mental disorders, including bipolar disorder, depression, an d autism spectrum disorder.
Pregnancy and birth complications with hypoxia and greater paternal age are associated
with a higher risk of schizophrenia for the developing fetus. In addition, other prenatal
and perinatal adversities, including stress, in fection, malnutrition, maternal diabetes, and
other medical conditions, have been linked wi th schizophrenia. However, the vast major-
ity of offspring with these risk factors do not deve lop schizophrenia. 
Culture-Related Diagnostic Issues 
Cultural and socioeconomic factors must be considered, particularly  when the individual
and the clinician do not share the same cult ural and socioeconomic background. Ideas that
appear to be delusional in one culture (e.g.,  witchcraft) may be commonly held in another.
In some cultures, visual or auditory halluci nations with a religious  content (e.g., hearing
God’s voice) are a normal part of religious experience. In addition, the assessment of dis-
organized speech may be made difficult by lin guistic variation in narrative styles across
cultures. The assessment of affect requires sens itivity to differences in  styles of emotional
expression, eye contact, and body language, wh ich vary across cultures. If the assessment
is conducted in a language that is differen t from the individual’s  primary language, care
must be taken to ensure that alogia is not rela ted to linguistic barriers. In certain cultures,
distress may take the form of hallucinations or pseudo -hallucinations and overvalued
ideas that may present clinically similar to true psychosis but are normative to the pa-
tient’s subgroup.
Gender-Related Diagnostic Issues 
A number of features distinguish the clinical expression of schizophrenia in females and
males. The general incidence of schizophrenia tends to be slightly lower in females, par-