composition, hemodynamics and autonomic modulation were also evaluated. RESULTS The VIDS showed lower BMI than the control and SED DS group. Body fat (%) was lower in LIDS and VIDS than in the control and SED DS group. The systolic and diastolic arterial pressure values were similar among the groups. When normalized, the frequency domain showed higher LF/HF, higher LF (nu) and lower HF (nu) component of heart rate variability in sedentary DS than in the control group. However, LIDS and VIDS groups showed similar values in LF (nu), HF (nu) and LF/HF than the control group. The symbolic analysis showed greater 0V and lower values in 2LV in sedentary DS group when compared to the control group. However, the LIDS and VIDS did not show difference in 0V when compared to the control group. The 2LV was lower in LIDS and VIDS than in the control group, but 2UV was higher in VIDS than in the control group. CONCLUSION: We conclude that, regardless of the intensity, exercise can promote positive adaptations in the autonomic modulation of DS patients.(AU)

Hypertension and Exercise Training: Evidence from Clinical Studies.

Hypertension is a worldwide prevalent disease, mostly manifested as its primary ethiology, characterized by a chronic, multifactorial, asymptomatic, and usually incurable state. It is estimated that more than one billion of the world population is hypertensive. Also, hypertension is the main cause of the two most frequent causes of death worldwide: myocardial infarction and stroke. Due to the necessity of the cardiovascular system to manage chronically increased levels of blood pressure, hypertension causes severe alterations in multiple organs, as the heart, vessels, kidneys, eyes and brain, thus increasing the risk of health complications. The heart is the main target organ and suffers several adaptations to compensate the increased blood pressure levels; nevertheless, long-term adaptations without proper control are extremely harmful to cardiovascular health. On the other hand, hypertension is a modifiable risk factor and its adequate control is highly dependent on lifestyle. Pharmacological treatment is of great success when adherence is high. Several classes of antihypertensive drugs are prescribed and can effectively maintain blood pressure within acceptable levels. However, non-pharmacological methods, as diet and exercise training, can not only optimize the treatment but also prevent or postpone hypertension development as well as its complications, acting as important complements to the ideal control of elevated blood pressure, and bringing together benefits beyond blood pressure decrease, as a general health status improvement and increased quality of life. There is consistent evidence that regular exercise training promotes several benefits when properly prescribed and practised, acting as "medicine" for dozens of chronic diseases. The effects of exercise training in blood pressure levels and in its mechanisms of control are of clinical relevance and efficacy. This chapter will describe the classical and recent results on the beneficial effects of different modalities of exercise training in the cardiovascular system of human primary hypertension, focusing on the mechanisms influenced by exercise training which help to decrease blood pressure and improve the cardiovascular system.

Short-term combined exercise training improves cardiorespiratory fitness and autonomic modulation in cancer patients receiving adjuvant therapy.

The present study aimed to investigate the impact of a short-term exercise training (ET) on the cardiorespiratory fitness and autonomic modulation of women with breast cancer who were receiving adjuvant radiotherapy, chemotherapy or hormonotherapy. Eighteen women previously diagnosed with breast cancer receiving adjuvant radiotherapy, chemotherapy or hormone therapy were randomly allocated into breast cancer nonexercise (BC) and exercise groups (BC+Ex). Moreover, nine healthy physically inactive volunteers were recruited to compose the noncancer control group (CG). The BC+Ex group was underwent to a combined ET program, which was based on resistance, aerobic and flexibility exercises. ET was performed 3 times a week, on nonconsecutive days, for 4 weeks at the hospital room under the professional supervision. In turn, BC and CG remained without be engaged in physical exercise programs. Volunteers were evaluated regarding their cardiorespiratory fitness and autonomic modulation (i.e., time, frequency domains, and nonlinear [symbolic analysis]) before and after the end of the ET program. A priori, data indicate that women patients with breast cancer showed impaired exercise tolerance, as well as autonomic dysfunction in comparison with age-matched healthy control subjects. However, a 1-month combined ET program could reverse such impairments, so that after the intervention, BC+Ex and CG showing similar results in the cardiorespiratory test and heart rate variability analysis. In conclusion, data of the current study indicate that 1 month of ET is able to reverse impaired cardiorespiratory fitness and autonomic modulation in women with breast cancer receiving adjuvant therapy.

Cardiovascular Response of an Acute Exergame Session in Prepubertal Obese Children.

PURPOSE: We aimed to analyze the acute autonomic response of obese and eutrophic prepubertal boys to an exergame (EXG) session. MATERIALS AND METHOD: Nine eutrophic (8.89 ± 2.71 years of age and 16.42% ± 6.30% body fat) and nine obese boys (8.70 ± 1.16 years of age and 40.76% ± 4.2% body fat) participated. Nutritional state was determined using World Health Organization guidelines. Variables were collected at rest, immediately post (IP), and 60 minutes after a 20 minutes EXG session. Autonomic nervous system (ANS) activity was assessed using heart rate variability in time and frequency domains, and data were analyzed using Shapiro-Wilk and ANOVA tests with Tukey post hoc. RESULTS: The obese group demonstrated an increased sympathetic activity at rest when compared with the eutrophic group (P < 0.05). The obese group also demonstrated an increased parasympathetic activity 60 minutes after the EXG session when compared with the eutrophic group (P < 0.05). CONCLUSION: We concluded that an acute session of EXG promoted ANS super compensation. We encourage research on chronic ANS response to EXG.

Corrida em ambiente quente altera o perfil leucocitário de sujeitos treinados saudáveis / Race in a hot environment changes the leukocyte profile in healthy trained subjects

OBJETIVOS: Analisar os efeitos de uma corrida de 15 km ao ar livre em ambiente de alta temperatura na modulação da leucocitose em homens saudáveis treinados em corrida. MÉTODOS: A amostra foi composta por 14 homens que participavam de um grupo de corrida recreativo. Foram incluídos voluntários que declarassem ser capazes de percorrer a distância mínima de 15 km, não estivessem tomando nenhum medicamento imunossupressor e não tivessem nenhuma doença infecciosa. Os critérios de exclusão foram hipertensão arterial em repouso antes da corrida, histórico de doenças osteomioarticulares, metabólicas e/ou cardiovasculares, e não completar o percurso da corrida. Amostras de sangue venoso antes e após a corrida foram coletadas para determinação do hematócrito e contagem de células imunes por imunocitoquímica. RESULTADOS: Observou-se aumento no número de leucócitos totais e neutrófilos no momento pós corrida (9,31±2,4×10³ células/µL e 7,64±3,4×10³ células/µL respectivamente) em comparação ao momento pré corrida (5,52±0.2×10³ células/µL e 2,90±0,6×10³ células/µL respectivamente) (p<0,05). Houve diminuição no número de linfócitos e eosinófilos no momento pós corrida (1,34±0,3×10³ e 0,36±0,2×10³ células/µL respectivamente) comparado ao pré corrida (1,67±0,3×10³ e 0,22±0,1×10³ células/µL respectivamente) (p<0,05). Não foram observadas diferenças significativas no número de monócitos e basófilos no momento pós corrida (0,45±0,1×10³ e 0,9±0,3×10³ células/µL respectivamente) comparado ao pré corrida (0,40±0,08×10³ e 0,8±0,3×10³ células/µL respectivamente) (p>0,05). CONCLUSÕES: A corrida de 15 km ao ar livre, em ambiente de alta temperatura, induziu a uma cinética leucocitária típica, com leucocitose às custas do aumento no número de neutrófilos, assim como queda no número de linfócitos e eosinófilos, em homens saudáveis com prévio treinamento em corrida. Estes resultados ajudam a compreender melhor a leucocitose induzida pelo exercício e podem indicar a intensidade do estresse promovido pelo exercício em condições ambientais extremas.

AIMS: To assess the effects of an outdoor race of 15 km in a hot environment on leukocyte kinetics in healthy trained men. METHODS: The sample consisted of 14 men who participated in a recreational race group. Volunteers who said they were able to run a minimum distance of 15 km, were not taking any immunosuppressants, and had no infectious disease were included in the study. The exclusion criteria were the following: hypertension at rest before the race, history of musculoskeletal, metabolic and/or cardiovascular diseases, and failure to finish the race. Venous blood samples were collected before and after the race for determination of hematocrit levels and immune cell count by immunocytochemistry. RESULTS: An increase in total leukocyte and neutrophil count was observed after the race (9.31±2.4×10³ cells/µL and 7.64±3.4×10³ cells/µL, respectively) compared to the pre-race period (5.52±0.2×10³ cells/µL and 2.90±0.6×103 cells/µL, respectively), (p<0.05). There was a decrease in lymphocyte and eosinophil count after the race (1.34±0.3×10³ and 0.36±0.2×10³ cells/µL, respectively) compared to the pre-race period (1.67±0.3×10³ and 0.22±0.1×10³ cells/µL, respectively) (p<0.05). There was no statistically significant difference in monocyte and basophil count after the race (0.45±0.1×10³ and 0.9±0.3×10³ cells/µL, respectively) compared to the pre-race period (0.40±0.08×10³ and 0.8±0.3×10³cells/µL, respectively) (p>0.05). CONCLUSIONS: The 15-km outdoor race in a hot environment led to a typical leukocyte kinetics, resulting in leukocytosis owing to the increase in neutrophil count as well as to a decrease in lymphocyte and eosinophil count in healthy trained men. These findings shed some further light upon exercise-induced leukocytosis and may indicate the level of stress produced by exercise under extreme environmental conditions.

Autonomic modulation analysis in active and sedentary kidney transplanted recipients.

Modulation of the autonomic nervous system on heart rate can be compromised in chronic kidney disease and may result in changes in the frequency and duration of the cardiac cycle. The aim of this study was to evaluate autonomic modulation in active and sedentary renal transplant recipients. Twenty renal-transplanted individuals were analyzed at the Centro de Prevenção de Doenças Renais (Kidney Disease Education Centre), in the academic hospital of Universidade Federal do Maranhão, and were divided into the active group (AG) and the sedentary group (SG). The AG comprised of six men and four women (age 43.10 ± 13.02) and was in regular concurrent training intervention for 8 weeks, while the SG was composed of three men and seven women (age 36.8 ± 9.26). Analysis of heart rate (HR) variability in time and frequency domain demonstrated that HR mean values in the SG and AG were 787.32 ± 79.60 and 870 ± 106.66 ms, respectively. Differences were observed in the time domain and frequency domain. The total index of low frequency and high frequency showed no differences between the SG and AG. Biochemical variables presented significantly lower levels after 8 weeks of training. Higher heart rate variability in the time domain and greater vagal modulation was observed in the AG. The AG ad greater vagal modulation when compared to the SG, with removal of the sympathetic and increased parasympathetic in the behaviour was confirmed by sympatho-vagal balance. The AG also presented significant improvements in the frequency domain.

Terapia cognitiva construtivista e psicanalise / Cognitive, construct therapy and psychoanalysis

A filosofia e as ciencias pos-modernas vem criticando severamente o reducionismo da fase historica denominada Iluminismo, a qual se caracterizou pelo objetivismo, com grandes contribuicoes para o desenvolvimento cientifico em varios campos, inclusive na...

O mito (complexo) dos vampiros: sua importância psicológica e psicopatológica

O autor se refere aos mitos, como efeito de 'complexos' que continuam a ter valor destacado para a investigação do inconsciente. Contudo, julga que a Psicanálise tem sempre enfatizado demais a Mitologia antiga, esquecendo-se da atual, principalmente como a mesma aparece no cinema e estórias em quadrinhos. A esse respeito, considera o 'mito dos vampiros', como surge na psicopatologia: desenhos de esquizofrênicos, por exemplo e em psicologia: figuras 'vampirescas' conforme criação de Hollywood e imitadas pelas mulheres mais sofisticadas de todo o mundo e mais recentemente, as figuras femininas em muitas estórias em quadrinhos, inclusive na Rússia. Vampiro e Édipo, conclui, concentram de maneira surpreendente, configurações psicodinâmicas evolutivas, verdadeiros marcos básicos para a compreensão psicológica e psicodinâmica. Enquanto 'Édipo' ilustra e sintetiza o 'inconsciente' da fase fálica (genital), exaustivamente estudado por Freud e responsável pelos conflitos neuróticos, 'Vampiro' faz o mesmo com a fase oral, aprofundada por Melanie Klein e ligada aos aspectos psicóticos da personalidade humana (AU)