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Objective The aim of this case study is to illustrate what role factors such as culture and migration history play for the course of mental illnesses. Methods We present a report on a male patient from Iraq, age 48, suffering from depression and chronicle pain syndrome. Stressful experiences such as the loss of his wife and daughter were the trigger for depressive episodes. Results There are three main challenges with regard to treating patients with different that recently immigrated: (1) the language barrier, (2) cultural differences that complicate communication, and (3) the use of stereotypes. In order to optimize treatment it is necessary to consider the specific background of migration as well as the details of the migration history itself. Conclusions There are specific difficulties that hamper the treatment of migrants, namely cultural differences and communication barriers. Support from complementary health care is necessary to prevent further social isolation.

Background Over the last years, the bavarian population, which was relatively homogeneous, has become increasingly culturally diverse. Many migrants to Bavaria have been exposed to extreme stress before, during, and after migration, with potential effects on their physical and mental health. Health problems and suicide rates are of great public health concern. This study compares descriptively frequencies of attempted suicide among native germans and immigrants in Bavaria. Methods We investigated official data on completed suicide in Bavaria in relation to nationality (german/non-german), age, gender and administrative district. Data were extracted from the Bavarian Police Mortality Database (2009–2010) and were analysed using multilevel models to investigate individual and regional factors and the relevance of nonspecific regional heterogeneity. Results After adjustments for age, sex and year, nationality (German vs. non-German) was significant associated with completed suicide in most models considered. We could not find significant regional heterogeneity. Conclusions Further research is needed regarding the influence of nationality and migration status on suicidal behaviour using multilevel models.

Vertigo and anxiety are frequent symptoms in both psychiatric and vertigo patients, especially in those with phobic postural vertigo (PPV). The aim of this study was the investigation of anxiety-associated functional responses in PPV patients compared to healthy controls. For that purpose cholecystokinin tetrapeptide (CCK-4), a valid model to experimentally induce anxiety symptoms, was used. 15 PPV patients and 15 matched healthy controls underwent challenges with CCK-4. During the paradigm, participants did not know the exact time point of the injection in order to separate the anticipatory and CCK-4 induced anxiety. The panic symptom scale score was assessed before and after the injection. During anticipatory anxiety healthy controls showed functional responses mainly in fronto-temporal regions. Patients suffering from PPV showed pronounced BOLD responses in the (ventral) anterior cingulate cortex (ACC), dorsolateral prefrontal cortex, orbitofrontal cortex and precuneus. In healthy subjects, CCK-4 induced anxiety was accompanied by activations in the medial and inferior frontal cortex. In PPV, the CCK-4 injection led to increased activities particularly in the ACC, the cuneus, the cerebellum, the amygdala and fronto-temporal regions. Given the fact of increased neuronal responses in emotion-related brain areas in patients with anxiety disorders these findings could provide evidence for common aspects of phobic postural vertigo and anxiety disorders.