This brief article reflects on the relationship between psychiatrists and pharmaceutical companies (pharma), which continues to generate debate and concerns. We suggest that psychiatrists should consider both the biomedical ethical principles and how values guide actions and clinical decision-making in their dealings with pharma. In addition, the Royal College of Psychiatrists should err towards eschewing influences that might be regarded by others as distorting its position, and individual psychiatrists should declare interests that others might regard as competing/conflicting in order to maintain the trust of patients and the public.

All doctors will encounter patients with intellectual disabilities and neurodevelopmental disorders, but most medical subspecialty training does not explicitly cover the needs of this population. This can leave doctors feeling underskilled and lacking in confidence to assess and manage these patients. It can also increase the risk of diagnostic overshadowing, adversely affecting patients’ health outcomes. This article reviews the current state of medical education in the psychiatry of intellectual disability and associated neurodevelopmental disorders in the UK. It follows the medical training pathway from undergraduate through to postgraduate level, highlighting the expected learning outcomes. Key challenges and gaps in training at each level are discussed, along with potential solutions. Looking more widely, the article finishes with a short description of the paediatric neurodisability specialty training pathway, and a description of the UK’s contribution to international medical training in intellectual disability.

Many authors have considered the ethical dilemmas of a doctor being both the treating physician and expert witness in litigation. The debate has often focused on the potential for bias and the adverse impact being an expert witness can have on the therapeutic alliance. Much of this debate seems rooted in the ethic of non-maleficence. In this article we attempt to examine the other end of this ethical quandary. Using a pragmatic approach, we explore these conflicts and consider biases from other sources. Ultimately, taking on the mantle of both roles is becoming increasingly unavoidable. Hence we argue that, although there are challenges, embracing this dual role can be an important part of holistic treatment, risk management and the pursuit of the ethical principle of justice.

This clinical reflection explores the evolving landscape of teaching and training in old age psychiatry, highlighting recent reforms such as the 2022 UK curriculum revision, which emphasises person-centred, interdisciplinary and digitally enhanced care. It examines national and international initiatives addressing health inequalities, integration of artificial intelligence, and co-produced education. The article underscores the need for adaptable, inclusive and forward-thinking training to meet the complex mental health needs of an ageing global population.

Following the COVID-19 pandemic, assessments by video link became a standard and acceptable form of medico-legal evaluation. The various challenges to achieving an accurate and robust medico-legal assessment via a remote platform are explored in this clinical reflection. It is concluded that any limitations to a remotely undertaken assessment must be highlighted to the court and an in-person assessment considered as a reasonable alternative in some cases.