In the field of emergency psychiatry, a person's ethnic background, race, religion, values, beliefs, customs, and language can affect the symptoms with which a psychiatric illness may present. A culturally competent evaluation of the psychiatric patient includes assessment of the cultural identity of the individual, the role of culture in the expression and evaluation of psychiatric symptoms, and the effect of cultural differences on the relationship between patient and clinician. The cultures of the clinician and system of care influence diagnosis, treatment, and delivery of care. Language barriers influence the authenticity of the informed consent process. According to federal classification, the four most recognized racial and ethnic minority groups in the United States are Hispanic Americans/Latinos, African Americans/Blacks, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives. Culture-bound syndromes in Hispanic populations include ataque de nervios (attack of nerves), nervios (nerves), and susto (fright or soul loss).