The game runs just about as you'd expect. The low and medium settings can get close to 60fps on occasion, but tend to average around 40-50fps. However, if you turn off the volumetric lighting entirely, then you can get around 60fps in a lot of cases even with everything else set to high.

The only caveat is that turning off volumetric lighting does lose a little bit of atmosphere (a lot of light sources lose their glow, and light shafts disappear), and the game doesn't really benefit from a constant 60fps. In addition, even with the volumetric lighting turned off, it still dropped to 50fps on occasion at High settings.

If 60fps is a must, will need to be on low or medium settings with no volumetric lighting. The game looks just fine this way, but considering Lovecraftian games generally benefit from atmosphere, I preferred running everything at max and capping to 30 (can be done in-game). Otherwise, no issues.