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@Schnappi: No, you can't.
The "madness cards" he was talking about are cards with an ability (Madness) that allows you to play them for a special mana cost (most often being cheaper than the casting cost) at the time you discard them from your hand.

Cards like the infamous Psychatog are much better for such decks though, since 1. discarding the cards for it doesn't require any mana (after playing Urza's Guilt there shouldn't be much mana left unless you play it in the late game) and 2. the discarded cards are used for a more useful effect; to pump that creature.
Posted By: Mode (8/7/2009 11:18:59 AM)
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This sounds fun if you have Megrim, Liliana's Caress, and Underworld Dreams out. 2 damage from underworld dreams, then 6 damage each from Megrim and Liliana's Caress, then 4 damage from the card itself. That's a total of 18 damage for this card. And if you have more Megrims/Caresses out, well, you're in an even better position.

EDIT: Oh, and you can get this fourth turn.

First turn: Swamp, Dark Ritual, Underworld Dreams
Second turn: Swamp OR Island, Liliana's Caress
Third turn: Swamp OR Island, Megrim
Fourth Turn: Swamp OR Island, Urza's Guilt.

As long as you play one island, they're dead, since they take at least two damage from Underworld Dreams even if you go second. Plus, this kills everyone BUT you regardless of the number of players, since this affects everyone. That's nasty.
Posted By: Andon_A (10/26/2010 3:54:32 PM)
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MISHRAAAAAAAA!!!!!!!!!!
Posted By: Zyxxel (5/8/2010 10:40:35 AM)
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No bad card in the right deck. Gives you threshold and allows you to play madness cards. Also, if you got more than 2 cards in your handw hen you play it, it improves your card quality by a good bunch.
Posted By: majinara (2/5/2009 5:35:56 AM)
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KAAAA- I mean, YAWGMOOOOOOOOOOOOOOOOOOOOOOOOOOTH!
Posted By: Test-Subject_217601 (9/2/2010 5:26:04 PM)
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What does that card do?
Oh sweet, I get some car-
Oh... Okay so I lose some car-
Ow...
Posted By: SAUS3 (6/18/2013 8:35:47 AM)
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Awesome for Archenemy.

OR wait til you are top decking and play this. You'll draw 2 and discard them, if they have 1 card ou'll empty their hand and make them discard. Use Megrim/Underworld Dreams in a grixis draw/discard nightmare deck and with 1 of each out you'd do 12 life loss for 4 mana. It's a good Johnny card, bad aggro card but who would want to play aggro/control over combo/control anyway..?
Posted By: OpenSeasonNoobs (6/1/2010 12:39:15 AM)
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good one to combine with megrim
Posted By: BryanFR (9/16/2009 9:02:55 AM)
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4 howling mine
4 anvil of bogardan
4 liliana' caress
4 megrim
4 burning inquiry
4 blightning
4 urza's guilt
3 wistful thinking
4 thoughtseize
1 memory jar

4 crumbling necropolis
4 dragonskull summit
4 drowned catacomb
7 swamp
3 mountain
2 island

something like that
Posted By: metalevolence (8/19/2010 2:02:35 PM)
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A great finisher with Megrim.
Posted By: Kirbster (12/13/2010 4:57:48 PM)
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