Proposed changes to the regulation of healthcare professionals in the UK setregulators a considerable challenge. Here I examine the nature of thechallenge and what the General Medical Council (GMC) and its partners aredoing to meet it. Relicensing and recertification are crucial. Revalidationis the sum of their parts and the duty of any responsible regulator.Effective revalidation will provide affirmation of doctors' entitlement topractise, and give the public the assurance that the doctors who treat themare up to date and fit to practise. The GMC's Good Medical Practice iscentral to any new system, and I outline the GMC's long-term thinking andimmediate priorities, including the development of colleague and patientquestionnaires and plans to introduce licences to practise.

The pharmaceutical industry is primarily responsible to its shareholders andso making profit is its primary motivation. The industry's marketingtechniques affect not only prescribing habits of doctors but also conceptsof mental health. This editorial examines the impact this has had on boththeory and practice in child and adolescent psychiatry. Undue influence bythe pharmaceutical industry contributes to a skewing of the literaturetowards biological disease models of childhood mental health in order tosupport the use of the pharmaceutical companies' products. Using fluoxetineand stimulants as two case examples, the article illustrates howpharmaceutical companies have contributed to widespread acceptance oferroneous beliefs about the safety and efficacy of using psychotropic drugsin children and adolescents. Suggestions are made on how childpsychiatrists, both individually and collectively, can incorporate thisknowledge into their professional development and practice.

Recent controversy over the use of serotonin reuptake inhibitors in childrenand adolescents has focused attention on the role of the pharmaceuticalindustry in the treatment of young people. Failure of pharmaceuticalcompanies to fully disclose negative outcome trials has led to newguidelines for publication of all trial results. Scrutiny is on the conductof trials and the relationship of the pharmaceutical industry withprescribing doctors and post-trial surveillance of new drugs. It is arguedthat drug treatments in child psychiatry are a powerful therapeutic tool butvigilance is needed to ensure that data on the efficacy and safety of drugsare freely available.

The subdivision of the class of antipsychotic drugs into two discrete groups– ‘conventional’ (or first generation) and ‘atypical’ (or second generation)– has been adopted as standard, with the latter generally accepted as‘better’ and widely recommended as automatic first-line choices. However,this perception has been thrown into confusion with the results of largepragmatic trials that failed to identify advantages with the new, moreexpensive drugs, while identifying worrying tolerability issues. Thisarticle explores the origins of ‘atypicality’, its construction on the backof a confusing and weak clinical validator (diminished liability to promoteparkinsonism) and how even in relation to the archetypical atypical,clozapine, the uncertain boundaries of drug-induced extrapyramidaldysfunction may be contributing to confusion about ‘efficacy’ and‘tolerability’. It argues that abandoning atypicality would open up clinicalpractice to all drugs of a single class of ‘antipsychotics’ and allow forindividualised risk/benefit appraisal as a basis for truly tailoredtreatment recommendations.

A formal therapy for depression, behavioural activation focuses on activityscheduling to encourage patients to approach activities that they areavoiding and on analysing the function of cognitive processes (e.g.rumination) that serve as a form of avoidance. Patients are thus refocusedon their goals and valued directions in life. The main advantage ofbehavioural activation over traditional cognitive–behavioural therapy fordepression is that it may be easier to train staff in it and it can be usedin both in-patient and out-patient settings. This article describes thetheory and rationale of behavioural activation, its evidence base and how todevelop a formulation that guides the strategy.

Expert witnesses have recently had a bad press but they have long played animportant role in the administration of justice. This article begins bydrawing attention to the guidance of the UK Academy of Medical RoyalColleges for medical expert witnesses and then sets out the latest guidancefor experts in civil cases.

There has been considerable progress in recent years in developingpsychosocial interventions for people who experience persistent psychoticsymptoms. However, it is sometimes difficult to generalise these findingsinto routine clinical practice. Long-term, psychodynamically informed,supportive psychotherapy is a valuable approach for working with individualsfor whom current psychosocial interventions are ineffective or whereunhelpful team reactions are obstacles to care. Its principles are used toinform a multiaxial formulation, which is shared with the treatment team andguides treatment, promoting good-quality comprehensive routine care. Thebenefits of this approach can best be seen at the individual case levelusing a subsequent multiaxial reformulation.

Vocational rehabilitation for people with severe mental health problems ispoorly developed in the UK. Although there is a clear evidence baseindicating the effectiveness of approaches to helping people with severemental health problems gain and retain employment there is generally a lackof awareness of this evidence. As a result there has been a lack ofimplementation within routine clinical practice of the most effectiveapproaches to improving employment outcomes for such individuals.

Childhood conduct disorder casts a long shadow over adulthood, often leadingto antisocial personality, drug misuse, increased rates of psychosis andearlier death. This article reviews a range of effective treatments, andshows what is ineffective. The common theme underlying interventions thatwork is that they change the environment around the young person, withparent training emerging as the most effective. Medication is largelyineffective. The task now is to enable more of these interventions to beavailable at a reasonably early age.

There has been little systematic study of personality disorders in olderpeople (65 years of age and above). However, with an ageing populationworldwide we should expect to find increased numbers of people with Axis IIdisorders surviving into old age. We undertook a qualitative review of therecent literature concerning personality changes and disorders in olderpeople, their prevalence and possible amelioration.