The elderly population is rapidly growing and increasing in diversity. Furthermore, mental disorders are common in this population. Elderly patients are at increased risk for developing psychotic symptoms. Consequently, clinicians must increase their awareness of culture and its effect on psychosis in the elderly. This article briefly reviews the components of cultural assessments, cultural issues pertaining to diagnosis and treatment, and culture-bound syndromes. Some studies have demonstrated ethnic differences in the presention, assessment, diagnosis, and treatment of psychotic disorders in the elderly. These differences may be explained by factors including clinicians' bias, cultural distance between patients and clinicians, culturally biased diagnostic instruments, stereotypes of psychopathology, and biological and other environmental factors. However, some studies have not documented ethnic differences in diagnosing and treating psychotic disorders. Appropriate assessments and diagnoses include patients' and clinicians' ethnic and cultural contexts. Rigorous methodological research is needed to further evaluate the prevalence and treatment of psychotic disorders in ethnic minority elders.