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Source Horror Adventures pg. 182
Fractures, cuts, and abrasions wound the body, but madness undermines the mind, spirit, and personality. Suffering from madness can be terrifying, causing those afflicted to act contrary to their desires or reason.

Madnesses are afflictions, similar in structure to poisons, diseases, and curses. They are used as part of the sanity system as an outcome of severe assaults on a character’s sanity, but GMs can use madness in other cases as well. Because madnesses are presented as afflictions, they can be used with the sanity and madness system from the Pathfinder RPG GameMastery Guide. If you’re using the rules for sanity and madness in the GameMastery Guide, when those rules call for a character to gain an insanity, roll d%. The character gains a lesser madness on a roll of 1–70%, and a greater madness on a 71–100%. Once the potency of the madness is determined, roll on the appropriate table (Table 5–1 for a lesser madness and Table 5–2 for a greater madness) to determine the kind of madness the character gains, or select an appropriate madness that fits the situation.

The madnesses in this section are works of fantasy. None are statements about or descriptions of existing maladies.

Table 5-1: Lesser Madness

67-76Night terrors

Table 5-2: Greater Madness

31-48Cognitive block
49-66Dissociated identity
79-85Psychosomatic loss

Reading a Madness Stat Block

Source Horror Adventures pg. 182
Madnesses are formatted in the same way as other afflictions, with the following changes.

Save: Unless the character has gained the madness via the sanity system, this is the save necessary to avoid contracting the madness. It is also the base saving throw needed to cure the madness (see Curing Madness below) and the saving throw the effects of the madness require. If, during the course of treating a madness, the affliction’s DC decreases, that new reduced saving throw also becomes the DC the afflicted character must succeed at to avoid any of the madness’s effects. It’s possible to suffer from multiple forms of the same madness. If a character becomes afflicted with a form of madness from which he is already suffering (even if it takes a slightly different form, such as phobias of different objects), the current DC of that madness increases by 5. All madnesses are mind-affecting effects.

Onset: When a character suffers madness from the sanity system (due to a sanity attack that deals sanity damage greater than or equal to his sanity edge), this onset time does not apply. Use this entry only when the character contracts the madness in other ways. During the onset time, the character gradually gains the madness effect, rather then suddenly experiencing the full effect after a number of days.

Effect: This is the effect of the madness. An afflicted character typically suffers this effect at all times, but some madnesses manifest only during certain situations. For complex effects or effects that rely on roleplaying, the description section of the madness contains a more detailed description of the effect. If you’re using the sanity system, this effect manifests as long as the madness is not dormant.

Dormancy Effect: If you’re using the sanity system, the afflicted character suffers this effect while the madness is dormant. Otherwise, ignore this entry.

Curing Madness

Source Horror Adventures pg. 182
Each madness has a DC representing its strength. Among other things, that DC specifies the saving throw the afflicted character must succeed at to recover from the madness. Recovering from a madness without magical aid is a lengthy process requiring significant rest. After 7 consecutive days of uninterrupted rest, the afflicted character can attempt a Will save against the madness’s current DC. If she succeeds, the DC is reduced by a number of points equal to 1/2 the character’s Charisma modifier (minimum 1). Instead of relying on her own strength of personality to reduce the effects of madness, a character can also seek out a single confidante, priest, or other advisor. The recovering character must meet with that person regularly (at least 8 hours each day) and gain guidance during the 7 days of rest. At the end of the rest period, the ally can attempt a Wisdom or Intelligence check (whichever is higher) with a DC of 15 for a lesser madness or a DC of 20 for a greater madness. On a success, the recovering character can reduce the madness’s DC by 1/2 the ally’s Wisdom or Intelligence modifier (whichever is higher, minimum 1) in addition to the decrease for resting. The character suffers the madness’s effect until the DC is reduced to 0.

Certain spells can also aid in recovery from madnesses or cure them outright. Lesser restoration has no effect on greater madnesses, but reduces the current DC of one lesser madness afflicting the target by 2, up to once per day. Restoration and heal reduce the current DC of one lesser madness afflicting the target by 5 or of one greater madness afflicting the target by 2, up to once per day each. Greater restoration, limited wish, and psychic surgery all either cure the target of all lesser madnesses or reduce the DC of one greater madness by the spell’s caster level (caster’s choice), while miracle or wish immediately cure a target of all lesser and greater madnesses.

Horrific Madnesses

Source Horror Adventures pg. 185
In both the Pathfinder RPG Core Rulebook and GameMastery Guide, lesser restoration has no effect on insanity, but under these rules it can be used to treat lesser madnesses. Conversely, greater restoration, heal, and psychic surgery have reduced effects against greater madnesses in this system compared to in the previous books. This allows madnesses to play a larger part at both higher and lower levels in horror games, or any other game featuring psychological threats. If you want to feature the madnesses as afflictions that are simple to remove for high-level spellcasters while outside the reach of anyone else— as per the more baseline Pathfinder RPG experience—assume lesser madnesses are not affected by lesser restoration, and greater restoration, heal, and psychic surgery remove all madnesses, whether lesser or greater.