[Polygraphy of a panic attack]

We studied a 24-year old female patient with Type 1 diabetes mellitus suffering for 4 weeks from a major depressive episode combined with panic disorder without agoraphobia. A spontaneous panic attack was serendipitously recorded by polygraph while the subject was at rest. Electrocardiogram, finger blood-flow, respiratory rhythm and muscle tone (forearm, forehead) were recorded. A triphasic course consisting of a "dynamic phase" (appr. 80 s) preceded by a discrete "initial phase" (appr. 140 s) and a "declining phase" (appr. 180 s) was observed. The dynamic phase is characterized by an acute increase of fingertip vasoconstriction and heart rate. The patient was not aware of the panic attack before the dynamic phase. The recognisable central regulation confirms previously published findings indicating a sympathetic-norepinephrine activation at the beginning of the panic attack without activating the musculoskeletal system. Furthermore, a paradoxical phenomenon involving heart and respiratory rate was observed before the onset of anxiety, i.e. an increase of the heart rate and a simultaneous decline of the respiratory rate, suggesting a non-antagonistic regulation of the ergotropic-trophotropic system. The autonomic state of the patient points to a lability in homeostasis from which panic attacks as a form of CNS response could develop.