During the settlement process, Akiteru suffered from mental unsoundness as he had to deal with several problems such as expelling opponent vassals, financial tightness caused by the Tempo Famine (triggered decrease in income and price run-up) and decline of the opportunity to perform the work of Jisha Tenso (liaison officers between the imperial court and temples and shrines), the government post that the family had been in charge of, and the friction with his aunt, Nariko, who had a great influence in the Imperial Court caused by the successor problem.
この過程で顕彰が対立した家臣を追放したこと、天保の大飢饉（収入の減少及び物価高騰）や勧修寺家が務めていた寺社伝奏の職務不振によって財政が逼迫してきたこと、前述の後継者問題などで宮廷内に強い影響力を持つ叔母・徳子と不仲となったことで心身に支障をきたすようになった。