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

The pharmaceutical industry is primarily responsible to its shareholders and so making profit is its primary motivation. The industry's marketing techniques affect not only prescribing habits of doctors but also concepts of mental health. This editorial examines the impact this has had on both theory and practice in child and adolescent psychiatry. Undue influence by the pharmaceutical industry contributes to a skewing of the literature towards biological disease models of childhood mental health in order to support the use of the pharmaceutical companies' products. Using fluoxetine and stimulants as two case examples, the article illustrates how pharmaceutical companies have contributed to widespread acceptance of erroneous beliefs about the safety and efficacy of using psychotropic drugs in children and adolescents. Suggestions are made on how child psychiatrists, both individually and collectively, can incorporate this knowledge into their professional development and practice.

Recent controversy over the use of serotonin reuptake inhibitors in children and adolescents has focused attention on the role of the pharmaceutical industry in the treatment of young people. Failure of pharmaceutical companies to fully disclose negative outcome trials has led to new guidelines for publication of all trial results. Scrutiny is on the conduct of trials and the relationship of the pharmaceutical industry with prescribing doctors and post-trial surveillance of new drugs. It is argued that drug treatments in child psychiatry are a powerful therapeutic tool but vigilance is needed to ensure that data on the efficacy and safety of drugs are 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 large pragmatic trials that failed to identify advantages with the new, more expensive drugs, while identifying worrying tolerability issues. This article explores the origins of ‘atypicality’, its construction on the back of a confusing and weak clinical validator (diminished liability to promote parkinsonism) and how even in relation to the archetypical atypical, clozapine, the uncertain boundaries of drug-induced extrapyramidal dysfunction may be contributing to confusion about ‘efficacy’ and ‘tolerability’. It argues that abandoning atypicality would open up clinical practice to all drugs of a single class of ‘antipsychotics’ and allow for individualised risk/benefit appraisal as a basis for truly tailored treatment recommendations.

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

Expert witnesses have recently had a bad press but they have long played an important role in the administration of justice. This article begins by drawing attention to the guidance of the UK Academy of Medical Royal Colleges for medical expert witnesses and then sets out the latest guidance for experts in civil cases.

There has been considerable progress in recent years in developing psychosocial interventions for people who experience persistent psychotic symptoms. However, it is sometimes difficult to generalise these findings into routine clinical practice. Long-term, psychodynamically informed, supportive psychotherapy is a valuable approach for working with individuals for whom current psychosocial interventions are ineffective or where unhelpful team reactions are obstacles to care. Its principles are used to inform a multiaxial formulation, which is shared with the treatment team and guides treatment, promoting good-quality comprehensive routine care. The benefits of this approach can best be seen at the individual case level using a subsequent multiaxial reformulation.

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

Childhood conduct disorder casts a long shadow over adulthood, often leading to antisocial personality, drug misuse, increased rates of psychosis and earlier death. This article reviews a range of effective treatments, and shows what is ineffective. The common theme underlying interventions that work is that they change the environment around the young person, with parent training emerging as the most effective. Medication is largely ineffective. The task now is to enable more of these interventions to be available at a reasonably early age.

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