Madhouse is a survival horror roleplaying game set within the Lakeshore Asylum. In this roleplaying game, the players take on the roles of patients who have been sent to the asylum to recover from their mental disorders, only to learn that survival might take precedence over recovery. Madhouse uses a D10-based "roll and keep" system that provides tactical options while keeping gameplay quick and intuitive. The Insanity mechanic features a "press your luck" mechanic that allows players to "push" to gain bonuses to their dice rolls. Each Push also increases a player's Insanity, however, and if a player accumulates too much Insanity, they might find themselves acting irrationally in situations that call for cool heads and critical thinking.