Effects of pentobarbital tolerance to and dependence on GABAB receptor binding

Effects of pentobarbital pellet implantation on [³H]baclofen binding in the frontal cortex of cerebellum of rat brains were examined. In the frontal cortex, pentobarbital tolerance caused an increase in the number of binding sites (B_max) without changing their affinity (K_D). Twenty-four hours after withdrawal of the pentobarbital pellets, there was a significant increase in the K_D and B_max values. Cerebellar binding, in contrast, was not significantly changed in any of the treatment groups. Addition of 1 mM of pentobarbital directly to binding assays using cortical membrane produced as increase in K_D without a change in B_max.In vitro, pentobarbital affected neither the K_D nor the B_max in the cerebellar [³H]baclofen binding. These results suggest that like the GABA_A receptor, [³H]baclofen binding to the GABA_B receptor in rat frontal cortex was affected by pentobarbital tolerance and dependence, and that there are regional differences in the properties of the GABA_B receptor.     

GABA<Subscript>B</Subscript> Receptors in Neuroendocrine Regulation

Gamma-amino butyric acid (GABA), in addition to being a metabolic intermediate and the main inhibitory neurotransmitter in the synaptic cleft, is postulated as a neurohormone, a paracrine signaling molecule, and a trophic factor. It acts through pre- and post-synaptic receptors, named GABA_A and GABA_C (ionotropic receptors) and GABA_B (metabotropic receptor). Here we reviewed the participation of GABA_B receptors in the regulation of the hypothalamic-pituitary-gonadal axis, using physiological, biochemical, and pharmacological approaches in rats, as well as in GABA_B1 knock-out mice, that lack functional GABA_B receptors. Our general conclusion indicates that GABA_B receptors participate in the regulation of pituitary hormone secretion acting both in the central nervous system and directly on the gland. PRL and gonadotropin axes are affected by GABA_B receptor activation, as demonstrated in the rat and also in the GABA_B1 knock-out mouse. In addition, hypothalamic and pituitary GABA_B receptor expression is modulated by steroid hormones. GABA participation in the brain control of pituitary secretion through GABA_B receptors depends on physiological conditions, being age and sex critical factors. These results indicate that patients receiving GABA_B agonists/antagonists should be monitored for possible endocrine side effects.     

mtDNA m.3635G>A may be classified as a common primary mutation for Leber hereditary optic neuropathy in the Chinese population

γ-Aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the mammalian central nervous system and exerts its actions via ionotropic (GABA_A and GABA_C) and metabotropic (GABA_B) receptors. The GABA_B receptor is a dimer composed of R1 and R2 components. In addition to their location on neurons, GABA and functional GABA_B receptors also have been detected in some peripheral tissues. In the present study, we combined immunohistochemistry, immunoblot and tension recording to determine if the human fallopian tube express glutamic acid decarboxylase (GAD65/67), two isoforms for synthesis of GABA and functional GABA_B receptors. Immunoblots showed that the human fallopian tube tissue contained GABA_BR1 protein which was localized in the epithelial cells and smooth muscle cells by immunohistochemistry. In addition, epithelial cells also expressed GAD65/67. Tension recording found that both GABA and baclofen, a GABA_B receptor agonist increased the spontaneous activity of human fallopian tube. The expressions of GABA_BR and GAD65/67 were significantly upregulated in the ectopic pregnancy group than in the intrauterine pregnancy group. We conclude that the human fallopian tube is capable of synthesizing GABA and expresses functionally active GABA_B receptors. An upregulation of GABA synthesis and corresponding GABA_B receptors may involve in ectopic pregnancy.     

Does gabapentin act as an agonist at native GABA<Subscript>B</Subscript> receptors?

Gabapentin, a novel anticonvulsant and analgesic, is a -aminobutyric acid (GABA) analogue but was shown initially to have little affinity at GABA_A or GABA_B receptors. It was recently reported to be a selective agonist at GABA_B receptors containing GABA_B1a-GABA_B2 heterodimers, although several subsequent studies disproved that conclusion. In the present study, we examined whether gabapentin is an agonist at native GABA_B receptors using a rat model of postoperative pain in vivo and periaqueductal gray (PAG) slices in vitro; PAG contains GABA_B receptors, and their activation results in antinociception. An intrathecal injection of gabapentin or baclofen, a GABA_B receptor agonist, induced antiallodynia in this postoperative pain model. Intrathecal injection of GABA_B receptor antagonists CGP 35348 and CGP 55845 antagonized baclofen- but not gabapentin-induced antiallodynia. In ventrolateral PAG neurons, baclofen activated G-protein-coupled inwardly rectifying K⁺ (GIRK) channels in a manner blocked by CGP 35348 or CGP 55845. However, gabapentin displayed no effect on the membrane current. In neurons unaffected by gabapentin, baclofen activated GIRK channels through GABA_B receptors. It is concluded that gabapentin is not an agonist at GABA_B receptors that are functional in baclofeninduced antiallodynia in the postoperative pain model in vivo and in GIRK channel activation in ventrolateral PAG neurons in vitro.     

The GABAB receptor associates with regulators of G-protein signaling 4 protein in the mouse prefrontal cortex and hypothalamus

Regulators of G-protein signaling (RGS) proteins regulate certain G-protein-coupled receptor (GPCR)-mediated signaling pathways. The GABA_B receptor (GABA_BR) is a GPCR that plays a role in the stress response. Previous studies indicate that acute immobilization stress (AIS) decreases RGS4 in the prefrontal cortex (PFC) and hypothalamus (HY) and suggest the possibility of a signal complex composed of RGS4 and GABA_BR. Therefore, in the present study, we tested whether RGS4 associates with GABA_BR in these brain regions. We found the co-localization of RGS4 and GABA_BR subtypes in the PFC and HY using double immunohistochemistry and confirmed a direct association between GABA_B2R and RGS4 proteins using co-immunoprecipitation. Furthermore, we found that AIS decreased the amount of RGS4 bound to GABA_B2R and the number of double-positive cells. These results indicate that GABA_BR forms a signal complex with RGS4 and suggests that RGS4 is a regulator of GABA_BR. [BMB Reports 2014; 47(6): 324-329]     

Age-Related Development of γ-Aminobutyric Acid (GABA)BReceptor Functions in Various Brain Regions of Spontaneously Hypertensive Rats

The age-related development of GABA_Breceptors and their coupling to adenylate cyclase were studied in the brains of spontaneously hypertensive (SHR) and normotensive Wistar-Kyoto (WKY) rats. Compared with WKY rats, the specific [³H]GABA binding to GABA_Breceptors showed a significant decrease not only in the posterior hypothalamus, midbrain, hippocampus and striatum of eleven-week-old SHR, which maintain a hypertensive state, but also in the posterior hypothalamus of four-week-old normotensive SHR. Similarly, the GABA_Breceptor agonists (baclofen and DN-2327)-induced suppression of adenylate cyclase activity showed a decrease in the posterior hypothalamus of four-week-old SHR as well as in the posterior hypothalamus and striatum of eleven-week-old SHR. These results suggest that the functions of the GABA_Breceptor in the brain of SHR may be decreased independently from the occurrence of blood pressure elevation and that such changes may even be involved in the pathogenesis of SHR.     

Cerebral GABAB receptor: Proposed mechanisms of action and purification procedures

The GABA_B receptor in brain is one of the GABA receptor subtypes, and has been found to be negatively coupled to adenylate cyclase and phosphatidylinositide turnover. This receptor easily solubilizes from cerebral synaptic membrane preparations by 3-[(3-cholamidopropyl) dimethylammonio]-1-propanesulfonate (CHAPS) in the presence of asolectin. GABA_B receptor solubilized from bovine cerebral cortex was purified using baclofen-coupled affinity beads (baclofen-coupled Toyopearl beads). Using these procedures, almost pure GABA_B receptor (80 KDa protein) was obtained in the affinity eluate. A monoclonal antibody has been also raised against the purified GABA_B receptor. The antibody recognized a protein of about 80 KDa in bovine brain synaptic membrane. Immunoabsorbent agarose beads conjugated with the antibody were able to remove more than 90% of the baclofen suppressive GABA binding activity in the solubilized synaptic membrane, and this system was found to be useful for the immunoaffinity column chromatographic separation of GABA_B receptor. Preliminary studies of immunohistochemical visualization of GABA_B receptor in the rat cerebellum suggested that this receptor may be exclusively localized at the presynaptic site of GABAergic neurons.Special issue dedicated to Dr. Claude Baxter.     

Up-regulation of GABAB Receptor Signaling by Constitutive Assembly with the K+ Channel Tetramerization Domain-containing Protein 12 (KCTD12)

GABA_B receptors are the G-protein coupled receptors (GPCRs) for GABA, the main inhibitory neurotransmitter in the central nervous system. Native GABA_B receptors comprise principle and auxiliary subunits that regulate receptor properties in distinct ways. The principle subunits GABA_B1a, GABA_B1b, and GABA_B2 form fully functional heteromeric GABA_B(1a,2) and GABA_B(1b,2) receptors. Principal subunits regulate forward trafficking of the receptors from the endoplasmic reticulum to the plasma membrane and control receptor distribution to axons and dendrites. The auxiliary subunits KCTD8, -12, -12b, and -16 are cytosolic proteins that influence agonist potency and G-protein signaling of GABA_B(1a,2) and GABA_B(1b,2) receptors. Here, we used transfected cells to study assembly, surface trafficking, and internalization of GABA_B receptors in the presence of the KCTD12 subunit. Using bimolecular fluorescence complementation and metabolic labeling, we show that GABA_B receptors associate with KCTD12 while they reside in the endoplasmic reticulum. Glycosylation experiments support that association with KCTD12 does not influence maturation of the receptor complex. Immunoprecipitation and bioluminescence resonance energy transfer experiments demonstrate that KCTD12 remains associated with the receptor during receptor activity and receptor internalization from the cell surface. We further show that KCTD12 reduces constitutive receptor internalization and thereby increases the magnitude of receptor signaling at the cell surface. Accordingly, knock-out or knockdown of KCTD12 in cultured hippocampal neurons reduces the magnitude of the GABA_B receptor-mediated K⁺ current response. In summary, our experiments support that the up-regulation of functional GABA_B receptors at the neuronal plasma membrane is an additional physiological role of the auxiliary subunit KCTD12.     

STRUCTURE OF GABAB RECEPTORS IN RAT RETINA

ABSTRACT

In the search for yet unknown subtypes of GABA_B receptors, the subunit architecture of GABA_B receptors in the retina was analyzed using selective antisera. Immunopurification of the splice variants GABA_B1a and GABA_B1b demonstrated that both were associated with GABA_B2. Quantitative immunoprecipitation experiments indicated that practical the entire GABA_B receptor population in the retina consists of the receptor subtypes GABAB_1a/GABA_B2 and GABA_B1b/GABA_B2, although low levels of GABA_B1c/GABA_B2 cannot be excluded. The data rule out the existence of GABA_B receptors containing the splice variants GABA_B1d and GABA_B1e. Moreover, no evidence for homomeric GABA_B1 receptors was found. Among the splice variants, GABA_B1a is by far the predominant one in neonatal and adult retina, whereas GABA_B1b is expressed only late in postnatal development and in the adult retina. Since GABA_B1a is expressed at high levels before functional synapses are formed, this specific receptor subtype might be involved in the maturation of the retina. Finally, subcellular fractionation demonstrated that GABA_B1a, but not GABA_B1b, is present in postsynaptic densities, suggesting a differential pre- and postsynaptic localisation of both splice variants.     

Synthesis of the Nanomolar Photoaffinity GABAB Receptor Ligand CGP 71872 Reveals Diversity in the Tissue Distribution of GABAB Receptor Forms

A radioiodinated probe, [¹²⁵I]-CGP 71872, containing an azido group that can be photoactivated, was synthesized and used to characterize GABA_B receptors. Photoaffinity labeling experiments using crude membranes prepared from rat brain revealed two predominant ligand binding species at 130 and 100 kDa believed to represent the long (GABA_BR1a) and short (GABA_BR1b) forms of the receptor. Indeed, these ligand binding proteins were immunoprecipitated using a GABA_B receptor-specific antibody confirming the receptor specificity of the photoaffinity probe. Most convincingly, [¹²⁵I]-CGP 71872 binding was competitively inhibited in a dose-dependent manner by cold CGP 71872, GABA, saclofen, (−)-baclofen, (+)-baclofen and ( )-glutamic acid with a rank order and stereospecificity characteristic of the GABA_B receptor. Photoaffinity labeling experiments revealed that the recombinant GABA_BR2 receptor does not bind [¹²⁵I]-CGP 71872, providing surprising and direct evidence that CGP 71872 is a GABA_BR1 selective antagonist. Photoaffinity labeling experiments using rat tissues showed that both GABA_BR1a and GABA_BR1b are co-expressed in the brain, spinal cord, stomach and testis, but only the short GABA_BR1b receptor form was detected in kidney and liver whereas the long GABA_BR1a form was selectively expressed in the adrenal gland, pituitary, spleen and prostate. We report herein the synthesis and biochemical characterization of the nanomolar affinity [¹²⁵I]-CGP 71872 and CGP 71872 GABA_BR1 ligands, and differential tissue expression of the long GABA_BR1a and short GABA_BR1b receptor forms in rat and dog.     

Presynaptic GABA(B) receptors modulate synaptic facilitation and depression at distinct synapses in fusiform cells of mouse dorsal cochlear nucleus

The mammalian dorsal cochlear nucleus (DCN) is considered to contribute to the localization of the sound sources. Fusiform cells (FCs), principal projection neurons in the DCN, integrate two excitatory inputs from auditory nerve fibers (ANFs) and parallel fibers (PFs). Although an immunohistochemical study suggested presence of GABA_B receptors at excitatory presynaptic terminals in the DCN, it has not been elucidated how GABA_B receptors modulate the synaptic transmission to FCs. Here, we examined effects of baclofen on the transmission in vitro. Baclofen reduced both PF-EPSC and ANF-EPSC by reducing transmitter releases, and it enhanced the facilitation in PF-FC synapses and prevented the depression in ANF-FC synapses. The enhancement and prevention were prominent during high-frequency (50 Hz) synaptic input, suggesting the activation of presynaptic GABA_B receptors may optimize both PF-FC and ANF-FC synapses for high-frequency transmission. Postsynaptic GABA_B receptors activated GIRK current and would further modulate the activity of FCs.     

GABAC receptors in the vertebrate retina

In the central nervous system (CNS), the inhibitory transmitter GABA interacts with three subtypes of GABA receptors, type A, type B, and type C. Historically, GABA receptors have been classified as either the inotropic GABA_A receptors or the metabotropic GABA_B receptors. Over the past 10 yr, studies have shown that a third class, called the GABA_C receptor, also exists. GABA_C receptors are found primarily in the vertebrate retina and to some extent in other parts of the CNS. Although GABA_A and GABA_C receptors both gate chloride channels, they are pharmacologically, molecularly, and functionally distinct. The ρ subunit of the GABA_C receptor, which has about 35% amino acid homology to GABA_A receptor subunits, was cloned from the retina and, when expressed inXenopus oocytes, has properties similar to retinal GABA_C receptors. There are probably distinct roles for GABA_C receptors in the retina, because they are found on only a subset of neurons, whereas GABA_A receptors are ubiquitous. This article reviews recent electrophysiological and molecular studies that have characterized the unique properties of GABA_C receptors and describes the roles that these receptors may play in visual information processing in the retina.     

Effects of central GABA receptors activation on catecholamine secretion in rats

We investigated the effects of muscimol, the GABA_A receptor agonist, and baclofen, the GABA_B receptor agonist, injected into the third cerebral ventricle on plasma epinephrine (E) and norepinephrine (NE) levels in anesthetized rats. Baclofen (0.4–5 nmol) increased plasma NE levels in a dose dependent manner but did not affect plasma E levels. Muscimol (2.5 nmol) affected neither plasma E nor NE levels. Concomitant injection of muscimol (2.5 nmol) with baclofen (5 nmol) attenuated the baclofen (5 nmol)-induced NE secretion. These findings suggest that activation of GABA_B receptors in the central nervous system (CNS) stimulates the sympathetic nervous system but not the adrenal medullary response. In contrast, activation of GABA_A receptors in the CNS affects neither the sympathetic nervous system nor the adrenal medullary response, but inhibits the sympathetic neural activity induced by activation of GABA_B receptors in anesthetized rats.     

Endoplasmic Reticulum-associated Degradation Controls Cell Surface Expression of γ-Aminobutyric Acid,Type B Receptors

Metabotropic GABA_B receptors are crucial for controlling the excitability of neurons by mediating slow inhibition in the CNS. The strength of receptor signaling depends on the number of cell surface receptors, which is thought to be regulated by trafficking and degradation mechanisms. Although the mechanisms of GABA_B receptor trafficking are studied to some extent, it is currently unclear whether receptor degradation actively controls the number of GABA_B receptors available for signaling. Here we tested the hypothesis that proteasomal degradation contributes to the regulation of GABA_B receptor expression levels. Blocking proteasomal activity in cultured cortical neurons considerably enhanced total and cell surface expression of GABA_B receptors, indicating the constitutive degradation of the receptors by proteasomes. Proteasomal degradation required Lys⁴⁸-linked polyubiquitination of lysines 767/771 in the C-terminal domain of the GABA_B2 subunit. Inactivation of these ubiquitination sites increased receptor levels and GABA_B receptor signaling in neurons. Proteasomal degradation was mediated by endoplasmic reticulum-associated degradation (ERAD) as shown by the accumulation of receptors in the endoplasmic reticulum upon inhibition of proteasomes, by the increase of receptor levels, as well as receptor signaling upon blocking ERAD function, and by the interaction of GABA_B receptors with the essential ERAD components Hrd1 and p97. In conclusion, the data support a model in which the fraction of GABA_B receptors available for plasma membrane trafficking is regulated by degradation via the ERAD machinery. Thus, modulation of ERAD activity by changes in physiological conditions may represent a mechanism to adjust receptor numbers and thereby signaling strength.     

Dephosphorylation of endogenous GABAB receptor R2 subunit and AMPK α subunits which were measured by in vitro method using transfer membrane

Protein phosphorylation can be regulated by changes in kinase activity, phosphatase activity, or both. GABA_B receptor R2 subunit (GABA_BR2) is phosphorylated at S783 by 5′-AMP-activated-protein kinase (AMPK), and this phosphorylation modulates GABA_B receptor desensitization. Since the GABA_B receptor is an integral membrane protein, solubilizing GABA_BR2 is difficult. To circumvent this problem and to identify specific phosphatases that dephosphorylate S783, we employed an in vitro assay based on dephosphorylation of proteins on PVDF membranes by purified phosphatases. Our method allowed us to demonstrate that S783 in GABA_BR2 is directly dephosphorylated by PP2A (but not by PP1, PP2B nor PP2C) in a dose-dependent and okadaic acid-sensitive manner. We also show that the level of phosphorylation of the catalytic subunit of AMPK at T172 is reduced by PP1, PP2A and PP2C. Our data indicate that PP2A dephosphorylates GABA_BR2(S783) less efficiently than AMPK(T172), and that additional phosphatases might be involved in S783 dephosphorylation.     

Proteasomal Degradation of γ-Aminobutyric AcidB Receptors Is Mediated by the Interaction of the GABAB2 C Terminus with the Proteasomal ATPase Rtp6 and Regulated by Neuronal Activity

Regulation of cell surface expression of neurotransmitter receptors is crucial for determining synaptic strength and plasticity, but the underlying mechanisms are not well understood. We previously showed that proteasomal degradation of GABA_B receptors via the endoplasmic reticulum (ER)-associated protein degradation (ERAD) machinery determines the number of cell surface GABA_B receptors and thereby GABA_B receptor-mediated neuronal inhibition. Here, we show that proteasomal degradation of GABA_B receptors requires the interaction of the GABA_B2 C terminus with the proteasomal AAA-ATPase Rpt6. A mutant of Rpt6 lacking ATPase activity prevented degradation of GABA_B receptors but not the removal of Lys⁴⁸-linked ubiquitin from GABA_B2. Blocking ERAD activity diminished the interaction of Rtp6 with GABA_B receptors resulting in increased total as well as cell surface expression of GABA_B receptors. Modulating neuronal activity affected proteasomal activity and correspondingly the interaction level of Rpt6 with GABA_B2. This resulted in altered cell surface expression of the receptors. Thus, neuronal activity-dependent proteasomal degradation of GABA_B receptors by the ERAD machinery is a potent mechanism regulating the number of GABA_B receptors available for signaling and is expected to contribute to homeostatic neuronal plasticity.     

Sustained Glutamate Receptor Activation Down-regulates GABAB Receptors by Shifting the Balance from Recycling to Lysosomal Degradation

Metabotropic GABA_B receptors are abundantly expressed at glutamatergic synapses where they control excitability of the synapse. Here, we tested the hypothesis that glutamatergic neurotransmission may regulate GABA_B receptors. We found that application of glutamate to cultured cortical neurons led to rapid down-regulation of GABA_B receptors via lysosomal degradation. This effect was mimicked by selective activation of AMPA receptors and further accelerated by coactivation of group I metabotropic glutamate receptors. Inhibition of NMDA receptors, blockade of L-type Ca²⁺ channels, and removal of extracellular Ca²⁺ prevented glutamate-induced down-regulation of GABA_B receptors, indicating that Ca²⁺ influx plays a critical role. We further established that glutamate-induced down-regulation depends on the internalization of GABA_B receptors. Glutamate did not affect the rate of GABA_B receptor endocytosis but led to reduced recycling of the receptors back to the plasma membrane. Blockade of lysosomal activity rescued receptor recycling, indicating that glutamate redirects GABA_B receptors from the recycling to the degradation pathway. In conclusion, the data indicate that sustained activation of AMPA receptors down-regulates GABA_B receptors by sorting endocytosed GABA_B receptors preferentially to lysosomes for degradation on the expense of recycling. This mechanism may relieve glutamatergic synapses from GABA_B receptor-mediated inhibition resulting in increased synaptic excitability.     

GABAB receptors and synaptic modulation

GABA_B receptors modulate transmitter release and postsynaptic membrane potential at various types of central synapses. They function as heterodimers of two related seven-transmembrane domain receptor subunits. Trafficking, activation and signalling of GABA_B receptors are regulated both by allosteric interactions between the subunits and by the binding of additional proteins. Recent studies have shed light on the roles of GABA_B receptors in plasticity processes at excitatory synapses. This review summarizes our knowledge of the localization, structure and function of GABA_B receptors in the central nervous system and their use as drug targets for neurological and psychiatric disorders.     

Possible Involvement of GABAA and GABAB Receptors in the Inhibitory Action of Lindane on Transmitter Release from Cerebellar Granule Neurons

Cerebellar granule cells in culture express receptors for GABA belonging to the GABA_A and GABA_B classes. In order to characterize the ability of the insecticide lindane to interact with these receptors cells were grown in either plain culture media or media containing 150 M THIP as this is known to influence the properties of both GABA_A and GABA_B receptors. It was found that lindane regardless of the culture condition inhibited evoked (40 mM K⁺) release of neurotransmitter ([³H]D-aspartate as label for glutamate). In naive cells both GABA_A and GABA_B receptor active drugs prevented the inhibitory action of lindane but in THIP treated cultures none of the GABA_A and GABA_B receptor active drugs had any effect on the inhibitory action of lindane. This lack of effect was not due to inability of baclofen itself to inhibit transmitter release. It is concluded that lindane dependent on the state of the GABA_A and GABA_B receptors is able to indirectly interfere with both GABA_A and GABA_B receptors. In case of the latter receptors it was shown using [³H]baclofen to label the receptors that lindane could not displace the ligand confirming that lindane is likely to exert its action at a site different from the agonist binding site.     

Regulation of GABAergic inhibition by serotonin signaling in prefrontal cortex: molecular mechanisms and functional implications

Serotonergic neurotransmission in prefrontal cortex (PFC) plays a key role in regulating emotion and cognition under normal and pathological conditios. Increasing evidence suggests that serotonin receptors are involved in the complex regulation of GABAergic inhibitory transmission in PFC. Activation of postsynaptic 5-HT₂ receptors in PFC pyramidal neurons inhibits GABA_A-receptor currents via phosphorylation of GABA_A receptor γ2 subunits by RACK1-anchored PKC. In contrast, activation of postsynaptic 5-HT₄ receptors produces an activity-dependent bi-directional regulation of GABA-evoked currents in PFC pyramidal neurons, which is mediated through phosphorylation of GABA_A-receptor β subunits by anchored PKA. On the presynaptic side, GABAergic inhibition is regulated by 5-HT through the activation of 5-HT₂, 5-HT₁, and 5-HT₃ receptors on GABAergic intereneurons. These data provide a molecular and cellular mechanism for serotonin to dynamically regulate synaptic transmission and neuronal excitability in the PFC network, which may underlie the actions of many antidepressant and antipsychotic drugs.