The notion of healthy brain function emerging from coordinated neural activity constrained by the brainâs network of anatomical connections â i.e. the connectome â suggests that alterations in the connectomeâs wiring pattern may underlie brain disorders. Corroborating this hypothesis, studies in schizophrenia are indicative of altered connectome architecture including reduced communication efficiency, disruptions of central brain hubs and affected ârich clubâ organization. Whether similar deficits are present in bipolar disorder is currently unknown. This study examines structural connectome topology in 216 bipolar I disorder patients as compared to 144 healthy controls, focusing in particular on central regions (i.e., brain hubs) and connections (i.e., rich club connections, inter-hemispheric connections) of the brainâs network. We find that bipolar I disorder patients exhibit reduced global efficiency (â4.4%, p = 0.002) and that this deficit relates (r = 0.56, p < 0.001) to reduced connectivity strength of inter-hemispheric connections (â13.0%, p = 0.001). Bipolar disorder patients were found not to show predominant alterations in the strength of brain hub connections in general, or of connections spanning brain hubs (i.e., ârich clubâ connections) in particular (all p > 0.1). These findings highlight a role for aberrant brain network architecture in bipolar I disorder with reduced global efficiency related to disruptions in inter-hemispheric connectivity, while the central ârich clubâ system appears not to be particularly affected.