Lost in Vivo is an horror game revolving around claustrophobia and other psychological fears.
You are walking with your dog when a storm comes, with the sudden rain your service dog falls down a broken sewer drain. You find the nearest sewer entrance and run in after it.
Along the way you will meet other people that are also stricken by an abnormal or psychological fear. You may be able to help them, just as you may be able to free yourself, but just as likely, they or you may be beyond any help.
This game provides examples of:
- Abnormal Ammo: The shotgun found in the Metro System fires rock-salt shells.
- Adult Fear: Finding yourself alone trying to find someone dear to you who got lost, while you are suffering a psychothic breakdown with hallucinations caused by an overwhelming fear.
- An Axe to Grind: Two of the three sledgehammer skins unlocked upon New Game+.
- Animalistic Abomination: Nezumi Testing Labs is rife with hideous, hunch-backed rat-human abominations. It's heavily implied that they're the result of Sotiris' influence over Dr. Piccinini.
- Creepy Cockroach: Some of the locations sport cockroaches that are as big as dogs.
- Driven to Suicide: The woman whose notes you can find throughout the subway is revealed to have killed herself by walking down the tracks in front of an oncoming subway train.
- Eldritch Location: The Grand Bulim Avenue Station, overlapping with Sinister Subway. The entire station is filled with an odd, red haze, one room's floor bulges upward like a massive tumour, and the layout is completely nonsensical for a subway station.
- Ghost Train: As you explore Grand Bulim Avenue, you're attacked by huge apparitions that take the form of subway trains. They attack by biting you with their huge, lamprey-esque mouths, which also happen to serve as their weak point.
- Hellhound: One of the enemies has the appearance of a dog. Specifically, yours.
- Hell Is That Noise: The game is full of unpleasant noises, and they're often heard before you see what's making them, like the extremely loud and jarring train horn noises that the Ghost Trains make as they screech toward you.
- Mirror Monster: Grand Bulim Avenue is infested with monsters that take the form of floating, ornate mirrors which show off a frightening reflection. Once killed, they shatter into pieces.
- Nonstandard Game Over: You can shoot your dog a bit after getting the gun. Doing so goes as well as you expect.
- Nothing Is Scarier: There are many parts on the game that are eerily devoid of characters.
- Railroad Tracks of Doom: Wandering too far down the tracks in the subway system results in a subway train hurtling down the tracks toward you, killing you instantly. A lot like what happened to the woman whose ghost now haunts the subway.
- Reliably Unreliable Guns: The damaged handgun you can acquire early on in the Sewers will jam on occasion when you fire it.
- Sinister Subway: The Royal Phantome Subway has been long abandoned, the system is prone to electrical failures, and the notes left behind by the former staff mention it as being in a bad side of town. Oh, and it's haunted, too.
- Through the Eyes of Madness: It's hard to tell if what is happening most of the time is actually real or an hallucination of the protagonist.