Background: Facial affect recognition is the ability of all individuals to recognize basic forms of affective expression reflected on people's faces. These expressions are happiness, sadness, fear, disgust, surprise, anger, and the absence of emotion, also called neutral expression. Patients with schizophrenia present difficulty in recognizing these expressions in themselves and/or in other people.

Objective: The objective was to determinate which emotions were confused and for what other emotion they were taken for (misattribution).

Method: We included three groups: 34 schizophrenic patients, 34 siblings, and 34 control subjects. All patients attend the schizophrenia clinic, their siblings were those closest in age and gender, and subjects without mental illness were paired by age and gender. We used SCID-I and SCL-90 scales to discard mental illness in siblings and controls. PANSS, CDSS, and CGI were used to measure the severity of the disease in schizophrenic patients. We used the Pictures of Facial Affect developed by Ekman (1976), to evaluate facial affect recognition.

Results: Across all groups, the least recognized emotion was fear; in the patients and siblings groups, the most recognized emotion was surprise. In the patient group happiness was mistaken for the neutral face in 13%. The patients mistook anger for neutral face in 5.6%, fear in 5.2%, surprise in 5.0%, and disgust in 4.9 %. Neutral face: only the patients group mistook the neutral face for sadness in 4.6%. Fear was the least recognized emotion; the patient group mistook it for surprise in 42.6% and anger in 6.9 %. The siblings mistook it for surprise in 41.3 %, and the control group also for surprise in 25.4%. Disgust: It was mistaken for anger by patients in 25.6%, siblings in 23.3%, and control subjects in 11.5%. Sadness: it was mistaken for fear in 15.6%, and for neutral faces in 10.9% in the patients group. In the siblings group the sadness was mistaken for fear in 14.1%, and the controls group sadness was mistaken for fear in 11.1%.

Discussion: patients with schizophrenia recognize facial emotion expressions less well than siblings and the control group. The differences in the recognition of emotions in previous studies reported a poor recognition of fear and sadness.In our study, we found in all groups that fear was mistaken for surprise. The patient group showed differences in relation to other groups, but the sibling group was closer to the patient group than to controls. The control group had a lesser degree of failure in recognizing emotion. This supports the presence of basic cognitive failures in patients and their siblings, reinforcing the fact that facial affect recognition could be part of a cognitive endophenotype.

Keywords: Facial emotion; affect recognition; schizophrenia; endophenotype