Deliberate practice (the seeking of situations in which one's skills are challenged and thus improved) is key to the acquisition of clinical expertise. This editorial outlines the philosophy of deliberate practice and potential difficulties in making use of it in psychiatry.

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.

This article argues that the current approach to guideline development for the treatment of depression is not supported by the evidence: clearly depression is not a disease for which treatment efficacy is best determined by short-term randomised controlled trials. As a result, important findings have been marginalised. Different principles of evidence-gathering are described. When a wider range of the available evidence is critically considered the case for dynamic approaches to the treatment of depression can be seen to be stronger than is often thought. Broadly, the benefits of short-term psychodynamic therapies are equivalent in size to the effects of antidepressants and cognitive–behavioural therapy (CBT). The benefits of CBT may occur more quickly, but those of short-term psychodynamic therapies may continue to increase after treatment. There may be a ceiling on the effects of short-term treatments of whatever type. Longer-term psychodynamic treatments may improve associated social, work and personal dysfunctions as well as reductions in depressive symptoms.

Following devolution, the mental health acts of the constituent countries of the UK are diverging in their provisions. This editorial describes three significant differences between the new Mental Health (Care and Treatment) (Scotland) Act 2003, which came into effect in Scotland in 2005, and the Mental Health Act 2007 for England and Wales.

The recovery approach is much in vogue, initiated by the user movement and embraced by politicians. Users and politicians have a variety of opinions about how it fits with professional psychiatric practice – some view recovery and professional practice as compatible, others view them as mutually exclusive, naming professional practice the ‘medical model’. This editorial explores the relationship between the medical model and the recovery approach. We argue that both have multiple points of similarity, and that applying the medical model to the recovery approach has the potential to significantly influence psychiatric practice.

This editorial discusses the needs of new consultants with reference to existing research and attempts made to meet these needs both within the Royal College of Psychiatrists and elsewhere. Some future challenges for new consultant psychiatrists are identified and discussed. Initiatives that can help meet their needs on a personal and also on an organisational level are suggested. A call is made for new consultants to take control of their own destiny using tried and tested methods and thereby creating hope for their future.

In this issue of APT Mountain & Shah seek to reconcile the currently fashionable ‘recovery’ paradigm of mental healthcare with the distinctly unfashionable ‘medical model’ of psychiatric practice. I argue that their article raises more questions than it answers – not least whether the recovery concept is amenable to empirical analysis.

I discuss the productive interface between psychiatry and the arts in the 20th century and ask whether such an interface is likely to remain as vibrant into the 21st. I review how new models of mental functioning that have an impact on current psychiatric practice have a wider cultural relevance. This editorial looks forward to a series of articles in future issues of APT which will explore some of these ideas in more detail.

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.

‘Delivering race equality’ is a 5-year action plan for tackling race inequalities in mental healthcare in England and Wales, based on the main themes of improved services, better community engagement and better information. The perception is that clinical teams have not been sufficiently engaged with the plan and progress is slow. This article shares insights from the author's work across government departments over the past 2 years and explores the potential for linking up different initiatives across the patient care pathway in support of the plan's delivery. A summary of conclusions from a pilot survey of consultant psychiatrists, commissioned by the Department of Health in June 2007, addresses the main controversial areas in the action plan, with suggestions for improvement. Areas for clinical engagement are identified that exploit new funding, investment and policy initiatives. Examples of good practice are offered.

‘Gulf War syndrome’ was a phrase coined after the 1991 Gulf War. This article looks at the variety of hypotheses that have been put forward about the origins of the concept and the studies attempting to characterise the health manifestations of Gulf service and the lasting effects on veterans. It also serves to bring readers up to date with research on the present deployment in Iraq. Finally, consideration is given to how Gulf War syndrome compares with the rich historical literature of post-conflict medical syndromes and how sociological factors may interact with symptom attribution in veterans.

Healthcare provision in the UK is in a process of continual change. The structures and processes by which people with mental health problems and people with learning disabilities receive support from statutory services have been, and continue to be, subject to many and varied strategic, policy and professional influences. Integrated and collaborative ways of working between generalist (‘primary’) and specialist (‘secondary’) care have become eroded over time and yet they may be needed more than ever. In this editorial we encourage a collaborative approach between practitioners in generalist and specialist care in studying and developing three strands of work: policy and strategy; training; and professional behaviour. Above all, we advocate strongly for a renewed and dynamic dialogue between psychiatrists and general practitioners in working together to provide high-quality mental healthcare.

Depression is increasingly recognised as a major public health problem worldwide. The heterogeneity of this condition implies that there may be several neurobiological pathways to depression. This article attempts to explore a pathway that links depression with the inflammatory response. Associations linking inflammation and chronic immune activation with depression have been noted, particularly in the context of (a) medical disorders with inflammatory pathophysiology and (b) immunotherapy for cancer and hepatitis C. Acute coronary syndrome is given as an example of how the inflammatory process might result in depression, and potential mechanisms are discussed. These include: direct action of pro-inflammatory cytokines on the serotonin system, with specific reference to the serotonin transporter; action of cytokines on the hypothalamic–pituitary–adrenal axis; and effects of pro-inflammatory cytokines on neurogenesis in the hippocampus. Reference is made to the potential anti-inflammatory effects of antidepressant drugs and antidepressant effects of anti-inflammatory treatments.

The development of atypical antipsychotics has stimulated research on the treatment of mania. Several well-established options now exist for monotherapy of mania. None of the atypicals has shown greater efficacy than haloperidol in improving manic symptoms, but they all produce fewer extrapyramidal side-effects and they may differ in their effects on depressive symptoms. Combinations of an antipsychotic with lithium or valproate offer further options, with somewhat greater efficacy in treating mania but also with more side-effects.

People turn to poetry and to psychotherapy when in states of heightened emotion – love, elation, despair, death and loss. Through the analysis of a particular poem this article suggests that there are formal similarities between poetry and psychotherapy that can illuminate the workings of the latter. Perhaps the most overarching of these is mentalisation: the capacity to ‘think about feelings’ or to be ‘mind-minded’. Finding the ‘right words in the right order’ is a task for therapists and their patients as well as for poets, since the appropriate image or metaphor can mirror or evoke feelings in the listener in a way that facilitates empathic attunement. If feelings can be objectified, their power to distress or overwhelm is mitigated. Thus, poetry and psychotherapy are similarly concerned with processes of repair of the human experiential and communicative fabric.

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.

In 2007, the UK government published a White Paper setting out a framework (revalidation) by which doctors will be assessed throughout their professional careers. Although revalidation is unlikely to be welcomed with open arms by many doctors, its discussion in the White Paper is a measured one in which medical Royal Colleges are given a strong voice in the setting and measuring of standards. The details of the revalidation process for psychiatrists have yet to be determined, but it is likely that it will include strengthened appraisal within which doctors will provide evidence that they have met the standards set by the Royal College of Psychiatrists. These will be laid out in a revised edition of the College document Good Psychiatric Practice.

Cannabis use is more common among people with severe mental illness than in the general population. It has detrimental effects on the course of the illness, physical health and social life of users, as well as being a financial burden on health services. It is important to understand why some people with severe mental illness continue to use cannabis, despite experiencing its effects on their condition. This article reviews research on the scale of cannabis use by such patients, the effects on the course of their illness, possible reasons to explain why they use it, and how they can be assessed in clinical settings, as well as providing some assessment tools to measure various characteristics related to cannabis use.

The Mental Health (Care and Treatment) (Scotland) Act 2003 was implemented in October 2005. This article summarises the main features of the Act and its differences from previous legislation. The Act was intended to provide a more flexible range of interventions, including compulsory treatment in the community. It also introduced a number of new safeguards. These are described and early data on their impact are presented. Some provisions of the Act are time-consuming and cumbersome, but there is evidence that psychiatrists are committed to its principles and this is borne out by early monitoring data. Some aspects of the Act are being reviewed at the time of writing.

Choice, responsibility, recovery and social inclusion are concepts guiding the ‘modernisation’ and redesign of psychiatric services. Each has its advocates and detractors, and at the deep end of mental health/psychiatric practice they all interact. In the context of severe mental health problems choice and social inclusion are often deeply compromised; they are additionally difficult to access when someone is detained and significant aspects of personal responsibility have been temporarily taken over by others. One view is that you cannot recover while others are in control. We disagree and believe that it is possible to work in a recovery-oriented way in all service settings. This series of articles represents a collaborative dialogue between providers and consumers of compulsory psychiatric services and expert commentators. We worked together, reflecting on the literature and our own professional and personal experience to better understand how choice can be worked with as a support for personal recovery even in circumstances of psychiatric detention. We were particularly interested to consider whether and how detention and compulsion could be routes to personal recovery. We offer both the process of our co-working and our specific findings as part of a continuing dialogue on these difficult issues.