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Sanatorium Secrets (Pragmatic Play) – Review & Demo Play
Sanatorium Secrets from Pragmatic Play play free demo version ▶ Casino Slot Review Sanatorium Secrets ✔ Return (RTP) of online slots on August 2026 and play for real money✔
Pros
- Hook mechanic feels genuinely different to spin
- Full-reel wilds carry multipliers up to 64x
- Puzzle round can award the max win instantly
- Grim asylum atmosphere done with real care
- Medium volatility keeps sessions ticking along
Cons
- RTP can drop to 94.49% at some casinos
- 150x super free spins buy is pricey
- No autoplay or quickspin for longer sessions
First look at Sanatorium Secrets
Sanatorium Secrets is a horror-themed slot from Pragmatic Play, set in a crumbling asylum on a 6x4 grid with 4,096 ways to win. I gave it a spin on a lazy Sunday and the Hook symbols dragging things across the reels grabbed me straight away. The atmosphere is grim, but honestly, it is easy to pick up.
I was not expecting much from another horror release, yet the mix of full-reel wilds, multipliers and a puzzle round kept me poking about. The base game ticks along nicely and the bonus popped up often enough to keep me interested. No need to overthink it, you just spin and watch the reels do their thing.
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RTP and volatility behaviour
RTP sits at 96.47% on the top build, which is above the usual mark, but some casinos run it lower at 95.47% or 94.49%. That gap is worth a quick check before you sit down. Volatility is medium, so the swings are not brutal, and the hit frequency of around 1 in 3.32 spins keeps small wins landing.
Max win is capped at 10,000x your stake. I am no expert, but that ceiling feels a touch modest next to some darker horror slots that push far higher. The stakes start low enough for a casual punt at 0.20, running all the way up to 240, so it suits most budgets.
Reading the paytable
Symbols split into two camps. The low pays are playing card ranks 9 through A, done up with a creepy spider look, while the premiums are four character portraits: a dark-haired patient, a blonde patient, an older doctor and a doctor. Six of the dark-haired patient pays up to 10x, and the royals top out around 1.20x for six. The paytable is simple to follow.
Then there are the special symbols doing the heavy lifting. The Wild comes in three flavours, a 1x1, a 1x4 and a big 2x4 that can carry a multiplier up to 64x. The Hook sits on reels 1 and 6, the Scatter shows up on reels 2-5, and the Super Scatter only lands on reel 6.
Symbols and payouts
| 6 | x10 |
| 5 | x5 |
| 4 | x2.5 |
| 3 | x1 |
| 2 | x0.3 |
| 6 | x5 |
| 5 | x2.5 |
| 4 | x0.7 |
| 3 | x0.4 |
| 6 | x2.5 |
| 5 | x1.5 |
| 4 | x0.6 |
| 3 | x0.3 |
| 6 | x1.5 |
| 5 | x1.2 |
| 4 | x0.5 |
| 3 | x0.3 |
| 6 | x1.2 |
| 5 | x1 |
| 4 | x0.4 |
| 3 | x0.2 |
| 6 | x1.2 |
| 5 | x1 |
| 4 | x0.4 |
| 3 | x0.2 |
| 6 | x0.8 |
| 5 | x0.6 |
| 4 | x0.3 |
| 3 | x0.1 |
| 6 | x0.5 |
| 5 | x0.4 |
| 4 | x0.2 |
| 3 | x0.1 |
| 6 | x0.5 |
| 5 | x0.4 |
| 4 | x0.2 |
| 3 | x0.1 |
| 6 | x0.5 |
| 5 | x0.4 |
| 4 | x0.2 |
| 3 | x0.1 |
| 6 | 10x |
| 5 | 5x |
| 4 | 2.50x |
| 3 | 1x |
| 2 | 0.30x |
| 6 | 5x |
| 5 | 2.50x |
| 4 | 0.70x |
| 3 | 0.40x |
| 6 | 2.50x |
| 5 | 1.50x |
| 4 | 0.60x |
| 3 | 0.30x |
| 6 | 1.50x |
| 5 | 1.20x |
| 4 | 0.50x |
| 3 | 0.30x |
| 6 | 1.20x |
| 5 | 1x |
| 4 | 0.40x |
| 3 | 0.20x |
| 6 | 1.20x |
| 5 | 1x |
| 4 | 0.40x |
| 3 | 0.20x |
| 6 | 0.80x |
| 5 | 0.60x |
| 4 | 0.30x |
| 3 | 0.20x |
| 6 | 0.80x |
| 5 | 0.60x |
| 4 | 0.30x |
| 3 | 0.10x |
| 6 | 0.50x |
| 5 | 0.40x |
| 4 | 0.20x |
| 3 | 0.10x |
| 6 | 0.50x |
| 5 | 0.40x |
| 4 | 0.20x |
| 3 | 0.10x |
The bonus engine
Three scatters trigger the free spins, starting with six spins and adding two for each extra scatter. Land three scatters plus a Super Scatter and you get Super Free Spins instead. Before either kicks off, a Hold and Win-style Puzzle round plays out, setting your minimum wild multiplier and stacking extra spins as pieces land.
Bonus features
The bonus engine continued
Fill the four middle reels with puzzle pieces and the game hands you the full 10,000x on the spot. During the spins, Hooks keep appearing in random spots, doubling any wild multiplier they cross. The features are not fiddly at all once you see them a couple of times.
One gripe from me: the Puzzle round can feel a bit sluggish when you have bought the bonus and just want to get to the spins, since every piece resets the counter and the whole sequence takes a while to resolve. Not a dealbreaker, but it slows the pace.
FAQ
How does the Hook symbol actually work?
What is the difference between the two Feature Buy options?
How many free spins does the Puzzle round add?
What multiplier can the biggest Wild carry?
Does the Ante Bet change your chances of the bonus?
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Gallery of video and screenshots of the game
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References
Our editorial team
All our content is written by our editorial team and checked before publication. We play the games ourselves, verify licences and withdrawal terms, and update every review as soon as something changes.
Under the supervision of Editor-in-Chief Mark Rylance