In Cthulhu Realms, your main resource is insanity, each player tries to reduce their opponents to insanity or have more sanity than their opponents when the deck runs out of cards. Each player starts the game with a small deck comprised of initiates, goons and followers. Five cards from the deck form a row of available cards on the table; with more than two players, place three available cards between each pair of players. Each turn, you start with five cards in hand, playing those cards in order to put locations into play, boost your own sanity or reduce that of others, collect conjuring power to acquire new cards. At the end of your turn, discard any cards still in hand. If you lose all of your sanity, you’re out of the game.