Recognition deficits in facial affect tend to be regarded as a vulnerability marker in schizophrenia. Unlike complex electrophysiological markers, recognition of facial emotions is relatively easy to assess and could be a useful test to identify individuals at risk.

To assess the recognition of facial emotions in a Tunisian population, confirming deficit in patients with schizophrenia unlike controls, and to a lesser level in their first-degree relatives. Performance of the designed test, as a vulnerability marker, was discussed.

One test was constructed from photographs of a famous actress face representing the Ekman's six basic emotions: happiness, anger, disgust, sadness, fear, and surprise. Maximum score was six. The test involves first the recognition of gender.

This test has been proposed to three groups: one group of patients with schizophrenia (n = 34), a group of first-degree relatives (n = 27) and a control group (n = 57).

Recognition deficits of emotions have been found in both patients and their first-degree relatives. Those recognition deficits were absent in the control group regardless of age, sex and educational level. The results also showed that this test is quite specific (77%) and sensitive (84%).

The findings suggest that patients with schizophrenia and their first-degree relatives are impaired of facial emotion recognition skills when compared with controls. This impairment may be a reflected endophenotype, and the constructed visual test should be used as a screening tool for people at risk of schizophrenia.