The film was directed by Egyptian-born Italian producer &  director Ovidio Gabriel Assonitis, who was known for his low-budget horror productions that often apped/ripped off popular films of the time such as The Exorcist with 1974’s Beyond the Door, and Jaws with 1977's Tentacles.  And while Madhouse clearly does borrow elements from other films, it’s far from a blatant rip-off, and does offer a fairly district twist on the slasher genre. The film's plot tells of Julia (played by Trish Everly) a young schoolteacher of deaf children living in Savannah, Georgia. She is haunted by horrid memories of her childhood, and the torture laid out by her sadistic twin sister Mary. She is convinced by her uncle, James ( played Dennis Robertson), a local Catholic to priest, to visit Mary, who is suffering from a severe skin disease, in a mental institution. The meeting does not go well and Mary vows to make Julia "suffer as she had suffered". And fairly soon after killing starts, which to begin with are been carried by Rottweiler, at the command of an unseen killer.

The other interesting & distinctive thing about Madhouse is its score which brings together swooning, dramatic & often discordant string work with slurred disco Tom hits & other electronic bashes. It’s scored by  Riz Ortolani- who had been working as a film composer from the early 1960’s scoring a whole host of different genres, but will be known to horror fans with his score to the original Mondo film 1962’s Mondo Cane. And the infamous Cannibal Holocaust- which has a fairly sound pallet to Madhouses soundtrack though lacks the moments of sad-yet-lush beauty found in Cannibal Holocaust score.

The film it’s self is fairly well shot & composed for a slasher/ exploitation movie- utilizing Savannah’s historic Kehoe House as it’s creepy gothic main setting.  For the most part, the cast if effective, though at times there is some over-acting, but this works well in the context of the film. And gore wise we get a mix of bloody dog maulings, stabbings, and one particular prolonged & nasty axe attack.   On the downside, the film often feels a little slow in places, and there’s certainly not a killing every fifteen minutes, as one might expect in your typical slasher of the period.

Extra wise on the disc you a get a new & exclusive full-length commentary from four piece slasher fan/ expert collective The Hysteria Continues, who are always give amusing, informative, and worthy commentary tracks. As usual, you get a mix of actor, crew & director facts, along with memories of when each member first say Madhouse and its impact on them.  These guys always do a great job, and I can’t say I’ve heard a duff commentary track from them.  Along with this you a get a selection of fifteen-to-twenty minute interviews with cast, crew & producers- the most interesting of these is with actress Edith Ivey, who played the house eccentric landlady. She discusses the film with great passion, as it's  one of the few horror films she did in her long film career. She also talks about the issues of having a mainly American cast trying to work with an Italian crew.

Madhouse may not be the goriest, most inventive, or shocking of slashers- but there is enough here to make any fan of 80’s horror enjoy the ride. As we’ve come to expect from Arrow they’ve done another nice job at this release, and certainly, if you’re a fan of the slasher genre it’s well worth adding to your collection.