[Risk assessment of threatened amok. New responsibilities for psychiatry?]

Although instances of amok are very rare, they have captured media and political attention following several occurrences in German schools. Mental health professionals are increasingly faced with threat assessment in order to help prevent such tragedies. Since the base rate of amok is low and current risk assessment lacks empirical foundations, the likelihood of false-positive results is high. The role of mental health professionals in this domain should be reframed. The focus should not be risk assessment but risk management since most of the mass murderers are in need of some type of psychiatric intervention prior to the massacre. In contrast, compulsory admission and involuntary treatment are only justified if the threats occur in the context of a diagnosed mental disorder. Prospective research approaches that integrate psychopathological and neurobiological methods are urgently needed.