The study showed that quantitative enquiry using
stimulus material such as case vignettes could elicit
the thinking that sits behind the decision of a psychiatrist
to prescribe RLAI. Variability across practicing
clinicians and across time periods was evident. A
frequent fi nding of the study was that there existed
a divergence between what the psychiatrist thought
might be best practice according to their knowledge
of evidence and what was their actual practice. This
included starting dose and titration patterns, use
early in the patient ’ s illness course, needle design and
effi cacy monitoring.
In Phase 1 especially most agreements about this
new treatment were around the general indications
for use (the who, when, and why) whilst most divergence
related to the specifi cs of use (the how). This
could be construed as the application of theory versus
practice. When it came to theory clinicians generally
agreed on the appropriate use of RLAI, and these
agreements were similar to the recommendations of
the product ’ s manufacturer. When it came to actual
clinical practice responses showed far more variance.
This variance was between clinicians and also
between actual and recommended practice. These
variations suggested a need for clearer guidance that
can impact on day-to-day treatment choices.