**4. Earthquake and cognitive function disorders**

Trauma has been shown to significantly compromise cognitive development. [Levine, 2007; Perry & Szalavitz, 2006] Cognitive deficits such as poor problem solving, (unable to think things out or make sense of what is happening), low self-esteem (how one thinks of oneself – victim-thinking) and hopelessness (loss of future orientation) have all been clearly linked to traumatic events including earthquake, influenza, and so on [Stein & Kendell, 2004; William Steele, 2007]. There is evidence in two independent studies that the trauma and second-trimester influenza, is associated with deficits in cognitive ability as measured by infant habituation to visual stimuli [Wang Xueyi, et al. 2001; Watson JB, 1999; Van OS, 1998]. In both of these studies, the infants whose mothers suffered an influenza infection during their second trimester of fetal development exhibited impaired habituation to visual stimuli. The test of infant habituation of attention is excellent predictor of later intellectual development school readiness and intelligence quotients. Based on the above two studies, we hypothesized that the trauma is related to cognitive impairment. Our purpose of this investigation was to examine the long-term effects of the severe earthquake (7.8 Richter Scale) that struck Tangshan, China in July 1976 on the offspring of women who were pregnant at the time of the earthquake. The extremely severe stress of the earthquake may have resulted in a physiological response in the pregnant women of Tangshan, which adversely affected their fetuses. To determine if exposure to the earthquake as a fetus results in a negative outcome we administered a test of cognitive functioning to test the following hypotheses: 1). The stress of a severe earthquake during gestation will disrupt neural development producing deficits in cognitive functioning. Thus, the exposed group should have poorer cognitive functioning as compared to the control group. 2) Exposure to a severe stressor during a critical period of fetal brain development (the second trimester of gestation) may result in more pronounced cognitive deficits as compared to those exposed during the first or third trimesters. The exposed group consists of 606 high school seniors who were fetuses at the time of the earthquake. The birth dates of the subjects were used to

Earthquake and Mental Health 219

important role in conscious recall of trauma-related events. Although declarative memory may account for much of the arousal-based cognitive symptoms of PTSD, procedural memory provides the seemingly unbreakable conditioned link that perpetuates the neural

To study whether severe stress caused by earthquake had negative effect on fetal cognitive function, Raven's Standard Progress Matrices (RSPM) was used to evaluate cognitive function of 616 young students who experienced earthquake during their fetal stage; 616 controls who did not experience this trauma were assessed with the same instrument. Scores of RSPM of earthquake group were significantly lower than those of controls, especially for those who experienced earthquake in their second or the third trimester (Wang Xuey,et al. 2001). Earthquake has negative effect on cognitive function

Post-Traumatic Stress Disorder has been recognized as a formal diagnosis since 1980. However, as early as the 6th century BC/BCE, reports of battle-associated stress reactions had been reported. One of the first descriptions of PTSD was made by the Greek historian Herodotus. In 490 BC/BCE he described, during the Battle of Marathon, an Athenian soldier who suffered no injury from war but became permanently blind after witnessing the death of a fellow soldier. However, it was called by different names as early as the American Civil War, when combat veterans were referred to as suffering from "soldier's heart." In World War I, symptoms that were generally consistent with this syndrome were referred to as "combat fatigue." Soldiers who developed such symptoms in World War II were said to be suffering from "gross stress reaction," and many troops in Vietnam who had symptoms of what is now called PTSD were assessed as having "post-Vietnam syndrome." PTSD has also

PTSD is an emotional illness that is classified as an anxiety disorder and usually develops as a result of a terribly frightening, life-threatening, or otherwise highly unsafe experience, for instance the earthquake. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat. The rates of

PTSD can cause many symptoms. These symptoms can be grouped into three categories:

Flashbacks—reliving the trauma over and over, including physical symptoms like

Re-experiencing symptoms may cause problems in a person's everyday routine. They can start from the person's own thoughts and feelings. Words, objects, or situations that are

Staying away from places, events, or objects that are reminders of the traumatic

reminders of the event can also trigger re-experiencing of traumatic events.

**5. Earthquake and Post-Traumatic Stress Disorder (PTSD)** 

cycle of trauma and dissociation.

been called "battle fatigue" and "shell shock."

**5.1 Symptoms of PTSD due to earthquake** 

a racing heart or sweating

1. Re-experiencing symptoms:

Frightening thoughts.

Bad dreams

2. Avoidance symptoms:

experience

PTSD suffered from earthquake vary from 2 to 87%.

development of fetus.

determine their stage of gestation at the time of the earthquake. The control group was assessed exactly one year after the exposed group and consists of 606 high school seniors, who were born exactly one year after the exposed group. Thus, the control subjects were not exposed to the earthquake as fetuses. The 1212 exposed and control subjects were matched for birth date so there are an equivalent number of subjects representing months one through nine of gestation. Assessment of the control subjects one year after the exposed group, resulted in an exposed and control group that were both 18 years of age at the time of testing. Both the exposed and control subjects were randomly drawn from the seniors students who attended the five high schools in Tangshan, China.

As we all know, that while in the arousal state or, not feeling safe at the sensory level, cognitive functioning and processing is altered. Short-term memory suffers; verbal memory also decreases. From our research, we can draw conclusion that: the subjects exposed to the earthquake during gestation had significantly lower scores on the Raven's Progressive Matrices at age 18 when compared to 18 year-old control subjects who were not exposed to the quake. The prenatal stress of a severe earthquake on a developing fetus is associated with lowered adult cognitive ability. Subjects exposed to a major prenatal stress (the severe earthquake of Tangshan China) during months five through nine had significantly lower score than control subjects who were born in the same months one year later. There were no differences in average Raven's scores for subjects exposed during months one through four when compared to control subjects matched for date of birth. Thus, a prenatal exposure to a severe stressor during months five through nine may adversely affect cognitive functioning at age of 18. It is probable that the stress of the Tangshan earthquake resulted in the elevation of glucocorticoids in the pregnant mothers. [Jin Guixing,Wang Xueyi,Wang Lan, et al. 2011] This elevation of glucocorticoids may have negatively affected the developing fetus. In addition vasoconstriction of the placenta may have occurred in pregnant mothers at the time of the earthquake, which could have had deleterious effects on the developing fetus. [Calvin Hobel, 2003].

Following exposure to trauma,such as earthquake, survivors may become frozen in an activated state of arousal. Research documenting the effects of arousal on cognition has become increasingly available and consistent in its descriptions of the cognitive and behavioral alterations. In the arousal state, changes in the brain are triggered by a variety of stress related functions. One researcher found that victims of trauma had lower memory volume in the left-brain (Hippocampal) area than did the non-abused (http://www.nimh.nih.gov). This left-brain function refers to understanding or processing information. One of these functional alterations takes place in the neocortex. On the contrary, the right brain is involved "in the vital functions that support survival and enable the organism to cope actively and passively with stress" The right hemisphere controls perception analysis of visual patterns and emotions. One study supports these and similar findings that appropriate responses to external changes (stress/crisis) can be altered by activation of the arousal state – the heightened state of fear induced by traumatic exposure.

Disorders of memory constitute one of the diagnostic categories for PTSD due to earthquake in the form of re-experiencing. Trauma-based memory phenomena often involve declarative memory in the form of variably accurate verbal and imaginal recall of the traumatic event. Declarative memory, the form of memory that relates to facts and events, initially involves hippocampal and prefrontal cortical pathways and plays an

determine their stage of gestation at the time of the earthquake. The control group was assessed exactly one year after the exposed group and consists of 606 high school seniors, who were born exactly one year after the exposed group. Thus, the control subjects were not exposed to the earthquake as fetuses. The 1212 exposed and control subjects were matched for birth date so there are an equivalent number of subjects representing months one through nine of gestation. Assessment of the control subjects one year after the exposed group, resulted in an exposed and control group that were both 18 years of age at the time of testing. Both the exposed and control subjects were randomly drawn from the seniors

As we all know, that while in the arousal state or, not feeling safe at the sensory level, cognitive functioning and processing is altered. Short-term memory suffers; verbal memory also decreases. From our research, we can draw conclusion that: the subjects exposed to the earthquake during gestation had significantly lower scores on the Raven's Progressive Matrices at age 18 when compared to 18 year-old control subjects who were not exposed to the quake. The prenatal stress of a severe earthquake on a developing fetus is associated with lowered adult cognitive ability. Subjects exposed to a major prenatal stress (the severe earthquake of Tangshan China) during months five through nine had significantly lower score than control subjects who were born in the same months one year later. There were no differences in average Raven's scores for subjects exposed during months one through four when compared to control subjects matched for date of birth. Thus, a prenatal exposure to a severe stressor during months five through nine may adversely affect cognitive functioning at age of 18. It is probable that the stress of the Tangshan earthquake resulted in the elevation of glucocorticoids in the pregnant mothers. [Jin Guixing,Wang Xueyi,Wang Lan, et al. 2011] This elevation of glucocorticoids may have negatively affected the developing fetus. In addition vasoconstriction of the placenta may have occurred in pregnant mothers at the time of the earthquake, which could have had deleterious effects on

Following exposure to trauma,such as earthquake, survivors may become frozen in an activated state of arousal. Research documenting the effects of arousal on cognition has become increasingly available and consistent in its descriptions of the cognitive and behavioral alterations. In the arousal state, changes in the brain are triggered by a variety of stress related functions. One researcher found that victims of trauma had lower memory volume in the left-brain (Hippocampal) area than did the non-abused (http://www.nimh.nih.gov). This left-brain function refers to understanding or processing information. One of these functional alterations takes place in the neocortex. On the contrary, the right brain is involved "in the vital functions that support survival and enable the organism to cope actively and passively with stress" The right hemisphere controls perception analysis of visual patterns and emotions. One study supports these and similar findings that appropriate responses to external changes (stress/crisis) can be altered by activation of the arousal state – the heightened state of fear induced by

Disorders of memory constitute one of the diagnostic categories for PTSD due to earthquake in the form of re-experiencing. Trauma-based memory phenomena often involve declarative memory in the form of variably accurate verbal and imaginal recall of the traumatic event. Declarative memory, the form of memory that relates to facts and events, initially involves hippocampal and prefrontal cortical pathways and plays an

students who attended the five high schools in Tangshan, China.

the developing fetus. [Calvin Hobel, 2003].

traumatic exposure.

important role in conscious recall of trauma-related events. Although declarative memory may account for much of the arousal-based cognitive symptoms of PTSD, procedural memory provides the seemingly unbreakable conditioned link that perpetuates the neural cycle of trauma and dissociation.

To study whether severe stress caused by earthquake had negative effect on fetal cognitive function, Raven's Standard Progress Matrices (RSPM) was used to evaluate cognitive function of 616 young students who experienced earthquake during their fetal stage; 616 controls who did not experience this trauma were assessed with the same instrument. Scores of RSPM of earthquake group were significantly lower than those of controls, especially for those who experienced earthquake in their second or the third trimester (Wang Xuey,et al. 2001). Earthquake has negative effect on cognitive function development of fetus.
